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More work needs to be done to put baby ... safely ... to sleep

Two KUSM-W researchers have found that even hospitals are not consistently following the AAP recommendations for safe sleep environments. And that means the facilities may be missing a chance to model these recommendations to parents who bring their infants to the hospital.

On a bright, brisk Saturday, a couple hundred pregnant women packed into a church in north Wichita for a community baby shower.

As you would expect at a shower, the women received gifts for their babies. Pack-n-Play cribs and sleep sack wearable blankets were abundant.

Refreshments were served. What's a shower without cake and punch?

But this was a baby shower with a twist. The real purpose of this gathering was to educate the moms-to-be about safe sleep for their babies. The event was hosted by the Wichita Black Nurses Association and the Kansas Infant Death and SIDS (KIDS) Network.

"It's a grassroots project," said volunteer Carolyn Ahlers-Schmidt, a member of the department of pediatrics at the KU School of Medicine–Wichita.

And it's a project that's particularly needed in Sedgwick County, which has one of the nation's highest rates of infant mortality for African-American babies, as well as being higher-than-average for infant deaths overall.

Ahlers-Schmidt and Stephanie Kuhlmann, also from the school's pediatrics department, are working to reduce infant mortality through a variety of means.

The two researchers have found that even hospitals are not consistently following the American Academy of Pediatrics (AAP) recommendations for safe sleep environments. And that means the facilities may be missing a chance to model those recommendations to parents who bring their infants to the hospital.

Safe sleep is defined as an infant asleep on her or his back in a crib containing no additional objects, or being held by an adult who is awake.

In collaboration with the Children's Hospital Association, Ahlers-Schmidt and Kuhlmann studied and also tried to improve sleep practices for children up to six months old in the pediatric units of Wesley Medical Center, and in seven other hospitals across the country.

As part of the process, the hospitals put into place a five-part improvement plan:

  • Creating a safe sleep policy
  • Training staff in the policy
  • Requiring infant caregivers to watch a video on safe sleep
  • Adding designated storage areas in infants' rooms to eliminate items from being stored in the crib
  • Providing caregivers with take-home resources on safe sleep

A total of 329 infants were observed before the improvement plan, and 283 afterward. Adoption of safe sleep practices rose from seven percent before the plan, to 39 percent after the plan's implementation. Correct sleep position was observed for 88 percent of the infants.

"We did see significant improvement, but we still want to get it higher," Kuhlmann said.

The KU School of Medicine–Wichita researchers noted that the admission of infants to the hospital should be a chance for the staff to reinforce safe sleep lessons that parents are taught when their babies are born.

In another study completed last year, Kuhlmann and Ahlers-Schmidt found that most parents are aware of, and follow, safe sleep position recommendations, probably as a result of the AAP's 20-year-old "Back to Sleep" campaign. But more than 60 percent acknowledged the presence of at least one item in their babies' cribs that could lead to accidental death.

Less than half of parents said they had spoken to their child's other care providers about safe sleep practices. A significant percentage of accidental deaths occur when babies are with caregivers other than their parents.

The Back to Sleep campaign is credited with reducing deaths from SIDS by half. Ahlers-Schmidt and Kuhlmann believe more improvement is possible.

Ahlers-Schmidt concludes, "It's not enough."


KU School of Medicine-Wichita