Infant Suffocation Deaths in the Sleep Environment

Infant Suffocation Deaths in the Sl E i tSleep Environment

March 24, 2011

C SModerator: CAPT Stephanie Bryn, MPHDirector, Injury and Violence Prevention

H lth R d S i Ad i i t tiHealth Resources and Services AdministrationSpeakers:

C i K Sh i M d PhD MPHCarrie K. Shapiro-Mendoza, PhD, MPHLena Camperlengo, RN, MPH, DrPH(c)

Theresa Covington MPHTheresa Covington, MPHLindsey Myers, MPH

Michael Goodstein MD FAAPMichael Goodstein, MD, FAAPJudy Bannon

Overview

• Recent trends in infant suffocation death rates

• Circumstances of the sleep environmentCircumstances of the sleep environment and risk factors in infant suffocation

• State and local community efforts in risk• State and local community efforts in risk reduction and prevention of infant suffocationsuffocation

• Community-based safe sleep and suffocation prevention programs

Speakers• Carrie K. Shapiro-Mendoza, PhD, MPH: Team Leader and

Lead Epidemiologist, Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention

• Lena Camperlengo, RN, MPH, DrPH(c): EGS, Inc. Contractor, Project Coordinator, SUID Initiative, Division of Reproductive Health National Center for Chronic Disease Prevention andHealth, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention

• Theresa (Teri) Covington, MPH: Director, National Center for Child Death Review

• Lindsey Myers, MPH: Injury Prevention Program Manager, Colorado Department of Public Health andManager, Colorado Department of Public Health and Environment

• Michael Goodstein, MD, FAAP: Attending Neonatologist, York Hospital; Director, York County Cribs for Kids

• Judy Bannon: Executive Director, Cribs for Kids & S.I.D.S. for Kids

Understanding SUID: Understanding SUID: Definitions Trends and the SUID CaseDefinitions Trends and the SUID CaseDefinitions, Trends and the SUID Case Definitions, Trends and the SUID Case

Registry Registry

Carrie Shapiro-Mendoza PhD, MPHandand

Lena Camperlengo RN, MPH, DrPH(c)EGS, Inc.

Infant Suffocation Deaths in the Sleep Environment Webinar

March 24, 2011National Center for Chronic Disease Prevention and Health Promotion Division of Reproductive Health

OverviewOverviewOverviewOverview

Definition of SIDS and other SUID Trends in SIDS and other SUID mortality SUID surveillance and death certificates CDC’s SUID Case Registry Pilot Program

DEFINITIONS OF SIDS AND OTHER SUID

SUID DefinitionSUID DefinitionSUID DefinitionSUID Definition

SUID : Sudden, unexpected infant death, p Infant deaths that:

Occur suddenly and unexpectedly in previously healthy infants Have no obvious cause of death prior to investigation

(unexplained) Excludes deaths with an obvious cause, e.g., motor vehicle

accidents

SIDS is a type of SUID

Some Types of SUIDSome Types of SUID

SUID CategoriesSUID Categories

Unexplained* Explained

SIDSU d t i d

Long QT MCAD Undetermined cause

Suffocation MCAD Head injury Infanticide Infanticide Hyperthermia Infection Infection Overdose

*Cause of death was unexplained by autopsy or autopsy was not completed

Sudden Infant Death Syndrome (SIDS)Sudden Infant Death Syndrome (SIDS)Sudden Infant Death Syndrome (SIDS)Sudden Infant Death Syndrome (SIDS)

“…sudden death of an infant under one year of age y gwhich remains unexplained after a thorough case investigation, including performance of a complete autopsy examination of the death scene and reviewautopsy, examination of the death scene, and review of the clinical history.”

Willinger M, James LS, Catz C. Pediatr Pathol 1991

Mechanisms of Accidental Suffocation and Mechanisms of Accidental Suffocation and Strangulation in Bed (ASSB)Strangulation in Bed (ASSB)Strangulation in Bed (ASSB)Strangulation in Bed (ASSB)

Suffocation by soft bedding, ill t b d ttpillow, waterbed mattress

Overlaying (rolling on top of or Overlaying (rolling on top of or against baby while sleeping)

Wedging or entrapment between mattress and wall, bed frame, etc

Strangulation (infant’s head and neck caught between crib railings)neck caught between crib railings)

*All could be designated as ICD 10 code W75

TRENDS IN SIDS AND OTHER SUID MORTALITY

Public Health Implications of SUIDPublic Health Implications of SUIDPublic Health Implications of SUIDPublic Health Implications of SUID

About 4600 per year, half are SIDS Most frequently reported causes:

SIDS• Leading cause of postneonatal mortalityLeading cause of postneonatal mortality

Unknown or undetermined cause (UNK) Accidental suffocation & strangulation in bed (ASSB)

• Leading cause of infant injury mortality• Leading cause of infant injury mortality• Potentially preventable

Less frequently reported causes: Infanticide/intentional suffocation (<5%), inborn errors of

metabolism (1%), cardiac channelopathies (5-10%), infection

Sources: Shapiro-Mendoza et al, Peds, 2009. Kinney and Thach, NEJM, 2009.

US SUIDUS SUID--specific infant mortality ratesspecific infant mortality rates19901990--20072007160 19901990 20072007

120

140

160

hs

80

100

120

0000

birt

h

40

60

80

hs p

er 1

00

0

20

40

Dea

th

01990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

SIDS UNK ASSB Combined SUID

SIDS: sudden infant death syndrome, UNK: Unknown cause, ASSB: accidental suffocation and strangulation in bed, Combined SUID: SIDS+UNK+ASSBSource: CDC WONDER, Mortality Files

Infant Supine Sleep PositionInfant Supine Sleep Position19921992 -- 201020101992 1992 20102010

90%

100%

73%

60%

70%

80%

30%

40%

50%

13%

0%

10%

20%

30%

0%

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

Source: National Infant Sleep Position Study

Proportion of SUID Proportion of SUID Unexplained by Autopsy, or no AutopsyUnexplained by Autopsy, or no AutopsyUnexplained by Autopsy, or no AutopsyUnexplained by Autopsy, or no Autopsy

UNK14%

ASSB2%

ASSB15%

SIDS84%

SIDS58%

UNK27%

1996 2006

SIDS: Sudden infant death syndrome UNK: Unknown causeASSB: Accidental suffocation and strangulation in bedg

SUID SURVEILLANCE AND DEATH What death certificates don’t tell us about SUID

CERTIFICATES

Cause of Death Section from US Death Cause of Death Section from US Death CertificateCertificateCertificateCertificate

entn umniral events such n cardAl:: Enter only one cau5e on.a .... e. Ad::ladd:tionaJ

IMMED TE CAUSE (Final d is.ule Of ccndition -----:> 01 •• _________ -" .. "'''''''...,''''''"'''''''', ________________________ _ resul'1ilg in dea:h ) Due:o (or ~s. a c(lflS('(!ueme of):

SequEntiaUy lin cond~on5 , b.----------"'''''''''.-.o;ru''''';;;;;-,''-------------------------if any_ leadine to the ~auu- Out to (or n a COI" u-qUi'I"Ci' 01): lis.led I)ft kle a. En:e! the

UNDERLYINGC AU!E c.- ---------"'"'"''''"''''"';rn""oo""C-----------------------(dis.ease or in~ that Du~:o (or ~s. ill COIoU'qUi'rQt of): in i: ia~Ed the @'\Oents. ft s.ulting in dea:h} LAST d.

a Net pregnln: wi:h n p.a~1 rear

o Yi' s. a ? rob,l)Jy a ?r;-gn;lllt .it &Ile c( dea:h

[] No a Unknaom a Not preon:wlt. butpreonalt with ir 42 tlayS of tli'~h

a Net pregnlm. but pregnanl 43 d<l)"> 10 1 (ear betJre death

i i

o Natural OHomici:!e

o A.ccident 0 PendilltJ Invulgaton

o Suici:!e 0 Could not be delenn:ned

, , o D river{:l~ra:cr

C Pas. .. enoer

o .(es. 0 tl o

IMMEOlATE CAUSE (Fina! d is~a ~e or COI"IditlOn --> resul\hg in d~a :h )

Seq\Kn:iaHy Ir.! C()nd'!ions. if any. k!,ad ing to the ~ause tis.ted 1)11 rlne i . Enter the UNDERLYING CAU!E (diSoe,1se or in.ury lhal in~a~td th~ events. ftsUlting ndea:h) LASf

o Yes. 0 ? rob-Ollly

C No 0 Un kncwn

o Net pregm nt w':Il n pa.Sl rear

a Pp.gnant i \ UI"Ie of de,1;h

o Not preon,1llt. butcweona,t with ir 42 dol.,.. 01 deJth

flItu tlmniraJ ~vem such as. card.ac Enter only Cl'Ie Ca\l5E on a Ine. Adj add;;ionaJ

o N,1turaJ D Homici:le

o Accident 0 Pendin,} lnYl's-;gafon

o Suici:le 0 Could not be ' ".m,n,' I

o Dri~r~:lp~ra tc r

C PaSSeftOE'f

o '(t's 0 flo

Mechanism attributed to suffocation deaths,Mechanism attributed to suffocation deaths,US death certificates, 2003US death certificates, 2003--20042004US death certificates, 2003US death certificates, 2003 20042004

Shapiro-Mendoza et al , 2009

Sleep surface or place where death occurred, Sleep surface or place where death occurred, US death certificates, 2003US death certificates, 2003--20042004US death certificates, 2003US death certificates, 2003 20042004


Bedsharing or coBedsharing or co--sleeping reported, sleeping reported, US death certificates, 2003US death certificates, 2003--20042004US death certificates, 2003US death certificates, 2003 20042004


What is needed?What is needed?What is needed?What is needed?

More comprehensive data to increase knowledge about:about: Circumstances or factors that may have contributed to or caused

the SUID caseSl i t• Sleep environment

• Prior medical history Quality of the death scene investigation or if one was even done

A SUID surveillance system that builds upon child death review may be the answerdeath review may be the answer

A new surveillance system to monitor trends in SIDS and other

CDC’S SUID CASE REGISTRY A new surveillance system to monitor trends in SIDS and other SUID

PILOT PROGRAM

Justification for SUID Case RegistryJustification for SUID Case RegistryJustification for SUID Case RegistryJustification for SUID Case Registry

Currently SUID surveillance is monitored using y gdeath certificate data

Death certificate data are limited; do not describe ;circumstances and events surrounding death

Need a more comprehensive data source to increase understanding of SUID-related factors

CDC’s SUID Case Registry collects data from scene investigations, autopsies, and other sources

Main Objectives for the SUID Case RegistryMain Objectives for the SUID Case RegistryMain Objectives for the SUID Case RegistryMain Objectives for the SUID Case Registry

To create state-level surveillance systems that build yupon Child Death Review activities

To categorize SUID using standard definitions g g

To monitor the incidence of different types of SUID

To describe demographic and environmental factors To describe demographic and environmental factors for each type of SUID

To inform prevention activities and potentially save To inform prevention activities and potentially save lives

Expected Outcomes and Impacts for Expected Outcomes and Impacts for th SUID C R i tth SUID C R i tthe SUID Case Registrythe SUID Case Registry

Strengthen states’ ability to identify, review, and g y y, ,enter data for all SUID case

Improve the completeness and quality of SUID case p p q yinvestigations by promoting policy and practice changes

Inform national, state and local policymakers and program planners

Identify at-risk groups to target prevention programs

Use as a potential source of cases for case-control study

SUID Case Registry ModelSUID Case Registry ModelSUID Case Registry ModelSUID Case Registry Model

Builds upon current Child Death Review activities pand protocols Uses pre-existing variables Integrates new and/or modified SUID related variables into Integrates new and/or modified SUID-related variables into

NCCDR Case Reporting System v2.2S

Supports states in their efforts to review child death Supports states in their efforts to review child death cases per state mandates

Strengthens states’ ability to identify, review, and g y y, ,enter data for all SUID cases

Variables included in the SUID Case RegistryVariables included in the SUID Case RegistryVariables included in the SUID Case RegistryVariables included in the SUID Case Registry

Individual variables Sleep environment Maternal health, including pregnancy complications

and injury Infant health, including newborn screening

System variables Components of death scene investigationp g Tests and exams performed during autopsy

SUID Case Review Data SUID Case Review Data SourcesSourcesSourcesSources

SUIDIRFLaw Enforcement reports Medical records Death Certificate

ME/C reportEMS reports

Witness interviewsScene reenactmentScene photos

Social service records ME/C reportAutopsy report

Hospital reports

SUID case review by multidisciplinary team

SUID Multidisciplinary Review TeaSUID Multidisciplinary Review Team

Medical Examiner/Coroner

SUID Multidisciplinary Review TeaSUID Multidisciplinary Review Team

Law Enforcement Public Health E S i Emergency Services Pediatrician or other Health Care Provider Child Protective Services Child Protective Services

The SUID Case Registry is…The SUID Case Registry is…The SUID Case Registry is…The SUID Case Registry is…

A process that m st in ol e m ltidisciplinar team A process that must involve multidisciplinary team review

A qualitative and quantitative processq q p A tool for assessing and improving case

investigations A vehicle for driving data to action

The SUID Case Registry is NOT…The SUID Case Registry is NOT…The SUID Case Registry is NOT…The SUID Case Registry is NOT…

A data linkage project A fill-in-the-blank exercise An isolated process implemented without input from An isolated process implemented without input from

key partners such as child death review, medico-legal professionals and public health

Case Information Flow ChartCase Information Flow Chart

Infant dies unexpectedly with no obvious cause of death

Review team notified of death

Case information and reports gatheredCase information and reports gathered

Team reviews and discusses available data and potential prevention strategies

Data entered into web-based reporting system

State grantee reviews data for completenessState grantee reviews data for completeness

NCCDR pools state level data and sends to CDC for analysis

SUID Case Registry State Grantees SUID Case Registry State Grantees

Note:Green states: Colorado, Georgia, Michigan, New Jersey, New Mexico; funding began August 2009Orange states: Minnesota, New Hampshire; funding began August 2010

First Year ProgressFirst Year ProgressFirst Year ProgressFirst Year Progress

Improved timelinessRecei e monthl data files from Vital Statistics Receive monthly data files from Vital Statistics

Fund staff in ME/C office

Improved death scene investigation reportingp g p g Pay for completed SUIDIRFs Train investigators to conduct doll reenactment and provide dolls

Increased access to autopsy information Increased access to autopsy information Create “summary sheets” for review teams Fund staff in ME/C office

Implemented quality assurance measures Ensure SUID Case Registry staff attend all review meetings Review each case for missing/unknown fields at state level Review each case for missing/unknown fields at state level

2010 SUID Cases* as of December 31, 2010 2010 SUID Cases* as of December 31, 2010

Identified: 567Identified: 567

Reviewed : 393

QA completed: 188

*States reporting: CO, GA, MI, NJ, NM

AcknowledgementsAcknowledgementsShin Y. Kim

Terry NjorogeTerry NjorogeRebecca Ludvigsen

Cristina Rodrig e HartCristina Rodriguez-Hart

For more information:

For more information please contact Centers for Disease Control and Prevention1600 Clifton Road NE, Atlanta, GA 30333

www.cdc.gov/sids1600 Clifton Road NE, Atlanta, GA 30333Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348E-mail: [email protected] Web: www.cdc.gov

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

National Center for Chronic Disease Prevention and Health Promotion Division of Reproductive Health

What is CDR TellingWhat is CDR Telling Us about Infant

S ff ti D thSuffocation Deaths

&

What are States Doing to HelpDoing to Help Reduce Risks?

Theresa Covington, MPH

Director

National Center for Child Death Review

Child Death Review is:

Helping improve:

investigations and diagnosis

services to familiesservices to families

Helping to describe the i t i i f t lcircumstances in infant sleep related deaths.

Healthy People 2020• IVP 5: (Developmental) Increase the number of• IVP–5: (Developmental) Increase the number of States and the District of Columbia where 90 percent of sudden and unexpected deaths to p pinfants are reviewed by a child fatality review team.

• Baseline data from 2007: 4,211 SUID deaths in the US, 37 states reviewed 2,849 SUIDs or 68%.

.. III 88 .5 ~ 0000

! II !Ii! 0000

f t 1,!d~h 1000000 •

!I! ! " ! 0000

I I I I . 1.!1 ~h l 1000000 ! • •

j I I !

,

r t I!!:! ! 00000 0

! !Hlllli 00000000

t t . ! ! 1 ! • I I I;, Iq'l I I ! !lHJ1!!! • • H~ 00000000

! .f! .fl lJuJl!! lJ!!JlI 1 · I 0001

0000 0001

000 I I "i II l! I I il t

!Hl!q !HI!1 11 til !!ooo l l. !!ooo l l .• lid!

.0 000 0 00 ~ . 0000

I I

, c

, c I c

, c

GRA.Co. • :: .i

Preliminary CDR data(November 15, 2010, 28 states, 30,920 infant deaths)

Infant’s airway was fully or partially obstructed when found

CDR Team Findings Suffocation SIDSUndetermined/ Unknown Cause

TotalUnknown Cause

Total Number of cases 1613 201 459 2273

Soft bedding* was relevant to death 716 45% 152 76% 282 62% 1150Sharing a sleep

f ** lsurface** was relevant to death 719 45% 31 16% 169 37% 919

*Blanket or pillow or comforter or mattress or pillowtop mattress or waterbed or air mattress or bumperpad or stuffed toy or clothing.** With adults, other children or animals

Infant’s Sleep Place

Incident Sleep placeSuffocation SIDS

Undetermined/ Unknown

CauseTotal

Total number of Cases 1613 201 459 2273

Crib 135 55 63 253

Bassinette 65 17 34 116

Couch 259 12 63 334

~50%Adult Bed 810 90 228 1128

Other 277 27 66 370

~50%

Other 277 27 66 370

Unknown 67 0 5 72

So What are States Doing?So What are States Doing?

37 States with Safe Sleep Promotion ActivitiesWhat are these activities?

Homo Yio.U

Differences in Messaging

What AAP Message li i lDo You Explicitly

Include in Your State’s Messaging?g gN=37

It NoToys

It No Pillows

11 No Bumper Pads

K No Quiltsor Blankets

It No Stomach or Side Sleeping

Why?

A Crib • A Mattress

A TIght-Fitt ing Sheet

A Baby Placed o n his Back to Sleep

Because babies who sleep alone in a crib without bum r d blankets, loys"o r p iliowsall' LESS likely 10 d ie from SIDr pa 5,

Safe Sleep for Baby is:

.,--_ .. _-.. ....... _ ... _ ...... -........... -.-.-~-- ....... --_ ..... _-_ ..... -............... -0 _ _ ____ ...

:::..:::'-~-::..=.:: ~ ..... --.--.... -. _ ... __ 0,...-... _ ....... ,. .. -.. _ ........ ... _-- ------.ro- .... ..... .. . _ __ - -_ ... -.... _-... _-----~--. :-.::.::::. ...............

ill baby on back

- , , ......... __ ... --... -....... -. -. -----... .. -.... -'"'- .. ........ .... ;::..-:.. ........ _---. ::::: ::.::::..."':'"'..::: -~ .... -.... -, .. -..... ----

.-~--.. - ...... --_ .. -..... ...... .... _ ... _ ... -_._ .. ,..--_ ... _---...... _- ,... -_ .. _ ... " .. .... -_ ..... _--_ ..... --_. -"-"'-..... _-- .......

in a safe crib

._--... --...... .. ..... _.-_ ... --_ ... _ .. -"'-_"'''''''' _"_.11_ ... _ ::::...~- _ ...

.......... --_ .. .... .... __ ._--.. _-- .... ------_ .. ----- ..... _._ ... --_ ... --_ .... -......... _-• __ .. w_

Lots of Target Populations

Lead AgenciesLead Agencies

Other:Multi‐agency coalitiolns

Lots of PartnersLots of Partners

Delaware’s Multi‐Agency Mass Media effort

SIDS Center of New JerseySIDS Center of New JerseyInstitutionalizes Safe Sleep Messages and

Policies by Working WithPolicies by Working With:

State Child Protection Services Primary Care Centers includingPrimary Care Centers including

Federally Qualified Health Centers Nursing staff in Newborn and

Neonatal Intensive Care Unitsl d h ld l h Maternal and Child Health Consortia

Child care programs Education programs for pediatricians,

family practitioners traineesfamily practitioners, trainees

Infant Mortality Reduction Initiative • Infant Morta li ty

Hom e Page

• MN Safe and As lee p Campa ign

• Orde r Infant Slee p Safe ty Educationa l Mate ria ls

~r~~~n~~pti~n

Interconception

• Resources

Maternal & Child Health

More from MDH • Pos iti ve

Alt e rnati ves

• Pos tpartum De press ion Education Materia ls

• Shake n Baby Syndrome Prevention Materia ls

Minnesota's Safe and Asleep Campaign

Annuall y, 40 or more otherw ise hea lthy Minnesot a bab ies d ie of s leep-re lat ed un int enti ona l injuries wh il e s leep ing in unsafe conditi ons such as in an adu lt bed or on a sofa with parent s or o lder ch il dren. Bab ies become t ang led in bedd ing , get st uck under p ill ows, or t rapped bet ween a s leep ing adul t and cushions of a sofa or rec li ner. Someti mes t he ir own s leep ing parent s ro ll over on t hem unint enti ona ll y, causing deat h from suffoca ti on and chest compress ion.

Minnesot a's Safe and Asleep in a Crib of Their Own Campa ign was launched in July 2007, and conti nues as a par t nersh ip bet ween t he Mat erna l and Ch i ld Hea lth Secti on of t he Minnesot a Department of Hea lth and t he Minnesot a Sudden Infant Ueath Lenter or Lh ll dren·s HOsp ita ls and Ll ln lcs. Add it iona l partners Inc lude the Department of Human Serv ices Ch il d Mort a lity Review Panel, t he Minnesot a Assoc iati on of Coroners and Medica l Examiners, Tw in Citi es Hea lthy St ar t, t he Crad le Minnesot a Chapt er of t he American Academy of Ped iat rics and loca l pub li c hea lth de~

••• w 0<><._ .' Safe and As leep Campa ign Press Re lease. July. 2007 ( PDF: 53KB12 pagE

., ... 0<><._ .' MN Coroners and Me dica l Exam iners' letter to prov iders. Ju ly. 2007 ( PDF

The American Academy of Ped iat r ics recommends t hat a ll infant s s leep on t he ir back: approved cr ib and in a smoke-free environment t o reduce t he r isk both of Sudden Infant Death Syndrome (SI C prevent ab le injury deaths.

Educational Materials

Download or order educational materials from t he MDH Mat erna l and Chi ld Hea lth Secti on t o safe infant s leep messages for parent s and other careg ivers. Other recommend m at er ia ls can t

at ht t p ://www. njchd .njh .gov/pub li cations/ includ ing magnet s and t he genera l ou t reach door h which MDH no longer has ava il ab le.

Additional Educational Materials

T' • • I. • .. , I. • • ~

Messaging Can Be Inconsistent

THE SOLACE OF THE family bed A renowned doctor

reassures parent!> that infant night waking is normal.

And it 's safe to 5leep with your kids.

Tips IOf caregivers

Follow these recommendations to help reduce the risk 01 sudden infanl death syndrome ar.d prevent accidental deaths:

• BabOe s should s leep an their backs (not stomach Of SIdes). whether sleepong d~ Of

""", • Keep loose or ftully bedding away from the infant and hisJher sleep are a. and us. a firm. l'!jhl.fi tting matren

If Babies Could TalkCould Talk

S f Sl S ’

71

Safe Sleep: a State’s Perspective of Linking MCH

d I j P i d and Injury Prevention and SUID Case Registry

INFANT SUFFOCATION DEATHS IN THE SLEEP INFANT SUFFOCATION DEATHS IN THE SLEEP ENVIRONMENT WEBINAR

March 24, 2011March 24, 2011

Lindsey Myers, MPHColorado Department of Public Health and Environment

Colorado Child Fatality Prevention SystemPrevention System• Began in 1989

72

Began in 1989• Legislatively mandated in 2005

45 b St t T 45 member State Team Review deaths of all children under age 18

U d t d th f hild d th Understand the causes of child deaths Make recommendations for policy changes

• Currently reviewing 2008 deaths

Colorado SUID Case Registryg y

• Case Identification: Death Certificates—2010 & 73

2011deaths• Data collection Coroner Reports and Autopsies Coroner Reports and Autopsies Law Enforcement Medical Records Child Protective Services

• Case abstraction• Multidisciplinary review of circumstancesMultidisciplinary review of circumstances• Identify factors that contributed to or caused death• Identify prevention strategies

2010 SUID Cases

• 2010 cases identified to date = 51

74

2010 cases identified to date 51 • Common Risk Factors Bed-sharing Bed-sharing Soft-bedding Unsafe sleep positionUnsafe sleep position

Prevention Recommendations

• Systems

75

Systems Death Scene Investigations AutopsiesAutopsies State Agencies

• Policy and LegislationPolicy and Legislation• Community Level Education campaigns and programs Education campaigns and programs

Investigation Recommendationsg

Use the SUIDI-RF for all child deaths

76

Use e SU o a c d dea s Doll reenactment Training for lay coroners and hospital pathologists g y p p g

regarding the national recommendation for child deaths to be investigated by forensic pathologists

Training for law enforcement regarding how to look for evidence of suffocationT k th t l t t f th th th Take the actual temperature of the room, rather than make an estimated guess

Autopsy Recommendationsp y

Clarify the Nation Association of Medical Examiners

77

C a y e Na o ssoc a o o Med ca a e s “autopsy standards” to define what a “complete autopsy” means and what test should be run

Educate coroners about filling out death certificates correctly, and about the danger of using the term SUDIT i l f ll i f d h Toxicology screens for all infant deaths

Prevention Recommendations

Safe sleep statewide campaign and education—78

p p gmultilingual and multicultural

Professional education for hospital nurses and home visitation nursesvisitation nurses

Professional education for social workers during new DHS Training Academy

Safe sleep education during home assessments for child placementS C ib f Kid P Start a Cribs for Kids Program

Expand nurse home visitation programs to serve more families

L l S f Sl C iLocal Safe Sleep Campaigns79

El Paso/Teller County CFRS f Sl C iSafe Sleep Campaign

C ll b b h l l CFR T

80

Collaboration between the local CFR Team and two local hospitals

Training for health care providers and child Training for health care providers and child care providers on safe sleep

Co-messaging with abusing head trauma programtrauma program

Posters

Billboards

Radio Spots

Education programs through churches

Local Health Fairs

Mesa County CFR S f Sl C iSafe Sleep Campaign

D h SIDS i i

81

Does not use the term SIDS in campaign

Press releases

Flyers distributed to WIC, Nurse Family Partnership, and doctors offices

30 minute segment on government access channel featuring the coroner, law enforcement, and pediatricians

Letter sent to health care providers to encourage them to adopt a policy to discuss safe sleep with

ipatients

Print and Radio ads

S id S f Sl I i i iStatewide Safe Sleep Initiative82

Linking MCH, IP, and CFPSg , ,

Child Fatality

83

yPrevention

SystemDept. of

Colorado Safe Sleep

Safe Kids Colorado

Human Services

Initiative

Injury Prevention Program

Maternal and Child

HealthgProgram

Colorado Safe Sleep Initiativep

• Collaboration with Safe Kids Colorado, based out

84

Collaboration with Safe Kids Colorado, based out of The Children’s Hospital

• Interest in creating a unified statewide approachInterest in creating a unified statewide approach• Safe Sleep Summit held in January 2011 Reviewed data from CFPS Reviewed data from CFPS Learned about local safe sleep programs Round Table DiscussionsRound Table Discussions

Safe Sleep Partnersp85

Child Fatality Prevention System Review Team

State MCH program

Prenatal Plus Programs State child care licensing

programp g Home visitation programs Local health departments

(esp MCH and injury

p g Child welfare programs WIC agencies

C l d B t F di (esp. MCH and injury prevention programs)

Public health nursesH i l

Colorado Breast Feeding Coalition

Local Safe Kids coalitions Hospitals Community birthing centers Physicians

Coroners County Attorney’s Office

y

Challengesg

• Inconsistent messaging coming from the health 86

g g gdepartment

• Some lactation specialists do not agree with AAP d irecommendations

• Crib distribution controversial because of liability issues• Due to shift in diagnosis from SIDS to undetermined or • Due to shift in diagnosis from SIDS to undetermined or

ASSB, some are reluctant to use national resources that link SIDS with safe sleep

• Limited funding• Program evaluation is difficult

Round Table Discussions87

• Messaging AAP Guidelines Bed-Sharing Terminology (to use SIDS or not to use SIDS)gy ( ) Culturally specific messages

• Community Strategies Current opportunities/venues Current opportunities/venues

• Provider Strategies Child care Health care Social workers

• Policy Training curricula (nurses, social workers) Hospital policies

Safe Sleep Summit Outcomesp88

• Agreement that there is a need for a statewide Agreement that there is a need for a statewide Safe Sleep Initiative

• Agreement to use AAP GuidelinesAgreement to use AAP Guidelines• Commitment to participate• Vision Statement Draft: A coordinated • Vision Statement Draft: A coordinated,

collaborative statewide message and strategy to reduce sleep-related deaths among Colorado reduce sleep related deaths among Colorado infants.

Next Stepsp89

• Develop Statewide Safe Sleep Coalitionp p Initial Subcommittees

• Data/Evaluation• M i• Messaging• Funding

• Literature review on best practices• Pilot hospital survey• Develop consistent safe sleep messaging to be used by

all partners• Create statewide strategic plan to disseminate message

Id if f di f i l i• Identify funding sources for implementation

Opportunitiespp

• Data from SUID Case Registry Pilot will help

90

Data from SUID Case Registry Pilot will help develop stronger prevention recommendations

• Public/private partnership could be beneficial to Public/private partnership could be beneficial to fund prevention activities

• Funding through state MCH Program to help fund Funding through state MCH Program to help fund local level MCH programs work on safe sleep

• Partners around the state using the same language Partners around the state using the same language will making it easier for parents to understand safe sleep recommendations

Evaluation of a Novel SIDSEvaluation of a Novel SIDS Risk-Reduction Program at a

Community HospitalCreating a Hospital and C it B d I f tMichael Goodstein, MD, FAAP, and Theodore Bell MS

Community Based Infant Safe Sleep Education and Theodore Bell, MSAwareness Program: The York Hospital Experiencep p

Michael Goodstein, MD, FAAP

91

York PennsylvaniaYork, Pennsylvania• Population base 425,000 (city 40,500)• Inner city, suburban, and rural populations• Almost 4,500 deliveries per year , p y

92

Infant Coroner Cases York Co. 2005-2010

678

eath

s

2345

mbe

r of D

e

*

012

2005 2006 2007 2008 2009 2010

Num

2005 2006 2007 2008 2009 2010

Year

93

total deaths SUID Inappropriate sleep

Infant Sleep SafetyInfant Sleep SafetyRequires a consistent and repetitiveRequires a consistent and repetitive message in the community to prevent

accidental deathsaccidental deaths

94

Advice on Infant Sleep Safety: p yWho Do You Listen to…

• Family and Friends• Doctors Nurses Lactation CounselorsDoctors, Nurses, Lactation Counselors• Magazines, Newspapers, Internet

O h D Phil D S k D S• Oprah, Dr. Phil, Dr. Spock, Dr. Sears• Grandma!!!

95

Why Develop a Hospital-Based P ?Program?

• It is the only way to capture 100% of theIt is the only way to capture 100% of the birthing population for education

• It is the point of intersection for all the• It is the point of intersection for all the members of the health care team including obstetrician pediatrician nursing andobstetrician, pediatrician, nursing, and lactation counselor with family membersN iti l l d l• Nurses are critical role models

• It is efficient and cost-effective

96

Hospital-Based Infant Safe Sleep Program

Goal: Reduce the risk of injury or death toGoal: Reduce the risk of injury or death to infants while sleeping

P id t d i t t i f t f• Provide accurate and consistent infant safe sleep information to hospital personnel

• Enable hospitals to implement and model infant safe sleep practices throughout the facility

• Provide direction to health care professionals so parents receive consistent, repetitive safe l d ti

97

sleep education

A Model Program

• Replicate Shaken Baby Program (now called p y gabusive head trauma)

• 50% reduction in shaken baby injuries reported by Dr. Dias (Peds April 2005)

• Program Components:g p DVD presentation on infant sleep safety Face-to-face review with nursing staffg Sign voluntary acknowledgement

statement

98

Infant Safe Sleep DVDsInfant Safe Sleep DVDs

99

Parent EducationParent Education• Prior to discharge, all parents view g , p

the Safe Sleep DVD• Nurse modeling of safe sleep g p

environment • Review of the “Safe Sleep for your p y

Baby” pamphlet. • Confirm there is a safe place for the p

baby to sleep. If not, social work referral to obtain a Pack ‘N’ Play.

100

Voluntary Acknowledgment Statement

…. that I have received this information and understand that babies should sleep on the back, and that sleeping with my baby increases the risk of my baby dying from SIDS. • An acknowledgement form only• Focuses family on the importance of the informationy p• Not for legal purposes

101

Infant Safe Sleep Program: Supplemental Components

• Posters placed prominently in every labor, maternity, and pediatric room, offered to all OB, Peds, FP offices

• Sleep sacks available for purchase at p pdiscount at gift shop and lactation center

• Display nursery: Infant Sleep Safety CenterDisplay nursery: Infant Sleep Safety Center• Hospital phone service (on-hold message)

102

Safe Sleep PostersSafe Sleep Posters

103

Model Nursery/Infant Sleep Safety CCenter

104

Organizational Chart for an Infant Sleep Safety Program

Hospital Based Infant Safe Sleep Program

Program Acceptance Curriculum Development Community Support

Hospital Administration

Physicians

Initial Staff Education

Maintenance of Education

Local Health Bureaus

Safe Kids Coalition

Nursing Staff

Other Staff (RT, LC, Aides)

Family Education Cribs for Kids Programs

Child Death Review Teams

105

Presentation for AdministrationPresentation for Administration• Support from physicians already pp p y y

knowledgeable about SIDS/SUID• Scope of problem: National and localScope of problem: National and local

statistics• Logistics of program: A successful• Logistics of program: A successful

program model that has produced excellent public health resultsexcellent public health results

• Cost-effectiveness

106

Infant Mortality Statistics

SIDS - United States 1999The major cause of infant death after the first month

26.5SIDS/SUID17.2

8.1Congenital Anomalies

Accident/Adverse Effects

SIDS/SUID

3.13.03.1

Pneumonia/Influenza

Homicide/Legal Intervention

Septicemia

1.00.70 7

p

Meningitis

Respiratory Distress % of total infant deaths28-364 days old

107

0.70.6

Bronchitis

Malignant Neoplasms

28 364 days old

Staff Acceptance “Buy-In”Staff Acceptance Buy In

• Pediatric and NBN nurses with knowledgePediatric and NBN nurses with knowledge about SUID make quick allies

• Resistance to “another program” is easily• Resistance to another program is easily overcome by:

C t f t d i f t Concept of a program to reduce infant mortality locally Use of statistics Use of statistics Use of Evidence-Based Medicine

108

Allegheny County, PASt d f 88 SIDS D th 1994 2000Study of 88 SIDS Deaths, 1994-2000

11% (10 babies)Found in cribs or bassinets

89% (78 babies)Found in unsafe sleeping environments

109Source: Allegheny County Coroner’s Office, Stephen Koehler, Ph. D., Forensic Epidemiologist

Nursing Buy-Ing y• Nurse Managers: NBN, ICN, L&D,

Pediatrics, ED• Discussions at staff organizational g

levels: multidisciplinary committees (neonatal care), nursing counsels ( ), g(education, practice) Nurse leaders: Support dissemination of pp

program concept to general staff Follow-up discussions at nurse staff

110

pmeetings, reinforcement through e-mail

Healthcare Provider EducationHealthcare Provider Education

• Develop an infant sleep safety policy forDevelop an infant sleep safety policy for the hospital: Set the standard of care at the institution Set the standard of care at the institution Sample policies on the Allegheny County

Dept of Health and First Candle websitesDept of Health and First Candle websites York Hospital policy modified the Allegheny

sample and was merged with existing policysample and was merged with existing policy Finalized through newborn and pediatric

hospital committees

111

p

Hospital Nursing EducationHospital Nursing Education• In-service lectures vs. computer-basedIn service lectures vs. computer based

training• Lecture compliance may be difficult if not• Lecture compliance may be difficult if not

mandatory…non-productive hoursComputer based easier to do but teaching• Computer-based easier to do, but teaching may be less effective P id d CME di• Provided CME credits

112

Hospital Nursing EducationHospital Nursing Education• Core group of volunteers to provide lecturesCore group of volunteers to provide lectures• Developed PowerPoint presentation and

had practice sessionshad practice sessions Materials included: AAP SIDS policy statement,

NIH materials Cribs for Kids lecture materialsNIH materials, Cribs for Kids lecture materials• Supplemental poster boards in clinical areas

M d t i i f S f Sl DVD• Mandatory viewing of Safe Sleep DVD Reinforce materials, know what parents will see

113

Avoiding Potential PitfallsAvoiding Potential Pitfalls• Focus on back vs. side sleeping and fear

of aspiration• Claims made against the program:g p g Anti-bonding Anti-breastfeedingAnti breastfeeding

• Focus on evidence-based medicine Eliminate emotion Eliminate emotion

114

Maintenance of EducationMaintenance of Education

• Safe sleep toolkit at nurses’ stations (modifiedSafe sleep toolkit at nurses stations (modified

from Allegheny county)

Hospital safe sleep policy Hospital safe sleep policy Review of appropriate practices Discussion points to review with families Discussion points to review with families

• Informational flip charts (scripted prompts, stats)

• Computer-based review course with test as part of yearly competencies

115

Healthcare Provider Education: In the CommunityIn the Community

• Went into local physician offices to lecture during staff meetingsduring staff meetings Pediatric and obstetrical

• OB office visits focused on prenatal educatorsOB office visits focused on prenatal educators Provided posters and teaching materials Discussed bad information in free magazines Discussed bad information in free magazines

• Family Practice Grand RoundsEmergency Department Education• Emergency Department Education

• VNA

116• Red Cross Educators• Prenatal Class Educators

Anticipated OutcomesAnticipated Outcomes

• Back to Sleep Campaign – 50% reduction inBack to Sleep Campaign 50% reduction in SIDS (compliance 87%)

• Shaken Baby Program 50% reduction in• Shaken Baby Program- 50% reduction in abusive head trauma injuriesS SUID t ti t t 90% f• Some SUID experts estimate up to 90% of these deaths are related to suffocation

• Reasonable expectation of up to 50% reduction in SIDS/SUID events

117

$$$ Cost of Program $$$$$$ Cost of Program $$$• DVD- Safe sleep for your baby – right from

the start- $20• Voluntary commitment statement – paper y p p

supplies• Safe sleep toolkit – more paper suppliesSafe sleep toolkit more paper supplies• Safe sleep educational brochures – free

from NIHfrom NIH• Computer-based training – no charge

118• Volunteerism – to assist with in-services

Infant Safe Sleep Program ResultsInfant Safe Sleep Program Results

• 6 months baseline; 6 months intervention• 2 725 healthy deliveries 2 256 surveys• 2,725 healthy deliveries, 2,256 surveys• Excellent knowledge base about sleep

i t (94 99% i 99% ib)environment (94-99% supine, 99% crib)• Knowledge does not equal intent (15% drop)

119

Infant Safe Sleep Program ResultsInfant Safe Sleep Program Results

• Improvement after program interventionI t ti t f ll th h ith• Intention to follow through with: Supine sleep position increased from 82% to

97% ( < 01)97% (p < .01) Crib or bassinette use increased from 81% to

92% (p < 01)92% (p < .01)

120

Results of HCP EducationResults of HCP Education

• Understanding of the AAP guidelines increased from 75% to 99% (p < 0.01)

• Agreement with all of the AAP guidelines increased from 88% to 94% (p = 0.049)% % (p )

• Staff adequately trained about ISS increased from 43% to 99% (p < 0 01)increased from 43% to 99% (p < 0.01)

121

ConclusionsConclusions

• A hospital-based community-wide InfantA hospital based community wide Infant Sleep Safety program can be maintained successfully at minimal costsuccessfully at minimal cost.

• To be successful:Id tif i f t l f t h i Identify infant sleep safety champions Build consensus

Eff i d i Effort, time, and passion

122

Program Replication• York Hospital• Memorial Hospital

• Magee Women’s Hospital• Mercy HospitalMemorial Hospital

• Gettysburg Hospital• Harrisburg Hospital

y p• St. Clair Hospital• Franklin Square HospitalHarrisburg Hospital

(Pinnacle Health)• Doylestown Hospital

q p• Williamsport Hospital• *Lancaster Women andDoylestown Hospital

• Hanover Hospital• West Penn Hospital

Lancaster Women and Children’s Hospital

• *Heart of Lancaster West Penn Hospital• Forbes Hospital• Sewickley Hospital

Hospital• *Geisinger Health System

123

• Sewickley Hospital g y• *Hershey Medical Center

Achieving a Cultural Shift on ISSInconsistency of message.Lack of HCP education.

Wrong advice from

National campaign withconsistency of message.

Improved HCP educationgfamily and friends.

Unsafe sleep images.Inappropriate sleep

products

Improved HCP education.Partnership: Religious

Leaders.Safe sleep images.S i l k iproducts.

SafeSleep

Social marketing.Legislation?

Safe Sleep

p

124

References and Contacts• The American Academy of Pediatrics Task Force on Sudden Infant

Death Syndrome. The changing concept of sudden infant death syndrome: diagnostic coding shifts controversies regarding thesyndrome: diagnostic coding shifts, controversies regarding the sleeping environment, and new variables to consider in reducing risk. Pediatrics 2005;116:1245-55.

• Colson et al Trends and factors associated with infant sleeping• Colson et al. Trends and factors associated with infant sleeping position: The national infant sleep position study 1993-2007. Arch Pediatr Adolesc Med 2009;163(12):1122-1128.

• Kinney and Thach Medical Progress: The sudden infant death• Kinney and Thach. Medical Progress: The sudden infant death syndrome. N Engl J Med 2009;361:785-805.

• Contact Information: Michael H Goodstein MD FAAP Michael H. Goodstein, MD, FAAP

Office of Newborn Medicine York Hospital1001 S. George St.York, PA 17405717 851 3452

125

717-851-3452717-851-2602 (fax)[email protected]

THANK YOU!!!

126

C ib f KidCribs for Kids® National Infant Safe Sleep Education and

Crib Distribution Program

Judy Bannon, Executive Director/Foundery ,www.cribsforkids.org

Cribs for Kids®

• Originated in Pittsburgh in Nov. 1998 through the combined efforts of DistrictAttorney Stephen Zappala, Mayor Bob O’C C d G Elli tt dO’Connor, Cmdr. Gwen Elliott, and Judy Bannon (SIDS of PA)

• Steering committee consisting of• Steering committee consisting of public health, political and business leaders and child death review teamswas formedwas formed

Of the 68 infant deaths between 2001-06, how many babies were in an ideal sleeping space?

( th b k i f ib i tt k ft b ddi )(on the back, in a safe crib, no cigarette smoke, no soft bedding)

Allegheny County, Pittsburgh, PA

Unsafe!

Only 2!

FACT!

The overwhelming majority of babies who die from SUID/SIDS are discovered in an unacceptable sleep position or sleep

location!

The overwhelming majority of babies whoThe overwhelming majority of babies who continue to die from SUID/SIDS are African

American babies!American babies!

Growth between 2006 and present!AK

ME

BC

Growth between 2006 and present!

NY

WA

MNWI

NYCMIOR

VNDMT

ME

NH

VE

ID

PA

OH

KY

VAIL

NCKS

MD

NYCMI

CA

DCDE

MO

NJNE WV

CONV IN

IA

UT

WY

KY NCKS

GAAL

CA

MS

MO

SCOKTN

AZ NMARHI

LAFL

To Date: 262 Partners in 48 States

TX

Cribs for Kids locations Awaiting signed agreement

262 Partners in 48 States

National Cribs for Kids® Partners

140

National Cribs for Kids® Partners

119

100

120

140

Health Departments & DPWAgencies

5960

80

100 DPW Agencies

Hospitals

SafeKids Coalitions

32

47

20

40

60

Community Based Organizations

Oth5

0

20

Number of Partners (262)

Other

( )

SIDS is NOT SuffocationSIDS is NOT Suffocation

Although SIDS is different fromAlthough SIDS is different from suffocation, all the measures we use for SIDS risk reduction also help to preventSIDS risk reduction, also help to prevent accidental deaths such as positional asphyxia overlay and entrapmentasphyxia, overlay, and entrapment.

Th d th 100%These deaths are 100% PREVENTABLE!

The Ideal Safe Sleep Environment

Used with permission from Tomorrow’s Child, Michigan SIDS

Baby sleeps in crib.

Nothing in sleep area.

Firm mattress, tight-fitting sheet.

Unsafe Sleep Environment:Soft BeddingSoft Bedding

Unsafe Sleep Environment

Unsafe Sleep Environment

j

Components of the Cribs for Kids® program

• Standardized materials

Cribs for Kids® program

Safe-sleep brochures, posters, etc. Training manuals Standardized forms Standardized forms Grant writing language Current safe-sleep literature review

P P i t t ti PowerPoint presentations• National fundraising initiatives• Crib distribution systemCrib distribution system• Networking opportunities• Ongoing supportg g pp

National Sponsors

Graco Children’s ProductsGraco Children s Products In January, 2006, Cribs for Kids was

made the exclusive commercial distributor of the Graco Pack n’ Playdistributor of the Graco Pack n Play

Pitt Ohi EPitt-Ohio Express In March, 2006 Pitt-Ohio Express

partners with us and offers free shipping p pp gto partners across the country. They also

donated a forklift to help with our shipping needs!

Cribs for Kids® Graco Pack ‘n Play

G ‘P k Pl ’Graco ‘Pack n Play®’ --$49.99

Our own C4K SKU numberCan not be returned to any retail

storeS f t dSafety approvedPortableCompactEasy to assembleEasy to assemble

Cribs for Kids® Crib Sheet with Safe Sleep Message

$5 00 each$5.00 each

Please Keep Me Safe…

For naps & at night to reduce the risk of SIDS

Back to Sleep

Now I lay me down to sleep,Alone in my crib, without a peep.On my back, in smoke-free air,

Thank you for showing me that you care.

www.cribsforkids.org1.888.721.CRIB

Portable Crib Sheet Design

Cribs for Kids® Logo Halo Sleep Sack$14 99 each

HALO™ SleepSack™ Wearable Blanket

$14.99 each

HALO SleepSack Wearable Blanket

Replaces loose blanketsReplaces loose blankets in the crib, lessening the likelihood of babies getting blankets over or around their face.

Respironic Soothie Pacifier$1.50$1.50

Soothie®

For Babies Without TeethSoothie is a premium pacifierdesigned for newborns and babies without

h h f ll b l

For Babies Without Teeth

teeth who are successfully bottle or breastfeeding. Its one-piece construction adheres to the American Academy of Pediatrics guidelines.Pediatrics guidelines.

Respironic Pacifier

“Keep Me Safe” Photo Magnet$ 75$.75

• New item added to Safe Sleep Survival Kit

• Safe Sleep Survival Kit same price still $69.99

Safe-Sleep Survival Kit $69.99

Safe Sleep Survival Kit


Now I lay me down to sleep,Alone in my crib, without a peep.On my back, in smoke-free air,

Thank you for showing me that you care.


Back to Sleep


Public Service AnnouncementInfant Safe Sleep VideoInfant Safe Sleep Video


Now I lay me down to sleep,Alone in my crib, without a peep.


Back to Sleep


On my back, in smoke-free air,Thank you for showing me that you care.

Becoming a Partner….H d I b i ?How do I begin?

Go to www.cribsforkids.org

Or

Call: 412-322-5680 Ext 3Call: 412 322 5680 Ext 3

Components of the ‘Cribs for Kids®’ Program

Application FormApplication Form


Trademark License AgreementTrademark License Agreement


Standardized BrochuresStandardized Brochures

www.nichd.gov/SIDS

For more educational supplies request from

g

For more educational supplies request fromwww.nichd.nih.gov/SIDS

Components of the ‘Cribs for Kids®’ Program Survey Instruments – Pre & Post TestsSurvey Instruments Pre & Post Tests

~. I-- I

-c... ... ......

T'IIfJl I12U , -_. ' ........ -,- , ~ -, - ~ -'-- • ,- ",--~,- - ""--. ==-----~~

p,.,.l .... ~:~~ . .. K lIl l ', .~. ---"-- , --'-" ..... _- ... ". ............ _ IU-.~."""t." -::c.- '.,...--- , ..,~..,. ... :r; - ..... -.- ..... ..,... .......,_.

___ G " .. , ... , ---) "'" """"-- --,.,. -----_.- La --... _ " ",,,,,, • --" . ..--.. ,..-_ .............. - , :. ...... -..- . ."",. , -_ .. ,.. ___ ....... _.-:0;. -'" -... -- .- - -~. ...". .. - ._- .- ,

"-~ - "',.. .--. -"-- , . ...... ... m -'.. ...,. ........... , :c:r.,,::"l0l , - -. -,-....... , , , , , "',..- ... _. , . ,..---- -..... --,...-' , , , , .... - .. -....

-,..~ -:: ........... -, ".,..-,.. ..... ~- , ..... ,..... ....... ....... -... _ . ,.._ • ..r , , , , .. _..., .

• _ ... _ .. '00'''"'" , , , , -.... .............. -. ---_ ... -,..~ ..... -.... ..... _J<, ... ..., --' , , , , ""- .... -... __ .. --... , , , , ---'--'~ .. ..... .-- ~. ----.".---.~ , "" ...... ........... ---_ ....... - , , • , "" ..... -......... .- -------.:::::: ........... ....... -,.....,.. , , , , -... -,..----............. _,.....,.

~-. -


Sample Grant Materialsp


Sample Grant MaterialsSample Grant Materials

Components of the ‘Cribs for Kids®’ Program -- Standardized Forms

Hold Harmless AgreementHold Harmless Agreement


Safe-Sleep ChecklistSafe-Sleep Checklist

How to Order a Safe Sleep En ironmentSafe-Sleep Environment

Mandated Legislation(language and guidance)(language and guidance)

Pennsylvania Act 73 of 2010

SIDS Ed ti d P ti PSIDS Education and Prevention ProgramSigned into law on October 19, 2010 by Governor Edward

Rendell of Pennsylvania, providing for education of parents relating to SIDS and unexpected deaths in

infanc taking effect on December 16 2010infancy, taking effect on December 16, 2010.

Networking & Ongoing SupportNetworking & Ongoing Support

• Semi-Annual conferenceSemi Annual conference• 24-Hour Hotline

E i d t ff t ti l ffi• Experienced staff at national office answers questions & provides guidance

• Fundraising Advice• Easy ordering of Safe Sleep Survival Kitsy g p

FACT!

Knowing is not enough:we must apply.

Willing is not enough:Willing is not enough:we must do.

……Goethe

Questions and AnswersQuestions and Answers Thank you for attending this event. Please

complete the evaluation directly following the p y gwebcast. An archive of this events will be posted (http://www.mchcom.com) within a few days.

Infant Suffocation Deaths in the Sleep Environment

Health & Medicine

Transcript of Infant Suffocation Deaths in the Sleep Environment