Prevent Child Deaths in Hot Cars

A child left in a hot car can die of heat stroke very quickly. But this tragedy can be prevented.

Facts about Child Heat Stroke in Cars

Here are some facts about hot cars and keeping kids safe:

  • Heat stroke is the leading cause of non-crash, vehicle-related deaths in children under 15.
  • Heat stroke can happen when the body is not able to cool itself quickly enough.
  • A child’s body heats up three to five times faster than an adult’s does.
    • When left in a hot car, a child’s major organs begin to shut down when his temperature reaches 104 degrees Fahrenheit (F).
    • A child can die when his temperature reaches 107 degrees F.
  • Cars heat up quickly! In just 10 minutes, a car can heat up 20 degrees F.
  • Cracking a window and/or air conditioning does little to keep it cool once the car is turned off.
  • Heat stroke can happen when the outside temperature is as low as 57 degrees F.
  • Because of climate change, we can expect more days to be hotter. Also, hotter days can happen throughout the year.

Set Reminders!

Any parent or caregiver, even a very loving and attentive one, can forget a child is in the back seat. Being especially busy or distracted or having a change from the usual routine increases the risk.

Here are some things you can do to prevent the unthinkable from happening to your child:

  • Always check the back seat and make sure all children are out of the car before locking it and walking away.
  • Avoid distractions while driving, especially cell phone use.
  • Be extra alert when there is a change in your routine, like when someone else is driving your child or you take a different route to work or child care.
  • Have your child care provider call if your child is more than 10 minutes late.
  • Put your cell phone, bag, or purse in the back seat, so you check the back seat when you arrive at your destination.
  • If someone else is driving your child, always check to make sure he has arrived safely.

Lock Your Car!

Keep your car locked when it is parked to prevent a curious child from entering when no one is around. Many hot car deaths have occurred when a child mistakenly locks himself inside.

Here are some reminders for parents and caregivers:

  • Make sure children do not have easy access to your car keys. Store them out of a child’s reach.
  • Teach children that cars are not safe places to play.
  • Keep rear fold-down seats closed to prevent a child from crawling into the trunk from inside the car.
  • Remind children that cars, especially car trunks, should not be used for games like hide-and-seek.

Important Tip: If a child is missing, always check the pool first, and then the car, including the trunk!

Take Action if You See a Child Alone in a Car!

Protecting children is everyone’s business! If you see an unattended child in a car and are concerned, you should immediately call 911.

If the child is not responsive or is in pain, immediately:

  • Call 911.
  • Get the child out of the car.
  • Spray the child with cool water (not in an ice bath).

If the child is responsive:

  • Stay with the child until help arrives.
  • Have someone else search for the driver or ask the facility to page them.

Article and image courtesy of and American Academy of Pediatrics

You’d Never Forget Your Child in the Car, Right?

Most of us think we’re incapable of making such a horrible mistake. So did the parents in this story.

It was Day 3 of a new routine for the Edwards family. Jodie, a professor and counselor at a private university in Cincinnati, had spent the summer of 2008 working two days a week and taking care of her two children: her then 3-year-old son and her 11-month-old daughter, Jenna. On the days Edwards worked, both children stayed with a babysitter near her office.

Now it was August and classes were beginning for Edwards, and preschool was starting for her son. Jenna would be with the babysitter Monday through Friday. “I could walk over and see Jenna, nurse her, and bring her back to my office when I wasn’t teaching,” Edwards says.

On Wednesday, August 20, she drove her minivan to her son’s Montessori school and took both children inside. “He was really worried about being in a new building, so we went in and stayed with him for 20 minutes, playing and helping him feel comfortable,” she recalls.

That was the last time the three of them ever played together. Edwards brought Jenna back to the van and strapped her into her rear-facing car seat. “I was talking and singing to her,” she recalls. “Five minutes into the drive Jenna started to sing in this little voice she uses when she’s sleepy. I had a child-safety mirror, and when I looked in it I could see that she was going to fall asleep.” Edwards thought about how much she wanted Jenna to stay asleep and finish her morning nap once she got to the babysitter’s. “In a very detailed way, I visualized getting there, walking around to the backseat door, unbuckling her straps, getting her out very gingerly, and covering her ears so the babysitter’s door wouldn’t wake her. I pictured myself saying to the babysitter, ‘Jenna’s sleeping. Can I lay her in the crib?'”

For the next 15 minutes, Edwards drove toward the babysitter’s. But instead of driving past her workplace and traveling another half block to the sitter’s house on the next street, she pulled into her office parking lot. “I parked my car,” she recalls. “My bags were in the front seat. I walked around and I got them out, and I went in to work” — leaving Jenna in the car on a 92°F day for the next seven hours.

Death Traps

Tragically, Jenna did not survive. She was one of 43 children who died unattended in a hot car that year. The same number of children also died that way in 2013, and since 1998, the number has ranged from 29 to 49 deaths each year. Roughly 20 percent were left in a car by a parent who, for instance, thought she’d run a “quick” errand and came out to find her child dead. Close to 30 percent entered a car without their parents’ realizing it and couldn’t get out. But 52 percent were left in the car accidentally. And more than half were under 2 years old.

A child is at greater risk than an adult in a hot car. That’s because a small body heats up three to five times faster than an adult’s would in the same circumstance. “The internal cooling system — sweating — isn’t as effective in kids as it is in adults because an adult has more skin through which sweat can evaporate to cool the body,” explains Kate Carr, CEO of Safe Kids Worldwide, a global organization devoted to preventing childhood injury.

When cooling doesn’t take place quickly enough, a child’s body temperature can rapidly rise to a dangerous level. If it reaches 104°F, major organs may begin to shut down. When it reaches 107°F, death from heatstroke is imminent. This can happen faster than most people think. Even on a mild, 70°F day, the inside of a car can become very hot within minutes, says Carr. “Deaths from heatstroke in cars have occurred 11 months of the year in nearly every state in the country.”

Every Parent’s Nightmare

For mothers and fathers who have unintentionally left their child in a car, the aftermath couldn’t be much worse: First and foremost, their child died. Second, they caused it. And third, the tragedy was completely preventable.

When Jodie Edwards realized what had happened to Jenna, she collapsed next to her minivan. “I had to lie on the ground,” she recalls. “I couldn’t even sit up.” Emergency workers and police had arrived, news helicopters were on their way, and her baby was dead.

But before Edwards collapsed, all she felt was confusion. She’d left her office at 4 P.M., eager to pick up Jenna — whose new photo she’d pinned to her bulletin board that day — from the sitter’s and her son from preschool. “I put my car in reverse. As I was backing out, I looked in my rear-view mirror and I saw her.” She stopped the car, ran around to the backseat while dialing 911, opened the door — and knew that Jenna was dead.

“I couldn’t figure out how she’d gotten there,” she says, because she was so sure she’d dropped her off with the babysitter. She’d carried her phone everywhere that day, in case the sitter needed to reach her. “I thought, ‘Who put Jenna in here?’ and I even looked to see whether someone had put my boy in there too.”

Frantic, she replayed the morning in her mind, and when she got to the part about asking the babysitter whether she could lay Jenna down so she wouldn’t wake up, she realized she hadn’t taken her. She began screaming, “No, no, no!”

In the chaos of the moment, before the police took Edwards away for questioning, there was one phone call she needed to make. “I had to tell my husband what had happened,” she says. “Remembering that will break my heart forever.”

How Tragedy Strikes

Whenever a case like this hits the media — and it always does — the public response is the same: How could a parent leave her child in a hot car? In most instances the child had fallen asleep, so there was no sound to remind the parent to take him out. And if a baby was in a rear-facing car seat in the backseat, there was also no visual cue: The baby’s head might not have been visible over the top of the seat.

This is a relatively new problem. Prior to the early 1990s, children were routinely placed in the front seat, where it was obvious that they were in the car. In fact, from 1990 to 1992 there were only 11 known deaths of children from heatstroke after being left in a car. After that, car seats were moved to the back. This is when airbags became common and kids riding in the front seat were being killed by them — 63 in 1995 alone. Not a single child has died due to an airbag since 2003, but at least 110 kids died of heatstroke from 2011 to 2013 — a tenfold increase over the prior decade. So although kids are safer in cars in one way, they are more at risk in another.

But that isn’t the only factor in heatstroke deaths, and safety experts stress that the backseat remains the safest place for children. Another major contributor, one that’s more difficult to comprehend, relates to the brain. “These are not negligent parents who have forgotten their kids,” says David Diamond, Ph.D., a neuroscientist in the psychology department at the University of South Florida, in Tampa, who has reviewed the details of many hot-car deaths and has spent time with dozens of parents who unintentionally left their child in the car.

Understanding what they did, he says, requires grasping how two very different parts of the brain work. There are the basal ganglia — the “background system” that controls our habits. “It allows us to do things without thinking about them,” Dr. Diamond says. When you’re training in sports, for example, you repeat an action over and over to fine-tune your skills. Once it’s time to compete, the action is automatic. “Your basal ganglia take over and you don’t have to think about how to bounce or shoot the ball.”

Then there are the parts of the brain that control new information: the prefrontal cortex and hippocampus. The basal ganglia and prefrontal cortex essentially compete with each other, Dr. Diamond says. When you change up your routine and do something different, then the new details have to be processed by the hippocampus and prefrontal cortex to override the basal ganglia’s strong desire to perform actions out of habit.

The basal ganglia play a big part in driving. “Once you’ve driven from Point A to Point B enough times, you can do it without thinking,” Dr. Diamond says. “You might not even remember the trip.” If new information enters the picture (say, your partner calls to ask you to stop at the store and buy milk), your prefrontal cortex and hippocampus have to kick into gear to incorporate it. “But it’s common to drive right past the store and come home. When your partner says, ‘Where’s the milk?’ you feel flustered because you remember the conversation, but for some reason you came home instead.” Why? Because you were on autopilot. “The basal ganglia actually suppress the prefrontal cortex and hippocampus from bringing that memory to your consciousness,” explains Dr. Diamond.

Stress worsens this phenomenon, he adds. “It affects how our prefrontal cortex functions and makes it more likely we’ll do something out of habit.” And those factors, ultimately, are what allow otherwise responsible parents to leave their child in a car. In every hot-car death Dr. Diamond has studied, something was different about the routine that day. Jodie Edwards had to make two stops instead of her usual one. In other cases, Dad drove the baby instead of Mom or there was some other extra stress. And the basal ganglia won control.

One Wrong Turn

It’s one thing to forget a gallon of milk and quite another to forget a child? … isn’t it? Dr. Diamond has been challenged in this way many times. “As a parent I sympathize with that view,” he says. “But as a scientist I can tell you that the basal ganglia can suppress all kinds of memories, even of things that are the most important to us.”

Brett Cavaliero, a 45-year-old father from Austin, Texas, lived this firsthand. On May 25, 2011, ten days after his daughter Sophia’s first birthday, he and his wife, Kristie, dressed her in a bright, flowery dress that had been a gift from one of her child-care teachers. He strapped her into her car seat in the backseat of his truck and started driving. He was running late, he had work on his mind, and Sophia was sleeping. “I drove down this giant hill, and at the bottom of the hill I would ordinarily make a left-hand turn, drop her off, and circle back to go to work,” he says. But that day he didn’t. “When I came to that traffic light, I made a right-hand turn and kept driving to work. Sophia was sleeping in the back. My mind went on autopilot and I drove to work.”

When he arrived, some of his colleagues were talking in the parking lot. He joined in and walked with them into the building, leaving Sophia in the truck. No one saw her through the tinted windows designed to keep cars cooler in the Texas sun.

Three hours later, Kristie came to her husband’s office to pick him up for a quick lunch. “We were driving down the road in my wife’s car, and we were talking about how beautiful Sophia looked that day in her flowery dress,” he recalls. “Suddenly shock came over me and I said, ‘I don’t remember what her teacher said about her wearing the dress she got her.'” And then it hit him: He couldn’t recall dropping her off. “I said, ‘Just drive back to my office as fast as you can.’ I could barely get the words out, but she understood and she called the child-care center to find out if Sophia was there. They said no, she never came in.” Kristie called 911 while Brett frantically called a coworker to ask her to see whether Sophia was in his truck.

An hour and 19 minutes later — after the Cavalieros had arrived on the scene to find Brett’s colleagues performing CPR and after an ambulance had taken the baby to the hospital — Sophia was pronounced dead.

To this day, Brett isn’t certain what made him turn right instead of left at that traffic light. He’s not sure whether he would have remembered his daughter if his coworkers hadn’t been in the parking lot. He does know one thing: “I made a terrible mistake,” he says. “I remember screaming on the ground begging God to take my life, not hers. I would’ve done anything in the whole world to save her.”

A Brutal Backlash

For parents whose children die, there is crushing grief and guilt. Sometimes, there are also serious legal repercussions. In 49 percent of all hot-car deaths, charges were filed against the adults who left the child in the car; 81 percent of those cases resulted in a conviction.

There is also, unfailingly, judgment and blame from the media, friends, neighbors, and perfect strangers. When Parents published a short article on this topic online last August, many mothers posted outraged comments, such as these: “Irresponsible people trying to make excuses!” “People who do forget [their kids] should get their priorities straight.” “Ummm, here is the deal. DON’T FORGET YOUR KID IN THE FREAKING CAR! There is no good excuse for being a bad parent!” And even this: “I am suspicious that these parents might have committed this crime as an easy way to lose unwanted children.”

Beneath this harsh judgment is a desire for self-protection, explains Janet Brown Lobel, Ph.D., a clinical psychologist in New York City and Pleasantville, New York. “The idea of forgetting a child in a car is such a horrifying prospect for parents that the only way they can deal with it is to make themselves feel as different as possible from the parent who did this,” she says. “That parent becomes a neglectful parent with whom you have nothing in common. Therefore, you don’t have to think about this tragedy because it could never happen to you.”

Janette Fennell, founder and president of, a national nonprofit focused on keeping children safe in and around vehicles, agrees: “People try to demonize these parents. The logic goes: ‘These people are monsters. I’m not a monster, so it won’t happen to me,’ and that is the biggest mistake anyone can make.”

A month before Jenna was born, Jodie Edwards saw a news story on TV about a baby who had died after being left in a hot car. Although she had checked out stacks of books from the library in preparation for motherhood and paid special attention to the chapters on safety, the heatstroke story didn’t worry her. “I didn’t think it was a safety issue I would be vulnerable to,” she says.

Nicolle Holmes-Gulick, a 33-year-old mother in Shoreline, Washington, was just as safety-conscious: “the kind of parent people relax around because I’m the one watching their kids like a hawk,” as she puts it. But one afternoon in August 2013, her house was more chaotic than usual. Her mother was there and her sister, with her two young children, had just arrived from out of town for a visit. Holmes-Gulick had to get her 13-year-old daughter to her first cheerleading practice of the season, and the clock was ticking. She’d been planning to leave her 21-month-old daughter, Presley, with her mother, but the toddler was fussy, so she wound up taking her too. “Two minutes after we started down the road, Presley fell asleep,” Holmes-Gulick recalls. “And when we got there my oldest said, ‘You have to come with me. It’s my first day.'”

So she got out of the car and walked to the park with her older daughter. “I talked to the coach and the other mothers,” she recalls. “Then one of my girlfriends asked me, ‘Where’s Presley?'” Horrified, Holmes-Gulick shouted, “Oh my God, I forgot my baby!” She ran to the car to find Presley sweaty and screaming. The little girl was fine — but Holmes-Gulick wasn’t. “I cried about 20 times that day,” she says. Presley was in the car for eight minutes on an 85°F day, and Holmes-Gulick knows what could have happened if her friend hadn’t said something. Being as cautious as she was, she never dreamed that could happen to her.

She’s also amazed by how many other parents have told her they’ve done something similar. “When I talk with my friends about it, everybody opens up,” she says. “People are insecure about their parenting and they aren’t going to say ‘I did that’ until someone else does. This happens to a lot more people than we think.”

The Aftermath

When Sophia Cavaliero died, her father was questioned by police. Charges were never filed against him, but that didn’t provide much solace. “I thought, ‘It doesn’t matter where you put me or what you do to me. I’ll live with this horror every single minute of every day and there’s nothing you can do to me that will be worse than this,'” says Cavaliero.

He never thought he would learn to manage his grief. But he’s getting there, with the help of his wife, who never blamed him, and supportive family and friends. He and Kristie are now the parents of 20-month-old twin girls.

Jodie Edwards wasn’t charged either, but that didn’t ease her grief in the least. “I have a sadness that will always be there. I just miss Jenna,” she says.

When she was waiting to be interviewed by the police, there was a part of her that wanted the ground to open up and swallow her. “I wanted to die,” she says, “but I couldn’t.” She had a 3-year-old son to take care of. “I refused to let his life be ruined by this, so I made a commitment right then to do whatever I could to be a healthy parent for him.” Her son is now 8 and has another sister and brother, ages 4 and 2 1/2 . “They’re all beautiful and happy. And they know about Jenna,” Edwards says.

“We have pictures of her all over the house,” she says. “We talk about her all the time and make sure she’s a part of every celebration in some way.” Every year on Jenna’s birthday, they do something they think she would have liked at the age she would’ve been. Two years ago they visited a butterfly garden; last year it was the zoo.

But Edwards believes that the greatest tribute she can make to her firstborn daughter is to do everything she can to raise awareness of how she died — and to help other parents understand that they could make the same mistake she did, even if they think it’s impossible. “I thought love would make me immune to such a tragedy,” she says. “But it didn’t.”

Article courtesy of

Interactive E-Handout for Safe Sleep Conversations

This interactive E-handout helps families learn about safe sleep practices. Health professionals can sit with families and click through the pages where they’ll find different sleep scenes and environments. A series of prompts and pop-ups show what is and is not safe and inspire learning conversations. Families can also access the handout at home and use it to teach their friends and families about safe sleep.

Courtesy of NICHQ

Every cigarette matters when you’re pregnant, a massive new study confirms

Smoking even one a day increases risk of SIDS twofold.

Since the 1990s, rates of sudden infant death syndrome (SIDS) have halved. Parents were widely encouraged to put their babies to bed on their backs and to clear cribs of potentially suffocating materials, and the efforts worked. But as those accidental deaths dropped out of the statistics, another factor became increasingly important: smoking.

Several studies in the intervening years have concluded that smoking is the biggest preventable risk factor for SIDS. Many of these studies have quantified how much more likely a baby is to die of SIDS if their parent smoked while pregnant—it ranges from roughly 1.5- to 6.5-fold higher—but they mostly look across broad groups. Nine months is a long time. Could quitting halfway through help, or is the damage already done in the first trimester? Researchers at the Seattle Children’s Research Institute decided to look in more detail, and recently published their results in the journal Pediatrics.

In looking at more than 12 million births between 2007 and 2011, the researchers found that every cigarette mattered. The difference between not smoking at all and smoking one a day was a twofold increase in SIDS risk, and every cigarette after that added another 0.07 to that risk. (Though it’s important to note that the overall risk of SIDS is low, at just 0.83 per 1,000 live births, so even a doubled risk is less than 2 in 1,000). Those who smoked all the way through—about nine percent of the study subjects—had offspring with a 2.52-fold higher risk of SIDS. Half of those patients didn’t reduce their smoking at all, but those who did helped their baby with each cigarette they avoided. People who were able to smoke less by the third trimester could decrease their risk elevation by 12 percent, while quitting entirely in that period resulted in a 23 percent risk reduction.

The curve plateaued after 20 cigarettes a day, so people who smoke more than a pack daily aren’t seeing a huge benefit if they merely get themselves down to a pack. People who smoke less than one pack per day are the ones most likely to see a significant change in SIDS risk by reducing their habit.

Researchers still aren’t entirely sure how smoking increases SIDS risk. The study notes that evidence so far points to changes in serotonin and other neurotransmitters in the brainstem of a growing fetus, which smoking has been linked to. Nicotine seems to influence serotonin release in animal studies, supporting that claim. But even without a solid mechanism, this study and others show that smoking is a huge risk factor for SIDS. These researchers estimate that 22 percent of all SIDS cases could be caused by smoking during pregnancy. It’s impossible to prove that without knowing the mechanism behind those deaths, but that figure represents 800 infant mortalities a year.

Although the number of women who smoke before getting pregnant is low, at just 11.6 percent in the U.S., three-quarters of them continue to smoke during pregnancy. And unfortunately, even those in the recent study who quit smoking before getting pregnant had a 1.47-times higher risk of their baby developing SIDS than did subjects who never smoked. One study estimated a similar rise in risk simply from inhaling smoke secondhand. In fact, the Centers for Disease Control notes that inhaling any tobacco smoke makes offspring more likely to weigh less at birth, to have ear infections, and to have more frequent asthma attacks.

Pregnant people tend to get a lot of grief for indulging in habits that are unhealthy for all of us, which is far from fair. But babies aside, smoking puts you at much higher risk of heart disease, stroke, chronic obstructive pulmonary disease, and at least a dozen types of cancer—if no one smoked in America, one in three cancer deaths wouldn’t happen. You have plenty of reasons to quit smoking that have nothing to do with the health of any hypothetical children you might carry one day. But if you’re pregnant or trying to become pregnant and need some motivation, know that any effort you can make to cut down on your habit could pay off.

Article and image courtesy of Popular Science

Better Sleep for Breastfeeding Mothers, Safer Sleep for Babies

When a mother breastfeeds, she releases oxytocin, a hormone that soothes her anxieties and helps her feel a unique emotional connection to her newborn baby. Oxytocin, also known as “the love hormone,” packs a powerful punch that, while supporting healthy breastfeeding, has one potentially dangerous side-effect: it can make moms tired.

“New mothers are sleep-deprived and understandably stressed,” says Michael Goodstein, MD, a neonatologist and safe sleep and breastfeeding expert. “Add to that a state of hormone-induced calm and it’s not surprising that mothers struggle to stay awake while breastfeeding. Falling asleep is the natural inclination.”

This inclination can become dangerous because it can result in accidental co-sleeping, a risk factor for sleep-related infant deaths. Acknowledging this risk alongside the significant health benefits breastfeeding brings moms and babies begs an all too common question for maternal health professionals: How do you realistically support tired and overwhelmed mothers to breastfeed safely?

Goodstein is a faculty expert on the NICHQ-led National Action Partnership to Promote Safe Sleep Improvement and Innovation Network (NAPPSS-IIN), which aims to make safe sleep and breastfeeding the national norm. He says designating time to talk to mothers about their own sleep habits can help.

“We can’t change mothers’ natural response to breastfeeding,” says Goodstein, “and we wouldn’t want to—oxytocin is incredibly valuable for mother-child bonding. But we can do a better job of helping mothers manage their stress and their sleep habits during those early months. And in doing so, we can reduce unsafe environments.”

Interested in learning more about infant health, bedsharing and breastfeeding? Click here for a recent NICHQ article.
Below, NICHQ’s NAPPSS-IIN team has identified three opportunities for health professionals to put Goodstein’s advice into practice, and better support healthy sleep habits for both moms and babies.

Advise self-care

Mothers are often told to “sleep when the baby sleeps.” This makes sense in theory, but in practice can be a difficult behavior to adopt. Mothers may need to use naptime to take care of other tasks; and they may have difficulty falling asleep on command. In both cases, mothers are left even more stressed and tired, and at a higher risk of accidentally falling asleep while breastfeeding.

“Along with advising mothers to find time to sleep, we need to specifically talk to them about the importance of self-care,” says Goodstein. “Chronic stress can exacerbate sleep loss, which then becomes a health risk for both moms and babies.”

Goodstein recommends discussing alternative opportunities to help mothers recharge, such as taking a walk outside while baby sleeps in a carrier or stroller, exercising at home or reading a book while baby naps. These activities can give mothers a mental and physical break that can be just as valuable as a couple hours of sleep.

Identify each mother’s support network

Having a new baby doesn’t keep other obligations at bay for long. New moms are often left balancing the needs of their families, their jobs and their homes, which can make for a seemingly endless day when you add in regular breastfeeding.

“Talk with mothers about who is going to support them during those early months,” advises Goodstein. “This may be a significant other, but help comes in multiple forms—friends, immediate and extended family, and support groups are all important resources that new moms can tap. By reviewing these options with mothers, we can help proactively alleviate some of the stress they’re bound to feel.”

Having someone help with daily tasks—even seemingly small responsibilities, like doing a load of laundry or washing the dishes—gives mothers precious time to sleep and engage in those activities that help them emotionally recharge.

Discuss strategies for helping fussy babies sleep

Does my baby feel safe? Is she hungry? Is she wet? These three questions can help mothers and caregivers address the most common reasons for crying babies. But once these issues have been resolved, moms are often left wondering what else they can do.

“We need to do a better job of helping moms and caregivers prepare for fussy babies,” says Goodstein. “By teaching families about successful soothing techniques, we can help both mom and baby feel happier and sleep better. Swinging motions that soothe babies, checking whether the baby might have been overstimulated by the environment, playing white noise and finding a change of scenery are all helpful strategies that care teams can discuss with families and help them go home feeling prepared.”

During these conversations, Goodstein also recommends making time to highlight pacifiers. Since non-nutritive sucking is soothing for babies, pacifiers can be used to calm them between feedings, after the first few weeks of life once breastfeeding, and breastmilk volume is established. Moreover, pacifier-use is known to significantly reduce the risk of SIDS. Remember though, Goodstein cautions, breastfeeding should be well-established before families introduce pacifiers.

Ultimately, Goodstein’s examples reaffirm the need to improve conversations with mothers about breastfeeding and safe sleep, conversations that address individual circumstances and set goals for breastfeeding. Telling mothers, ‘breastfeed but don’t bed-share’ isn’t enough; instead, it’s more effective to work to understand what circumstances might make this difficult—such as sleep deprivation—and then develop plans of care that account for those barriers and reduce risks for sudden unexpected infant deaths.

Article and image courtesy of NICHQ

How Safe Sleep Savvy Are You?

A teaching tool for reducing infant sleep related deaths.

This short video quiz can be used by health professionals to engage caregivers in conversations about safe sleep recommendations. It provides eight different examples of sleeping infants and asks viewers to identify whether or not the depicted behavior is safe. An explanation and recommendation is provided after each scenario.

Physicians, nurses, home visitors and other public health professionals can use the quiz as an interactive, visual tool to prompt discussions around best-practices.

Take the quiz to find out!

Back to Sleep, Tummy to Play

What are the 2 most important things to remember about safe sleep practices?

  • Healthy babies are safest when sleeping on their backs at nighttime and during naps. Side sleeping is not as safe as back sleeping and is not advised.
  • Tummy time is for babies who are awake and being watched. Your baby needs this to develop strong muscles.

Remember…Back to Sleep, Tummy to Play!

How much tummy time should an infant have?

Beginning on his first day home from the hospital or in your family child care home or center, play and interact with the baby while he is awake and on the tummy 2 to 3 times each day for a short period of time (3-5 minutes), increasing the amount of time as the baby shows he enjoys the activity. A great time to do this is following a diaper change or when the baby wakes up from a nap.

Tummy time prepares babies for the time when they will be able to slide on their bellies and crawl. As babies grow older and stronger they will need more time on their tummies to build their own strength.

What if the baby does not like being on her tummy?

Some babies may not like the tummy time position at first. Place yourself or a toy in reach for her to play with. Eventually your baby will enjoy tummy time and begin to enjoy play in this position.

Doesn’t sleeping on her back cause the baby to have a flat head?

Parents and caregivers often worry about the baby developing a flat spot on the back of the head because of sleeping on the back. Though it is possible for a baby to develop a flat spot on the head, it usually rounds out as they grow older and sit up.

There are ways to reduce the risk of the baby developing a flat spot:

  • Alternate which end of the crib you place the baby’s feet. This will cause her to naturally turn toward light or objects in different positions, which will lessen the pressure on one particular spot on her head.
  • When the baby is awake, vary her position. Limit time spent in freestanding swings, bouncy chairs, and car seats. These items all put added pressure on the back of the baby’s head.
  • Spend time holding the baby in your arms as well as watching her play on the floor, both on her tummy and on her back.
  • A breastfed baby would normally change breasts during feeding; if the baby is bottle fed, switch the side that she feeds on during feeding.

How can I exercise the baby while he is on his tummy?

There are lots of ways to play with the baby while they are on their tummy.

  • Place yourself or a toy just out of the baby’s reach during playtime to get them to reach for you or the toy.
  • Place toys in a circle around the baby. Reaching to different points in the circle will allow them to develop the appropriate muscles to roll over, scoot on their belly, and crawl.
  • Lie on your back and place the baby on your chest. The baby will lift their head and use their arms to try to see your face.
  • While keeping watch, have a young child play with the baby while on their tummy. Young children can get down on the floor easily. They generally have energy for playing with babies, may really enjoy their role as the “big kid,” and are likely to have fun themselves.

Back to sleep and tummy to play

Follow these easy steps to create a safe sleep environment in your home, family child care home, or child care center:

  • Always place babies on their backs to sleep, even for short naps.
  • Place babies on a firm sleep surface that meets current safety standards. For more information about crib safety standards, visit the Consumer Product Safety Commission Web site.
  • Keep soft objects, loose bedding, or any objects that could increase the risk of entrapment, suffocation, or strangulation from the baby’s sleep area.
  • Make sure the baby’s head and face remain uncovered during sleep.
  • Place the baby in a smoke-free environment.
  • Do not let babies get too hot. Keep the room where babies sleep at a comfortable temperature. In general, dress babies in no more than one extra layer than you would wear. Babies may be too hot if they are sweating or if their chests feel hot. If you are worried that babies are cold, use a wearable blanket such as a sleeping sack or warm sleeper that is the right size for each baby. These are made to cover the body and not the head.
  • If you are working in a family child care home or center, create a written safe sleep policy to ensure that staff and families understand and practice back to sleep and sudden infant death syndrome (SIDS) and suffocation risk reduction practices in child care. If you are a parent with a child in out-of-home child care, advocate for the creation of a safe sleep policy.
The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.

Racial And Ethnic Disparities Persist In Sudden Infant Deaths

American Indian and Alaska Native families are much more likely to have an infant die suddenly and unexpectedly, and that risk has remained higher than in other ethnic groups since public health efforts were launched to prevent sudden infant death syndrome in the 1990s. African-American babies also face a higher risk, a study finds.

American Indians and Alaska Natives had a rate of 177.6 sudden unexplained infant deaths per 100,000 live births in 2013 (down from 237.5 per 100,000 in 1995) compared with 172.4 for non-Hispanic blacks (down from 203), 84.5 for non-Hispanic whites (down from 93), 49.3 for Hispanics (down from 62.7) and 28.3 for Asians and Pacific Islanders (down from 59.3). The declines were statistically significant only among non-Hispanic blacks, Hispanics and Asians/Pacific Islanders.

“There are still significant gaps and disparities between races and ethnicities,” says Lori Feldman-Winter, a professor of pediatrics at Cooper University Health Care in Camden, N.J., who wasn’t involved with this study but was a co-author of the most recent sleep guidelines from the American Academy of Pediatrics, released in the fall.

Overall rates of sudden unexpected infant death, which includes sudden infant death syndrome as well as accidental suffocation or strangulation in bed and other unexplained deaths, declined sharply in the five or so years after a national campaign was launched in 1994 to encourage caregivers to put babies to sleep on their backs. But the rates have not declined since 2000. Researchers at the Centers for Disease Control and Prevention wanted to know whether those changes were uniform across racial and ethnic groups.

“We had the overall picture, but no one had really taken a close look at what was happening within that,” says Sharyn Parks, an epidemiologist at the CDC and an author of the study, published Monday in Pediatrics.

The reasons behind those changes and why rates among American Indians/Alaskan Natives and African-Americans remain so much higher than those of non-Hispanic whites, Hispanics and Asians/Pacific Islanders aren’t known.

One important consideration is that the study didn’t control for socioeconomic or other factors, such as prenatal or postnatal exposure to alcohol or tobacco and breast-feeding patterns. So disparities or changes might be influenced by other factors besides race and ethnicity, such as the differences in the prevalence of prenatal care, says Parks.

It’s also not possible to determine whether the public health campaign on safe sleeping played a role in reducing death rates.

An editorial accompanying the study notes that while non-Hispanic black infants saw death rates decline significantly, separate research has shown that African-Americans are also less likely than other racial and ethnic groups to embrace the safe sleeping recommendations. That suggests something else may have helped drive the improvement in that group, says Richard Goldstein, an author of the editorial and a pediatrician at Dana-Farber Cancer Institute and Boston Children’s Hospital. He says it’s important to consider all the factors that might have helped improve survival, including advances in care for premature infants and a decline in the rate of women younger than 20 having babies. Both preemies and infants born to young mothers are at higher risk of sudden unexplained death.

Goldstein’s own research looks at whether an underlying vulnerability might account for some sudden unexplained infant deaths and possibly other infant deaths that occur soon before and after birth. For example, he and colleagues showed that sudden unexplained deaths in infancy and later in childhood were both associated with a brain abnormality usually seen in temporal lobe epilepsy. It’s not clear whether the abnormality caused the deaths, though.

Parks says research into potential biological factors, including brain abnormalities and genetic variations, is important. She also says it’s essential to do more research on the differences in sleeping behaviors, such as bed sharing, between ethnic and racial groups and how to change those behaviors.

“Something continues to hamper the ability to get the message out or for folks in different cultures to receive the message,” says Feldman-Winter.

Socioeconomic status can be a big factor, she says, noting that while the AAP recommends against bed sharing, some families may not be able to afford a crib.

“People should do whatever they can to reduce the risk,” says Goldstein.

Inflatable Beds: Dangerous For Infants, Attractive To Cash-Strapped Parents

Inflatable beds can be cheap, which is good news for consumers who want an alternative to pricey traditional mattresses. But their uneven, soft, impermeable surfaces are dangerous for babies, and can increase the risk of sudden infant death.

The dangers may be particularly acute for low-income families, a recent essay in the American Journal of Public Health argues.

Without knowing the dangers of putting babies to sleep on an inflatable surface, “people without a lot of disposable income may seek out an air mattress as a permanent alternative,” says Jennifer Doering, a public health researcher and nurse at the College of Nursing at the University of Wisconsin, Milwaukee and one of the authors of the paper. And, she notes, “infant death tends to affect racial and ethnic minorities more often than Caucasian populations.”

Doering specializes in research about product safety and infant sleep environments, and says she sees a multiple troubling trends around infants and air beds. Bedbug infestations in American cities have required people to dispose of traditional mattresses, and decreased the willingness of some charitable organizations to accept mattress donations, she writes.

Simultaneously, the inflatable bed industry has expanded.

“We’re starting to see people using them more full time as a sleep solution, rather than the mother-in-law just comes over,” says Matthew Whalen, the director of risk management for the company Intex, which he describes as the largest distributor of air mattresses in the world. In an search, eight of the top 10 results for “air mattress” were manufactured by Intex.

And, Whalen says, there is anecdotal evidence that suggests people with less income may be turning to inflatable beds more. “Air mattresses have gotten less expensive,” he explains. The cheapest inflatable mattresses on Amazon are around $20.

It all adds up, Doering says, to a potentially risky situation for young children.

Doering and a co-author report that 108 infants died in connection with sleeping on an air mattress between 2004 and 2015, according to data from 24 states, collected in the National Child Death Review Case Reporting System.

That number is relatively small compared to the total number of infants who die of accidental suffocation or strangulation in bed. In 2015, that number was about 900, according to the Centers for Disease Control and Prevention.

But the issue of air mattress-related infant death is enough of a concern that regulators looked into it. In 2014, the Consumer Product Safety Commission announced it had worked with the industry and child safety advocates on new safety labeling.

“We recommend that infants under the age of 15 months should not be put to sleep on an inflatable air mattress,” says CPSC Acting Chairman Ann Marie Buerkle.

Whalen and a colleague at Intex helped develop the safety labels, which are printed on the package and on the side of the air mattress.

Doering says the labels are a good start, but that protecting infants from inflatable beds requires more than safety labels. “You know, you buy it, you might look at it once, but are the rest of your family members going to look at it every time you blow it up? No, not necessarily,” she says.

She notes that many pediatricians don’t know to warn parents about the dangers of putting an infant to sleep on an air mattress, and that safe sleeping materials from the American Academy of Pediatrics do not warn parents specifically about the dangers of inflatable beds.

Similarly, there appears to be no prominent mention of inflatable mattresses in the website for the National Institute of Child Health and Human Development’s federal “Safe To Sleep” public education campaign, although the CPSC’s landing page for the campaign does include a link to a warning poster.

“It has to be multiple strategies,” says Doering. That includes health care professionals, position statements from organizations and sleep education brochures, she says, to get the message out in multiple ways.

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