SAFE SLEEP SAVES LIVES

• If a baby goes home from the hospital healthy, the biggest risk to their survival until their first birthday is sleep-related infant death. • Any infant in an unsafe sleep environment is vulnerable and can face a sleep-related infant death. Even a healthy infant with no risk factors can become wedged between a wall and a mattress or suffocated via overlay. • However, the risk for sleep-related infant death is cumulative. The greater the number of risks present in the infant and in their environment, the greater the risk of death. • Helping families and caregivers understand the risks of unsafe sleep can save lives.

• The Child Fatality Review. It’s a confidential process that allows Baltimore City Health Department staff to review all cases of unexpected or unexplained child death happening to Baltimore City residents. The findings are used to prevent future deaths and improve the health and safety of all children in our communities. • This team reviews every case of sleep-related infant death. This includes data from the investigation, the child’s health records, the parents’ health records, and any locally maintained records pertaining to this death and the history of this family. • Every jurisdiction in Maryland has a similar program, and a lot of data and learning come out of this work.

• Providers are some of the most trusted individuals that families look to for health information. While providers are extremely busy and tasked with providing tremendous amounts of education to families, this trust makes your role in encouraging safe sleep essential. • In addition to providing education on the ABCDs (Alone - Back - Crib - Don’t Smoke) of safe sleep and pointing them to BHB resources,(https://www.healthybabiesbaltimore.com/safe-sleep) you can connect families to resources through critical referrals. These include: The prenatal risk assessment (PRA) (https://b4dea98f-9178-4396-bd41-56b09399b976.filesusr.com/ugd/92aa1a_c29b3e4a040a4592a983568fbd65b8da.pdf)and the postpartum infant maternal referral (PIMR).(https://b4dea98f-9178-4396-bd41-56b09399b976.filesusr.com/ugd/92aa1a_6daab13c206d4006a7d661cf9b709b28.pdf) • By submitting these referrals for your patients during prenatal care and after delivery, you connect them automatically to care coordination and other resources that can help them with challenges they may face when consistently putting their babies to sleep safely.

• Consistent safe sleep can be really tough, especially as parents may be experiencing work or relationship stress, caring for multiple young children, or facing other challenges. • To start a conversation and get more information about the family, their current challenges, and sleep practices, it can be useful to start with open-ended questions such as: What are your plans for how your baby will sleep during naps and at night? Where does your baby sleep? What questions do you have about safe sleep for your baby? • Try not to start with a leading question (e.g., your baby sleeps in a crib, right?) as it may prompt families to give you the answer you want to hear, rather than describing their situation. Once you know the barriers preventing consistent safe sleep, you can help them troubleshoot. • While talking with parents, providers can offer this resource,(https://drive.google.com/file/d/1WlGN-Ggink225xZXCn2w6ZywISAUxnvS/view) developed in partnership with Baltimore City families, and reinforce safe sleep tips for sleep-deprived parents.(https://www.healthychildren.org/English/ages-stages/baby/sleep/Pages/safe-sleep-tips-for-sleep-deprived-parents.aspx?_gl=1*6irq36*_ga*MjA1MDAxMDkxMi4xNzI0NDI0MjM0*_ga_FD9D3XZVQQ*MTc0MTEwMjQxNy4xMC4xLjE3NDExMDM4NjEuMC4wLjA)

• Other options serve as safe cribs as well. A bassinet, a pack-and-play, and a side sleeper are all considered safe cribs. • Baltimore City makes pack-and-plays available through HealthCare Access Maryland. Learn more.(https://www.healthybabiesbaltimore.com/_files/ugd/8aca6e_df4878b521904db48ee73400df50dbcf.pdf)

• In an emergency, there are several acceptable alternatives, including a cardboard box, a basket, a laundry basket, or a dresser drawer, according to the American Academy of Pediatrics (AAP). See examples below. • Every time, these should be used with a thin, firm padding and no pillows, blankets, or soft objects. https://static.wixstatic.com/media/92aa1a_87b4ea8ebae143cbb47e48fada483032~mv2.png

• It is true that for many reasons, NICU staff may not follow safe sleep practices during the newborn’s stay. However, the AAP recommends that as soon as the infant is medically stable — and definitely prior to discharge — parents and caregivers learn safe sleep practices to care for the baby at home. • Find additional information on transitioning from the NICU: For Parents (https://www.healthychildren.org/English/news/Pages/Safe-Sleep-for-Babies-in-the-Neonatal-Intensive-Care-Unit.aspx)and For Providers.(https://publications.aap.org/pediatrics/article/148/1/e2021052045/179976/Transition-to-a-Safe-Home-Sleep-Environment-for?autologincheck=redirected)

• Any kind of smoke. This includes tobacco, marijuana, vaping, and anything that produces smoke. Smoke-free environments are important for pregnant people, as it is also dangerous for them to be around second-hand smoke. • Families need to hear clear, consistent messages on this: Don’t smoke while you’re pregnant. Don’t allow anyone to smoke near your baby or in your home. Ask family members who smoke to change their clothes before they hold the baby. Don’t allow anyone to smoke in your car, even if the windows are down. And choose babysitters who don’t smoke. • In Baltimore City, we have found that smoking during pregnancy is also a risk factor for infant death due to unsafe sleep, making these messages vitally important for all providers. • Read a cannabis-specific brief.(https://b4dea98f-9178-4396-bd41-56b09399b976.filesusr.com/ugd/92aa1a_a7f7d0e7a39b48bfaaad56af6e26c508.pdf)