Text Alternative: Healthy Native Babies Project: Safe Sleep Train-The-Trainer Module 4 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 ofChild 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 the SIDS Risk Continuum chart showing pictures of baby in different situations and where they would fall under “Reducing Risk” or “Increasing Risk.”
Leah Henry-Tanner: I think one thing to really, really be clear about is making sure that parents ...

Lowering SIDS Risk

Always reduce the other SIDS risks:
  • Always place baby on his or her back to sleep–for naps and at night.
  • Never place a baby to sleep or sleep with the baby on an armchair, couch, sofa or waterbed.
  • Remove soft items (pillows, toys, quilts, comforters, sheepskins) from the sleep area.
Leah Henry-Tanner: ... aren't sleeping with babies or putting babies on armchairs, or couches, or sofas, or water beds, because those surfaces are really soft. And so, it's really important to stress that. And then, also making sure that the sleep area is free of clutter, and pillows, and blankets, and any other things.

Lowering SIDS Risk

Reduce the other SIDS risks:
  • Do not cover the baby with adult bedding.
  • Do not sleep with baby if you have had alcohol, smoke tobacco, or take drugs or medicines that make you sleepy.
Leah Henry-Tanner: Then other ways we can reduce the risk is making sure that baby's not covered in adult bedding. And then also, if a mom chooses to sleep with a baby, make sure she knows that the risk goes up if she's had alcohol, smokes commercial tobacco, or takes drugs or over-the-counter medicines that could make her sleepy.
(Camera cuts to Geradine Simkins.)

Geradine Simkins raises her hand when she asks," Who's ever slept with their babies before?"
Geradine Simkins: When you take a poll in a room like this from Alaska down to Michigan and you ask, "Who's ever slept with their babies before?" OK. So what we understand, then, is this is the normal impulse for mothers, right? But we also, again, have to understand how do we risk–how do we rate the risks of sleeping with the baby versus not sleeping with the baby when we have risk factors.

And, that's part of what we're gonna do when we get to this risk continuum–this SIDS risk continuum exercise–is ask you to put on this chart, on the one end, "no risk," and on the other end, "big risk," and maybe in the middle the "neutral risk," and have a look at this situation. And, remember we talked about how risks compound. So, if you have one risk, it's like that. If you have two risks, it sort of jumps up. You have three risks, it's sort of an exponential jump–the more risks that you add.

So what we, in this project, do is say that the American Academy of Pediatrics said that the safest place for a baby is in the same room with the mother, near the mother. And we've talked about safe locations, and safe surfaces, and not having a lot of things around the baby, and not having blankets and all that. That is the safest place.

Now, if you have a mother who says, "I sleep with my babies." So, how are you going to counsel her and say, "OK, if you've been drinking, if you have a smoker in the house, if somebody is obese, if somebody is taking sleep medication–those are all things that will add to the risks of SIDS for your baby. You need to weigh those risks." You know, give people the information. If you have a cat in the bed, if you have the family bed where everybody sleeps, those are risks.

Lowering SIDS Risk

*Some health care providers in AI/AN communities suggest these actions might reduce the risk of accidental suffocation:
  • Move bed away from walls and other furniture.
  • Place mattress low to or on the floor.
  • Place baby in the area just above where adult heads are in the bed.
  • Do not allow siblings, other children, or pets in the bed.
Leah Henry-Tanner: As Gera mentioned, we have many, many, many conversations about this topic. So, some health care providers in American Indian/Alaska Native communities suggest these actions might reduce the risk of accidental suffocation: moving the bed away from walls and other furniture so baby doesn't get trapped;  putting mattresses low to the floor or on the floor itself; placing the baby in the area above where the adult heads are in the bed, like above where mom's head is; and then not allowing siblings or other children or pets in the bed with the baby.

Lowering SIDS Risk
  • Breastfeed your baby because it has a protective effect against SIDS.
  • Give your baby a dry pacifier that is not attached to a string for naps and at night.
(Here the camera cuts back and forth between Leah Henry-Tanner, the participants and the slides.)
Leah Henry-Tanner: We talk a lot about breastfeeding. It's so beneficial for so many reasons, but there have been studies showing that it's a protective factor against SIDS. So, we really, really support and encourage breastfeeding for all women. Of course, our focus is American Indian/Alaska Native women, but I think we all would like to see babies and families thrive–all babies thrive.

Also, there's research showing that pacifier use is also a protective factor. But, before introducing a pacifier, we really stress that if baby's breastfed to make sure that that's well established. So, it usually takes about a month for breastfeeding to get well established, so we recommend waiting until baby's used to breastfeeding, and then introducing a pacifier. And if the pacifier falls out while baby's sleeping, there's no need to put it back in. And, make sure it's not attached to anything or coated in any sugary substances.
  • Have Public Health Nurse visit the home.
Photo of baby on mother’s lap and a health care provider listening to the baby's heart with a stethoscope.

(Camera cuts to Geradine Simkins.)
Leah Henry-Tanner: There's also research showing that a public health nurse visit to families lowers the risk of SIDS. I think home visits are so important to keeping families healthy. And a public health nurse visit–if you've got research showing it, then I think people buy into it a whole lot better.

Geradine Simkins: Part of it, again, goes back to this relationship that the nurse and the family build with one another, where she's invited into the home–which is big, because sometimes you know they aren't invited into the home. But the nurse comes into the home and that automatically gives the mother the message, "I think somebody might care about me. Somebody might be interested in me. Somebody might be interested. This could be a person maybe I could talk to about what's really going on in my life." You know?

A lot of um... this is sort of a side bar, but something we haven't gotten into yet, and that's safety. Who does home visits in this room? OK, so almost everybody. So, I have had the experience of going into someone's home where she has told me that she is not safe in her home. That her partner is abusive and that she's not safe. But in the office, she couldn't quite get that out of her mouth. Right? So, you find out some things about what's actually going on in the home that you might not find–like you were mentioning right off the bat–that you might not find by somebody coming into your office.

So, it's very interesting that this study, that that was one of the factors–a public health nursing visit, which is a relationship thing, right? That's not about suffocation or smoking or alcohol; that's about building a relationship of trust so that people trust you, and that people understand that you do care about them. I mean, that's what that picture is all about. I care about you and your baby. You know?

The Following Do Not Reduce the Risk of SIDS
  • These items should be avoided for use to reduce the risk of SIDS.
    • Commercial products that claim to reduce SIDS.
    • Home health monitors that claim to reduce the risk of SIDS.
(Here the camera cuts back and forth between Leah Henry-Tanner and the slides.)
Leah Henry-Tanner: Some products claim to prevent SIDS or safely position the infant for sleep, but most of these items have not been tested for safety or effectiveness, and many pose a danger to babies. Other companies sell home monitors that claim to detect SIDS and other life-threatening events, but research has shown these types of monitors are not effective in detecting or reducing SIDS.

I think people just have a product they want to sell. And so, they target people who are legitimately concerned, wanting to keep their baby safe, and they sell them these products. And then, parents should especially avoid products made of foam, rubber, or memory foam types of materials, because they increase the risk of suffocation.

Risk Reduction
  • Risk reduction is a behavioral change concept.
  • Individuals make their own choices about what they are willing/able to change.
  • Informed choice is our goal.
Illustration showing a long line with an arrow on both ends and a line going down the center. On the left side, it says, "Reducing Risk" and the arrow points to the Healthy Native Babies logo. On the right side, it says, "Increasing Risk."

(Here the camera cuts back and forth between Geradine Simkins and the slides.)
Geradine Simkins: This particular slide represents, for me, sort of the heart of what we're trying to do in this training. Risk reduction is a behavioral change concept. We talked earlier about the fact that we chose not to use an abstinence model or another kind of model, but a behavioral change model about risk reduction. And, individuals make their own choices about what they're willing and able to change.

One of the things I think is so important is understanding that parents want to make good choices. Parents want to make good choices, even parents who are in compromised situations like some of the people that you have described working with. They still want to make good choices. And so, let's just trust that that is true and give them the information they need so that they can make informed choices.

And that's sort of the nugget for me about what this program is about. And when we get to this SIDS risk continuum we'll talk a lot about, again, how to help people make those decisions, even those who are in compromised positions–how to make those decisions.

Remember Tummy Time!

Back to Sleep, Tummy to Play!

Photo of baby on her tummy playing with her mother.
Leah Henry-Tanner: One thing we didn't spend a whole lot of time talking about, but it's also important that babies have some time on their tummies because it helps them to develop their muscles. If baby is on their tummy, make sure, of course, they have to be awake, and that there's an adult or a caregiver right there to play with them. Because, it's a good way to bond with baby and to help them strengthen their muscles.

Safe Sleep Train-The-Trainer

This Concludes Module 4 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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