Patients sleep easier and safer at Cincinnati Children’s
In the state of Ohio, unsafe sleep practices account for more infant deaths than any other cause except prematurity. More than three sleep-related infant deaths occur every week – enough to fill seven kindergarten classrooms each year. African-American and male infants are disproportionately affected.
The American Academy of Pediatrics (AAP) has long provided safe-sleep guidelines, which have cut the number of SIDS deaths in half since 1992. But that reduction rate reached a plateau in 2011. The AAP then redoubled its efforts and developed the Safe to Sleep campaign, which included new recommendations that were recently updated. The public, including children’s hospitals nationwide, has been slow to adopt these guidelines.
But Cincinnati Children’s is bucking that trend. Since 2014, several teams across the medical center have joined forces to make sure all of our tiniest inpatients have a safe sleeping environment.
“We realized that, as professional caregivers, we were not following all of the AAP recommendations and that we needed to be modeling the appropriate behavior for families,” says Mike Gittelman, MD, co-director, Comprehensive Children’s Injury Center. “There’s a lot of literature that says parents will imitate the behavior of the hospital staff in caring for their child.”
Cincinnati Children’s safe-sleep collaboration has involved many personnel from a variety of disciplines and divisions – doctors, nurses, social workers, child life specialists, Cradle Cincinnati, the Comprehensive Children’s Injury Center, the Get Well Network, the Center for Professional Excellence and the Ohio AAP. They all work together under the direction of Gittelman and Sam Hanke, MD, assistant professor, The Heart Institute.
Hanke has a deep-seated passion for promoting safe sleep. He and his wife lost their son, Charlie, to SIDS in 2010. Since then, he has worked tirelessly to educate families about why safe sleep is so important. He is now the safe-sleep lead physician for Cradle Cincinnati.
Changing expectations
Gittelman, Hanke and the team began by developing a safe sleep policy for the hospital that went into effect in December 2014. It states that all patients should be in a safe sleep environment unless they have a medical condition that warrants otherwise. This includes sleeping alone in an approved crib free of loose bedding, pillows, toys, etc. In addition, all infants should be placed in an appropriate-sized sleep sack when available.
“We knew we needed to set expectations,” says Hanke. “Once the policy was in place, the Center for Professional Excellence took the lead and came up with required education modules for staff. We also brought in a safe-sleep expert for Grand Rounds. Then, in collaboration with an Ohio AAP program, we set up a system to perform audits on the units. The clinical directors now do about 100 audits each month.”
The audits revealed something even more important. “We didn’t have an environment that was conducive to safe sleep,” says Hanke. “There were a lot of loose blankets and diapers in the cribs. And families who brought along a breastfeeding sibling had no safe place to lay their infant.”
The team immediately set about correcting the situation. They provided sleep sacks to babies, which eliminated the need for blankets, and gave Pack ‘n Play® Playards to families for siblings. Both items were also made available to families at a discount in the Family Resource Center.
“We distribute 10 to 15 Pack ‘n Plays each month,” says Hanke. “We also have connections with United Way’s 211 to get cribs for families who can’t afford them.”
The Get Well Network contributes by making educational videos available to families.
Says Gittelman, “We’ve even collaborated with Marketing and Communications to make sure that any images we use in our advertising or patient/family education materials depict safe sleep. We’re attacking this issue from a lot of different angles.”
The work is paying off. In just a nine-month period, the rate of safe-sleep compliance went from 25 percent to nearly 80 percent. The medical center is also one of the few children’s hospitals to have earned gold certification from Cribs for Kids.
Changing the culture
Despite solid evidence supporting safe-sleep practices, some families are still resistant.
“Sometimes, it’s a financial issue, which we’ve tried to address with our discount and give-away programs,” says Gittelman. “But in other cases, it’s cultural – this is how we do it in our family. People also have a sense that ‘it can’t happen to me’ or ‘I think my child is safer in bed with me.’ But it’s not true, and the statistics bear that out.”
Community physicians have a substantial role in promoting safe-sleep practices.
“Families get inundated with safe sleep messages at the hospital where they deliver,” says Hanke. “But after they get home, there aren’t a lot of ways to reinforce it. It’s more than worth it to talk with families about the sleep environment at home to spare them the devastation of losing a child. Most of these deaths are preventable.”
AAP safe sleep recommendations
- Breastfeeding is recommended and is associated with a reduced risk of SIDS.
- Infants should be immunized. Evidence suggests that immunization reduces the risk of SIDS by 50 percent.
- Bumper pads should not be used in cribs. There is no evidence that bumper pads prevent injuries, and there is a potential risk of suffocation, strangulation or entrapment.
- Always place your baby on his or her back for every sleep time.
- Always use a firm sleep surface. Car seats and other sitting devices are not recommended for routine sleep.
- The baby should sleep in the same room as the parents, but not in the same bed (room-sharing without bed-sharing).
- Keep soft objects or loose bedding out of the crib. This includes pillows, blankets, and bumper pads.
- Wedges and positioners should not be used.
- Pregnant woman should receive regular prenatal care.
- Don’t smoke during pregnancy or after birth.
- Offer a pacifier at nap time and bedtime.
- Avoid covering the infant’s head or overheating.
- Do not use home monitors or commercial devices marketed to reduce the risk of SIDS.
- Infants should receive all recommended vaccinations.
- Supervised, awake tummy time is recommended daily to facilitate development and minimize the occurrence of positional plagiocephaly (flat heads).
