Womens and Infants Health

Model Behavior - Hospital-based SIDS Risk Reduction

Sudden infant death syndrome or SIDS is “the sudden death of an infant less than one year of age, which remains unexplained after a thorough case investigation, including performance of a complete autopsy, examination of the death scene, and review of the clinical history” (Willinger et al, 1991).  Typically, these deaths occur among well infants who are placed to sleep in a crib and the caregiver returns to find the infant is not breathing. 

From 2003 to 2007, there was an average of 78 infant deaths per year due to SIDS in Virginia.  SIDS accounts for about 10 percent of infant deaths in Virginia. Compared to the nation, Virginia has suffered higher SIDS rates since 2000.  Like the nation, SIDS is the third leading cause of infant death in Virginia.  Moreover, there are glaring racial and ethnic disparities in Virginia.  Black infants are twice as likely as White infants and three times more likely than Hispanic infants to die of SIDS. 

Despite the American Academy of Pediatrics (AAP) recommendations on safe sleep practices and the national “Back to Sleep Campaign,” the practice of placing babies in the prone sleep position and bed-sharing is still occurring.  While the safe sleep messages were well received by many, there are still segments of society that are not being reached, particularly mothers who are Black, young, poor, residents of a southern or mid-Atlantic state, or who have more than one child. 

Parental practices regarding infant sleep position are strongly influenced by three factors: (1) their observation of the sleep position of their infant in the hospital; (2) perceived infant preference; and (3) advice from healthcare professionals (Aris et al, 2006; Colson et al, 2001; Vernacchio et al, 2003; Brenner et al, 1998).  In addition to advocating supine sleep position, there are other safe sleep practices supported by the AAP (Table 1).  Teaching parents about safe sleep practices begins with healthcare professionals modeling safe sleep behaviors in the hospital (Aris et al, 2006). 

Hospital nurses can play critical roles in influencing and encouraging the infant safe sleep environment in the hospital and in the home.  Nursing literature is acknowledging the impact of nursing’s influence on parental knowledge and behaviors and are finding that infants are more likely to be placed in the supine position for sleep when the healthcare professional recommended the position and the parent was able to observe the behavior.

Survey Results

In 2008, DWIH (Division of Women’s and Infants’ Health) conducted a survey to examine the hospital policies regarding infant sleep environment across the Commonwealth of Virginia as well as to assess patient and staff educational activities.  Below is a summary of the survey’s findings:

• Of the 61 hospitals delivering newborn infants during the year 2008 in Virginia, 51 (84 percent) participated in the study.  These 51 hospitals accounted for approximately 85 percent of the live births in Virginia. 
• About half of hospital units reported having written policy on supine sleep position among infants less than one year of age. 
• One-quarter of hospital units reported having written policy regarding co-sleeping. 
• More than 80 percent of hospital units reported not having a nursing competency to promote safe sleep practices. 
• Approximately 60 percent of the hospital units reported not having staff attend an in-service on safe sleep policies and procedures.
• The most common methods of communication were
written materials,
verbal discharge instructions, and
the educational television channel in the patient’s room.
• The most common safe sleep messages were
back to sleep,
not overheating the infant,
using no buffed pads and stuffed animals in the crib, and
not smoking around the infant. 
• Almost all (97 percent) of the birthing hospitals reported screening for tobacco use among pregnant and delivering women.  However, only 45 percent of birthing hospitals reported screening for tobacco use in the place of residence of the infant. 

Sign Up  

In 2009, sponsored by the CJ Foundation, the DWIH will partner with First Candle SIDS Alliance to provide train-the-trainer workshops to nurse managers on how to develop hospital-based policy regarding safe sleep environment and how to model safe sleep practices for parents.  There will be 5 training dates and locations across the state.  Click Here to sign up your hospital for this free, 2-hour training. 

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