A Pediatrician Explains AAP’s New Safe Sleep for Babies Practices

By Dr. Georgie Pechulis, pediatric hospitalist at CHOC Children’s

The American Academy of Pediatrics (AAP) recently released updated recommendations on safe sleep practices for infants under one year of age, which are outlined below. Safe sleep is a top priority for all parents to reduce the risk of Sudden Infant Death Syndrome (SIDS) and other sleep-related deaths that claim as many as 3,500 infant lives in the U.S. every year SIDS is the unexplained death of an infant, even after thorough investigation, autopsy, and review of medical history.

safe sleep for babies
Dr. Georgie Pechulis, a pediatric hospitalist at CHOC Children’s

What can be done to prevent SIDS and other sleep-related deaths?

We know there are a number of practices proven to lower an infant’s risk of SIDS and sleep-related deaths. Taking these actions can help to create a safer sleep environment for your baby. Here are a few of the key points from the AAP’s updated recommendations.

Back to sleep for every sleep

Research shows that putting your baby to sleep completely on their backs for the first year greatly reduces the risk of SIDS.

Once an infant can roll on their own, they can be allowed to remain in the sleep position that he or she assumes.

To help prevent flat head syndrome or positional plagiocephaly, supervised and awake tummy time is recommended.

It is recommended that infants sleep in the parents’ room, close to the parents’ bed, but on a separate surface designed for infants. This is recommended for ideally for the first year of life, but at least for the first six months.

Evidence shows that sleeping in the parents’ room but on separate surfaces decreases the risk of SIDS by as much as 50 percent.

Separate designated sleeping arrangements can prevent entrapment, suffocation and strangulation that can occur when infants sleep in an adult bed

Keep soft objects and loose bedding away from the infant’s sleep area to reduce the risk of SIDS, suffocation, entrapment and strangulation

Although they are widely available on the market, crib bumpers and pads, stuffed animals and toys, pillows, and blankets are not recommended in the crib as they can easily block your baby’s breathing.  The crib should only contain your baby, the mattress, and a fitted crib sheet.

If appropriate for the climate, infant sleep clothing, such as a wearable sleep sack or blanket is preferable.

Consider offering a pacifier at nap time and bedtime

A pacifier has been shown to have a protective effect, even if it falls out of the infant’s mouth. It doesn’t need to be reinserted if the baby falls asleep. It is not recommended to use any attachments to the pacifiers. Ensure breastfeeding is well established prior to any use of pacifiers in breastfeeding babies.

Avoid overheating and head covering in infants

Avoid the use of commercial devices that are inconsistent with safe sleep recommendations

Ensure that products conform to safety standards of the Consumer Product Safety Commission

Car seats, strollers, swings and infant carriers are not recommended for routine sleep, per the AAP’s recommendations. If an infant falls asleep in any of the above devices, they should be moved to a safe sleep surface as soon as is safe and practical.

Do not use home cardiorespiratory monitors as a strategy to reduce the risk of SIDS.

What else is new in the recommendations?

The AAP’s SIDS Task Force also addressed infant feeding and comforting in bed. As always, it is recommended to have your infant sleep separately in a designated surface apart from the parent sleep area. However, the AAP does recognize that parents frequently fall asleep while feeding their infant and evidence suggests that is it less hazardous to fall asleep with the infant in the adult bed than on a sofa or armchair. No pillows, blankets, sheets, or any other objects should be in the bed. Many infants who die from SIDS and sleep-related deaths are found with their head covered in bedding.

Infants who are brought into bed for feeding or comforting should be returned to their own crib or bassinet when the parents are ready to return to sleep. If a parent does fall asleep, the infant should be returned to their separate sleep surface as soon as the parent awakens.

Among the above recommendations, parents should avoid smoke exposure, alcohol and illicit drug use during pregnancy and after birth, as these can also increase risk of SIDS.  Regular prenatal care and immunizations per the Centers for Disease Control and AAP guidelines are also encouraged. And as always, breastfeeding is recommended and is known to provide a protective effect. Any degree of breastfeeding has been shown to be protective, increasing with exclusivity.

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The Dangers of Secondary Drowning

By Dr. Georgie Pechulis, pediatric hospitalist at CHOC Children’s

Dr. Georgie Pechulis

With Memorial Day weekend right around the corner, it generally signals the beginning of summer and the opening of the much-anticipated pool season. Our kids will undoubtedly be awaiting their water time with endless excitement, and we as parents will do our best to keep them safe. Amidst our best efforts to educate ourselves and our children on water safety, drowning still tends to peak in these summer months. Secondary drowning is another danger, albeit rare, that parents should be aware of.

What is secondary drowning?

We as pediatricians actually don’t like this term, since it creates a lot of confusion.

Drowning is defined by the International Liaison Committee on Resuscitation as, “a process resulting in primary respiratory impairment from submersion/immersion in a liquid medium.” So what does that mean? Any event from being in water that causes problems breathing, whether it is primary, secondary, wet or dry, or any other forms of drowning.

Secondary or delayed drowning refers to the phenomenon of water inhalation, followed by presumed recovery, and respiratory problems that appear afterwards. Often the story involves being underwater or inhaling water with immediate symptoms that appear to go away.  However, vague symptoms persist and cause breathing problems long after the event, to the surprise of parents. It is a subset of drowning and thankfully, is relatively rare.

Here are a few of the most common questions I receive from parents about secondary drowning:

My child coughed after accidentally swallowing some water- should I bring him to the ER?

Fortunately, most simple aspiration events are not serious. Parents will need to look for the persistence of symptoms. In other words, you’ll notice your child hasn’t returned to his or her normal breathing or behavior after the incident.

  • Breathing: Your child is working hard to breathe by using his belly muscles or if you notice her nostrils flaring or head bobbing. Also, look out for persistent coughing even long after the event, and darkness or blue coloring of the lips.
  • Behavior: You notice your child is not acting right. He or she is lethargic, irritable, or not their usual self. This will be different from what you’re normally used to. Use your parental instinct.

My child seemed fine. What happened?

If water irritates the lungs, it can cause inflammation, fluid buildup, and difficulty for the body to receive the oxygen that you breathe. Sometimes these effects happen long after the event has occurred. We expect these symptoms to show within 24 hours after aspiration of water.

 If you have any of these concerns, please seek medical attention with your pediatrician or even the Emergency Department if your child appears in distress.

How can I keep my child safe?

As always, the best way to keep your child safe is to monitor them at all times in the water and to ensure they do not have any access to potential water hazards.  This includes not only pools, but filled bathtubs, hot tubs, lakes, koi ponds, and fountains.

  • Never leave them unsupervised. For toddlers or any children who are not able to swim, an adult should be within arm’s reach at all times. Never leave the child unattended, even if it is to quickly run in the house and grab something. Commonly, drowning occurs when caregivers briefly leave the child unattended to grab cameras, phones, food or drink, etc. Appoint dedicated and qualified adult supervisors to substitute watch if you need to leave.
  • Supervise without distraction. Your job as the supervisor is to do so without distraction. No cell phones, no reading materials, and no distracting conversations. Those brief lapses of attention are when incidents can occur. It’s an important job to supervise your kids in the pool and really key to ensuring your child’s safety.
  •  Drowning is usually silent. The typical drowning scenario in a movie usually depicts arm flailing, screaming, and water splashing in all directions. The truth is that most drowning occurs without noise. Often the child struggles quietly and slips under the water without a sound. Always be alert and on the watch, for it may not be obvious.
  • Be aware of your environment. If you are visiting a family or friend’s home, be aware of any potential water dangers nearby. Homes that do not usually have children often have open access to pools, spas, and natural bodies of water such as ponds and lakes. Children are curious and will want to explore new environments. Be alert.

As a hospital pediatrician and as a mother, often I hear the stories of caregivers shifting their attention to engage in conversation, running in the house to grab something, or other forms of quick distractions that lead to these accidents. If I could ask anything, it’s that we just take time to really focus on protecting our kids by being their undistracted monitor.  We want them to enjoy many endless summers of water time to come.

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