Text Alternative: Healthy Native Babies Project: Safe Sleep Train-The-Trainer Module 1 of 6

To view the original video, please go to https://safetosleep.nichd.nih.gov/training/native-communities.

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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.
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Photo: Leah Henry-Tanner

Leah Henry-Tanner, BS
Nez Perce Tribe of Idaho

Photo: Geradine Simkins

Geradine Simkins
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Safe Sleep Train-The-Trainer

Training Location:
Yakama Nation Cultural Heritage Center
Toppenish, WA August 7, 2014
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Safe Sleep Train-The-Trainer


Photo of three women sitting at a table.
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What is Sudden Unexpected Infant Death (SUID)?
  • SUID refers to infant deaths that occur suddenly and unexpectedly.
(Here, and in the following sections, the camera cuts back and forth between Leah Henry-Tanner and the slides.)
Leah Henry-Tanner: What is unexpected infant death–SUID? You'll see these terms referred to quite often, so it's helpful to get to know what SUID is, as versus SIDS. SUID is sudden unexpected death. So, it's when a baby dies unexpectedly.

SUID = All Unexpected Deaths

SUID includes both explained and unexplained infant death.
  • Explained
    • Poisoning
    • Head injury
    • Metabolic disorders
    • Neglect or homicide
    • Hypo or hyperthermia
    • Accidental suffocation
  • Unexplained
    • SIDS
    • Cause unknown or unspecified, for example: Cannot rule out suffocation from unsafe sleep environment
Leah Henry-Tanner: SUID covers all unexpected infant deaths, the explained and unexplained.

Explained infant deaths would be something like poisoning, or any kind of injury, a metabolic disorder, neglect or homicide, hypo- or hyperthermia, or accidental suffocation. Those can all be explained by a medical examiner or a coroner.

Unexplained infant deaths are deaths like SIDS (sudden infant death syndrome), or causes unknown or unspecified, like for example, cannot rule out suffocation from an unsafe sleep environment. We'll have some activities that will go over what an unsafe sleep environment would be, but it's something like soft bedding, or a lot of materials in the baby's sleep area, or toys, and stuff like that.

Types of SUID

Circular graphic with SUID in the center.  Surrounding circles for SIDS, Accidental suffocation, Unknown, Poisoning, Metabolic disorders, Hypothermia/Hyperthermia, and Neglect or homicide.

Source: CDC
September 2008
Leah Henry-Tanner: This is just another way of looking at the different types of sudden unexpected infant death. So, this is the overarching umbrella, and then all the different unexpected ways babies can die. And so many of deaths get classified as unknown, which is really challenging to try to figure out what you can do to prevent those.

Incidence of SUID
  • Approximately 4,200 infants die of sleep-related SUID.
  • One-half of these deaths are categorized as SIDS.
Source: Centers for Disease Control and Prevention (CDC), SUID and SIDS, September 4, 2012 - Website: http://www.cdc.gov/sids/
Leah Henry-Tanner:  Approximately 4,200 babies die of sleep-related, sudden unexpected infant deaths, and about half of those sudden unexpected infant deaths are categorized as SIDS.

Other Sleep-Related Infant Death Terms
  • Sleep Accidents
  • Accidental Strangulation
  • Accidental Suffocation
  • Overlay
  • Wedging or Entrapment
Leah Henry-Tanner: Other death terms are like sleep accidents, such as accidental strangulation, accidental suffocation, overlay (which is when a parent or whoever's sleeping–sharing a bed–with the baby accidentally rolls over on the baby), and then wedging or entrapment. So, like baby is sleeping on an adult surface and then gets trapped between the bed and the wall.
(Camera cuts to Geradine Simkins.) Geradine Simkins: One of the things we're finding out is that different communities are using different terms. Sometimes the term “sudden infant death syndrome” does not resonate with people, and people say: “My baby doesn't have a syndrome,”“My baby is healthy,” "There's nothing wrong with my baby.”

For example, like in Michigan, the Michigan Healthy Start Project–the tribes involved in the Michigan Healthy Start Project–decided to use the term "accidental infant death." That term was clear. It resonated with people–accident, infant, death. Some of these other terms, e.g., strangulation, suffocation, and sudden infant death syndrome, didn't speak to the people as much as "accidental infant death," and that's the term they're using.

What is SIDS?

SIDS is the sudden death of an infant younger than 1 year of age that remains unexplained after a thorough case investigation, including:
  • Performance of a complete autopsy;
  • Examination of the death scene; and
  • Review of the clinical history of the infant.
Source: Willinger M, James LS, & Catz C. Pediatric Pathology, 1991.

(Here, and in the following sections, the camera cuts back and forth between Leah Henry-Tanner and the slides.)
Leah Henry-Tanner: Now, we'll really delve into what SIDS is. SIDS is the sudden death of an infant that's younger than one year old that remains unexplained after a thorough case investigation that includes a complete autopsy, an examination of the death scene, and then a review of the clinical history of the infant. And so, as Gera said earlier, SIDS is a catch-all category. So, if the medical examiner or coroner can't really determine if it was an accidental suffocation or entrapment or something like that, they'll just lump it into SIDS. But only after all of these steps have been undertaken.

Incidence of SIDS
  • 2,226 infants died from SIDS in the United States in 2009.
  • SIDS rates are declining in the United States, but disparities still exist among certain populations.
Source: CDC. Infant Mortality Statistics from the 2009 Period Linked Birth/Infant Death Data Set. National Vital Statistics Report; 61(7)
Leah Henry-Tanner: About 2,226 babies died from SIDS in the U.S. in 2009. SIDS rates are declining in the U.S., but there are still disparities that exist among certain communities. There's still so much that we need to do to reduce the risk of SIDS, because we want every baby to have a chance to grow up and be successful members of our community.

SIDS is….
  • The leading cause of infant death between 1 month and 1 year of age
  • A sudden, silent medical disorder
  • Determined after autopsy, exam of death scene, and review of medical records
  • 2 times to 4 times more likely to occur in AI/AN babies
Leah Henry-Tanner: SIDS is the leading cause of infant death between 1 month and 1 year of age. It's a sudden, silent medical disorder. It's only determined after an autopsy, examination of the death scene, and a review of the medical records; and it's 2 to 4 times more likely to occur in American Indian and Alaska Native families. Since we don't know the cause, we can't prevent SIDS, but we do know risk factors. So, what we can do is reduce the risk of SIDS.

  • Preventable, but risks can be reduced
  • Caused by suffocation
  • Caused by diphtheria, pertussis and tetanus (DPT) vaccine, or other shots or vaccines
Leah Henry-Tanner: SIDS is not preventable, like I just mentioned, but risks can be reduced. It's not caused by suffocation, and it's not caused by vaccines.

  • Contagious
  • Result of child abuse or neglect
  • Caused by cribs
  • Caused by choking or vomiting
  • The cause of every unexpected infant death
Leah Henry-Tanner: SIDS is not contagious. It's not the result of child abuse or neglect. It's not caused by cribs. It's not caused by choking or vomiting. And, it's not the cause of every unexplained infant death–or unexpected infant death.

Proportion of Infant Deaths Due to SIDS

Chart showing AI/AN Rates for Urban Indian Health Organization Counties 1997-2003*

*Data for counties with greater than 250,000 total population only.

The chart shows, per 1,000 live births, approximately 1.4 deaths for “AI/AN” and 0.58 deaths for “All Races.”

Source: National Center for Health Statistics, CDC; prepared by the Urban Indian Health Institute.
Leah Henry-Tanner: This is just another data slide showing the proportion of deaths due to SIDS in urban Indian communities. So, you can see it's statistically significantly higher than it is for all other races. We have to have data to tell our stories because that's what funders are requiring. But, you can see it's not even .6 for all other races, but for American Indian/Alaska Native families it's almost 1.4.

AI/AN SIDS Rates from 2002-2004

Chart showing AI/AN SIDS rates from 2002-2004 for the IHS Areas per 1,000 live births:

Aberdeen - ~2.0
Alaska - ~1.55
Bemidji - ~1.7
Billings - ~2.0
Portland - ~1.6
All IHS Areas - ~1.2
US All Races 2003 - ~0.55

Source: National Center for Health Statistics, CDC; prepared by the Indian Health Service (IHS) Office of Program Statistics
Leah Henry-Tanner: This is broken down–SIDS rates broken down–by the northern tier area. And you see here is Portland, this is our area, and you can see here is U.S. all races. And, again there's a statistical significant difference.

What causes SIDS?
  • Biological Basis for SIDS:
    • Brainstem abnormalities
    • Genetic susceptibility
    • Affected infants may lack coordination of vital systems: breathing, blood pressure, temperature, reflexes, waking, and sleeping
  • But these alone aren’t likely to cause death.
Leah Henry-Tanner: As I mentioned earlier, there's been a lot of research going on into trying to figure out what causes SIDS. There was a study that came out 2 to 3 years ago that was looking at brainstem abnormalities and they published–I can't remember what journal they published in–but they had some really interesting findings that came out of that.

There's also some genetic susceptibility that people are looking at. They're also looking at things that might affect the infant's lack of coordination of the vital systems, such as breathing and blood pressure, temperature and reflexes, and then waking and sleeping. But, these alone aren't likely to cause SIDS. There's a whole lot of other factors that go into it.

What cause SIDS?

Graphic showing the Triple Risk Theory:
A Venn diagram shows three intersecting circles labeled "Critical Development Period," "Vulnerable Infant," and "Outside Stressor(s)." Where the circles intersect in the middle, it says "SIDS."

Adapted from Filiano & Kinney 1994.
(Camera cuts to Geradine Simkins.)
Geradine Simkins: Studies from researchers at Children's Hospital in Boston showed that the brains of babies who died of SIDS had abnormalities in the nerve cells that make serotonin. Now, that may or may not mean anything to you, depending on what you know about serotonin, but serotonin is a chemical messenger and a neurotransmitter. And, it works in the part of the brain that controls functions like breathing, body temperature, blood pressure, heart rate, and waking from sleep. I'm on page 26 if anybody wanted to look that up. So, this serotonin–when serotonin is missing, one of the things that may not happen is the baby's breathing may not be regulated well.

The person who made our prayer, what was your name? Linda? Linda was mentioning something about her grandson who didn't breathe–couldn't breathe during sleep–is that how it was? So, that's one of the things that they're finding out in terms of susceptibility is that some babies are born with some abnormalities–some brainstem abnormalities–where the normal mechanisms for breathing and temperature control aren't there.

What the Triple Risk Theory tells us is that there's a critical period where babies develop both fetally and when they're newborns. And during that time, for example, say we have a baby that has a lack of serotonin or a very diminished serotonin. So, this baby has a risk factor already, right? His brain or her brain does not tell her to breathe regularly so when she goes to sleep, she goes too deeply into sleep. Right? So, that's a critical development period.

Then you have some outside stressors. Say the mom smokes, or say the infant lives in an environment where there are smokers, and we have a lot of secondhand smoke. Say we have a mom who has been using alcohol her entire pregnancy. So we have some stressors.

Then we have a vulnerable infant. Say that infant lives in a household that is highly stressed–that it's unsafe, it's too cold or too hot. It has something in that environment that makes that infant more vulnerable.

These three things together: the fact that we have a critical development period where the baby's lacking something; the fact that we have outside stressors, usually behavioral things, such as smoking, drinking, that kind of stuff; then we have a vulnerable infant–poverty. Right? Those kinds of issues. Those three things together, that is one of the theories that causes SIDS. That to have this alone, or to have this alone, or to have this alone, may not make a baby at high enough risk to cause SIDS.

When you have infants that have these three things in place they're more likely to die of SIDS. For example, a baby like that, who the parents over-bundle and overheat, and has a brain stem issue where he or she doesn't wake up–that's a baby that's at higher risk. Then you have a smoker or somebody who gets into bed who is using alcohol and is rolling too close to the baby, perhaps smothering the baby. Those are the kinds of things–we have a compounding situation–is typically what we're finding out is what causes SIDS.

Safe Sleep Train-The-Trainer

This Concludes Module 1 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
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