Printer-Friendly
share this image
Skip sharing on social media links

Text Alternative: Healthy Native Babies Project: Safe Sleep Train-The-Trainer Module 3 of 6

To view the original video, please go to http://www.nichd.nih.gov/sts/news/videos/healthynative/Pages/default.aspx

Video/ Graphics Audio
TITLE SLIDE:

Healthy Native Babies Project
logo.

Healthy Native Babies Project
:
Honoring the Past, Learning for the Future


A Collaboration Between the Healthy Native Babies Project Workgroup and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH)

U.S. Department of Health and Human Services logo.

NIH Eunice Kennedy Shriver National Institute of Child Health and Human Development logo.
No audio
GRAPHICS SLIDE:

Trainers


Photo: Leah Henry-Tanner

Leah Henry-Tanner, BS
Nez Perce Tribe of Idaho

Photo: Geradine Simkins

Geradine Simkins
RN, CNM, MSN
No audio
GRAPHICS SLIDE:

Safe Sleep Train-The-Trainer

Training Location:
Yakama Nation Cultural Heritage Center
Toppenish, WA
August 7, 2014
No audio
GRAPHICS SLIDE:

Safe Sleep Train-The-Trainer  

BABY SLEEPING ENVIRONMENT


Photo of three women and one man sitting at a table with a woman in front of a crib holding a blanket.
No audio
GRAPHICS SLIDE:

Lowering SIDS Risk
  • Sleep Position
    • The most effective action that parents and caregivers can take to lower the risk for SIDS is to always place the baby on his or her back to sleep, for naps and at night.
    • Every sleep time counts!
(Here, the camera cuts back and forth between Leah Henry-Tanner and the slides.)
Leah Henry-Tanner: Another way to lower SIDS risk is sleep position. I think we spend a lot of time in the Bedtime Basics for Babies program talking about always put baby to sleep on the back. And so, the most effective thing that parents or other caregivers can do to keep baby safe during sleep is to place baby on his or her back, and not just for sleep or for night time sleep, but for every time the baby sleeps. So, at nap time. Like it says, every sleep time counts.
GRAPHICS SLIDE:

Back Sleeping Does Not Cause Vomiting or Choking

When a baby is in the back sleeping position, the trachea lies on top of the esophagus.

Anything regurgitated or refluxed from the esophagus must work against gravity to be aspirated into the trachea.

Illustration showing that when a baby lies on its back, the trachea is located above the esophagus.

(Here, and the next slide, the camera cuts back and forth between Geradine Simkins and the slides. Geradine Simkins is demonstrating the location of the trachea and esophagus using a white and yellow highlighter and doll.)
Geradine Simkins: The whole issue around back sleeping does not cause vomiting and choking–we'd like to demonstrate why that is.

First of all, when a baby is in the back sleeping position, the trachea lies on top of the esophagus. And, I'm going to demonstrate that. Anything regurgitated or refluxed from the esophagus must work against gravity to be aspirated into the trachea.

Alright so, let's pretend that these two items are the trachea–clear, air, wind, white. And the esophagus yellow, bile, vomit. OK? So, you can see the difference in these two. The esophagus connects the throat to the stomach. So the esophagus goes right from the throat right to the stomach. It's an 8 inch tube, and it lies behind the windpipe, and goes all the way down to the stomach. OK? So, in a baby, the esophagus goes from the mouth down to the stomach.

The trachea, where the air comes through, is about a 4 inch tube, and, it lies on top. OK? And, the trachea connects to what we call the bronchi. So, it starts here. It's about a 4 inch tube, and it goes into the bronchi, and then goes to each lung. So bronchi, trachea, and esophagus behind it into the stomach.

When this baby vomits, that vomit has to work against gravity to jump up and get into the trachea. Right? So, if the baby's lying on its back, and we have esophagus there, trachea there. When the baby throws up, it will naturally go on the side, because gravity will pull the material down to the side. Right?

However, if you have this baby lying on its belly, now we still have the trachea behind and the trachea in front and the esophagus behind. But when the baby is lying there, the vomit can pool right here, and the baby can suck it in. Right? Much more easily. So, there's vomit laying around the baby. And babies–little, tiny babies–sometimes their heads aren't turned completely aside. Sometimes, they're like that. Right? And so when they go to throw up, it just–it just pools there and they [sucking noise].

Whereas, if they're lying on their back and you have the esophagus behind and the trachea in front, it's gotta go up hill to get into that wind pipe. So you can see–maybe I should put this up here–you can just see anatomically how that this is not necessarily a logical argument.
GRAPHICS SLIDE:

Stomach Sleeping Could Cause Vomiting or Choking


When a baby is in the stomach sleeping position, anything regurgitated or refluxed will pool at the opening of the trachea, making it easier for the baby to aspirate or choke.

Illustration showing that when a baby lies on its stomach, the trachea is located below the esophagus.
Geradine Simkins: So, when a baby is in stomach sleeping position anything regurgitated or refluxed will pool at the opening of the trachea making it easier for the baby to aspirate or choke. Yeah, makes a lot of sense. And, until you see this actually demonstrated, I think we don't necessarily get it. This way is safe. This way is not as safe. Side lying is not as safe either. So, the whole message of the safe sleep campaign is "back to sleep." All of the stories that you might have heard about side lying, or those kinds of pillows that support the baby from the behind–not safe. On the baby's back is what is safe.
(Camera cuts to Leah Henry-Tanner.) Leah Henry-Tanner: The risk period for SIDS is really the 2 to 4 month period, and then after that it drops. It's still possible, but the risk drops. So, by that time baby is rolling over on their stomach and so, you don't–if they're at that point where they're rolling over, you don't need to force them back on their back to sleep.
GRAPHICS SLIDE:

Lowering SIDS Risk
  • Sleep Surface and Sleep Environment
    • Firm sleep surface
    • No objects, toys, or loose bedding
    • No crib bumpers
  • Overheating
    • No more than 1 layer more than what an adult would wear to be comfortable
(Here, and in the following sections, the camera cuts back and forth between Leah Henry-Tanner, the participants, and the slides.)
Leah Henry-Tanner: So, we talked a lot about safe sleep, baby on the back, on a firm surface with no objects, toys, or loose bedding, and no crib bumpers. And, I think that's sometimes kind of hard because usually when you buy a nice thing for your baby it includes the bumpers, the nice fluffy blankets, and the nice pretty comforters.

But really baby just needs–a sleep sack would be ideal, on a mattress that has a tight fitting sheet. So, this really demonstrates what a safe sleep environment is. See? No bumpers. Baby is on back, all by himself, and no loose blankets or toys in the crib.

One of the things we saw a lot of when I participated in child death review was the cribs often had a lot of blankets or clothes or other stuff.

Participant: Pillows. Yeah, or pillows in this environment. Obviously, baby was in an unsafe sleep environment.
GRAPHICS SLIDE:

Lowering SIDS Risk
  • A blanket is not recommended, but if using a blanket, use "feet to foot" method:
    • Feet at the end of crib
    • Blanket tucked under mattress
    • Blanket no higher than chest
    • Sleep clothing that is appropriate to room temperature
Leah Henry-Tanner: If parents are using a blanket, make sure that the baby's feet are toward the end of the crib, and that the blanket is tucked under the mattress, and the blanket only comes up to baby's chest like that (so the arms are loose), and then also to make sure that baby's not overheated, and that the sleep clothing is appropriate for the temperature of the room–because overheating, again, is one of the SIDS risk factors. So, we want to be able to counter that.
GRAPHICS SLIDE:

Lowering SIDS Risk
  • Alternative Sleep Surfaces*                       
Illustrations showing baby in a basket, box or carton, drawer, and wash tub.

*Babies should be placed on their backs. No data exists on the safety of these items and must be careful about baby turning over as he/she grows and flipping the basket/box over. (Here, Leah Henry-Tanner demonstrates how to make a safe sleep environment with a laundry basket.)
Leah Henry-Tanner: Like I mentioned, there are often parents or caregivers that can't afford a crib. And so, one of the things that we thought was really important to include as part of the Healthy Native Babies Project is identifying other alternative places where babies can sleep that they'll still be safe.

And so, in a basket, just a laundry basket. [Laughter.]

And this is a cardboard box or just a little piece of cardboard that has a receiving blanket clipped down so that it's nice and it's firm, and you can put it at the bottom of the laundry basket.

Also, a box or carton, but make sure it's clean and hopefully not used with food or anything that had pesticides on it; a drawer is a great alternative, or a washtub.
(Camera cuts to Geradine Simkins.)

Geradine Simkins points to slide with illustrations of a baby in a basket, box or carton, drawer, and wash tub.
Geradine Simkins: You know, if the idea is to have the baby in a separate location, it's safe on its back, then the next step would be where it's not too cold, you know, or where there isn't a draft. Just helping them try to think through the most logical thing. If they are a member of a family that can't afford a crib, or doesn't have a crib, but can get a three dollar laundry basket.
GRAPHICS SLIDE:

Lowering SIDS Risk
  • Choose safe sleep locations.
  • Use separate sleep area in the same room as parent or caregiver.
Photo of baby in crib and mother in a bed located next to the crib.

(Here the camera cuts back and forth between Leah Henry-Tanner, the participants, and the slides.)
Leah Henry-Tanner: But if you do use or families use an alternative sleep surface, just make sure that baby's in it all by itself–that there's no kids jumping on it or animals crawling into it–cats or dogs.

And then, the SIDS risk is significantly higher when a baby shares a bed with other children or is placed on a sofa (because a sofa is really soft),  sleeps in a bed with a mom who smokes cigarettes, or sleeps in a bed with an adult who's been drinking alcohol. And then also, be aware that the risk factor increases if baby sleeps in a bed with more than one bed sharer, especially if the baby's sharing a bed with two adults. And, it's also riskier if the baby is younger than 14 weeks of age.

But there have been studies that show room sharing, having a separate sleep area for baby in the same room where a parent sleeps, reduces the risk for SIDS and other sleep-related infant deaths. And so because of this evidence, the American Academy of Pediatrics, the AAP, recommends room sharing as the best option.

Studies suggest that bed sharing is always riskier than not bed sharing in terms of SIDS and other sleep-related causes of infant death, such as accidental suffocation or smothering and other accidental or unknown causes of injury and death. So, room sharing instead of bed sharing.

I really like this whole approach of risk reduction because we know that telling people "don't do this" is just not the way to teach anything to anybody. And so, that's why we're always so happy to come to communities to be able to share these materials, because they're really important.
GRAPHICS SLIDE:

Safe Sleep Train-The-Trainer

This Concludes Module 3 of 6


For more information and materials about SIDS, reducing SIDS risk, or the Healthy Native Babies Project, contact the Safe to Sleep®campaign at:  1-800-505-CRIB (2742) or http://safetosleep.nichd.nih.gov
No audio
Back to Top 

Safe to Sleep® is a registered trademark of the U.S. Department of Health and Human Services.