A Spotlight on Sudden and Unexpected Infant Death and Sudden Infant Death Syndrome Prevention Efforts
The impact of SUID and SIDS in infant mortality continues to be an important public health issue nationally and states are tackling this issue using a variety of strategies, from forging federal-state partnerships to expanding upon the current research in the field to ensuring that there is consistent prevention messaging. In this article, AMCHP highlights some of the great work that is being done to reduce infant mortality, and shares some of the challenges and successes of translating research and data into practice in the field.
Federal and State Agencies Collaborate to Improve Surveillance System for Infant Deaths
Each year approximately 4,500 U.S. infants die suddenly with no immediately obvious cause of death. Sudden infant death syndrome (SIDS), a type of sudden unexpected infant death (SUID), is a leading cause of infant mortality. However, SIDS is prone to discrepancies in classification, hindering our ability to accurately monitor and understand SIDS and SUID trends.
Death certificates, the primary source for surveillance, cannot fully describe the circumstances leading to SIDS and other SUID, indicating the need for a more comprehensive source of surveillance data. State public health departments, program prevention planners, medico-legal investigators, and researchers have all expressed the need for enhanced surveillance data to monitor trends and characteristics associated with SIDS and other SUID, evaluate case investigation practices, and ultimately prevent many infant deaths.
CDC has built partnerships with several state health departments and HRSA’s National Center for Child Death Review to enhance surveillance and ultimately reduce infant deaths. In August 2009, CDC awarded funding to Colorado, Georgia, Michigan, New Jersey, and New Mexico to participate in the CDC SUID Case Registry (SUID-CR) Pilot Program. With this funding, states are linking child death review data, death scene investigation and pathology data to create state-based surveillance systems. CDC will pool state data to create a multistate surveillance system that can generate public health surveillance information at the national, state, and local levels that is more detailed and timely than is currently available.
As of June 2010, pilot states have identified 269 SUID cases. Also, each state has developed strategies to work with local medico-legal professionals to improve data collected at the scene and have encouraged their participation in multidisciplinary review meetings. Beginning in October 2010, Minnesota and New Hampshire will also participate in the pilot program.
The Study of Attitudes and Factors Affecting Infant Care (SAFE)
The purpose of this project is to continue to evaluate trends in infant sleep practices and the dissemination and adoption of the American Academy of Pediatrics' and the Public Health Service's "Back to Sleep" recommendations to reduce the risk of SIDS by expanding on current studies with a new study that examines in greater depth the factors influencing these trends and the racial disparity.
The SAFE study will survey mothers of infants ages two to four months about infant care practices including sleep position, bed sharing and pacifier use. This new strategy will institute specific methodologies designed to illuminate risk factors for non-compliance in the particularly vulnerable socioeconomic and minority populations. With this approach, we will: 1) evaluate trends, in a nationally representative sample, with regard to each of the three recommended infant sleep practices - supine sleep position, non-bed sharing and use of pacifier; and 2) identify and quantify specific barriers - socio-demographic, cultural, and ethnic - to adherence to infant sleep practice recommendations, particularly, but not exclusively, in vulnerable populations and in those with lower compliance with recommended sleep practices.
Successes and Challenges to SIDS and SUID Prevention: Perspectives from the Field
Translating the latest SIDS/SUID data for programmatic efforts can at times be challenging. Even today, there is still some confusion about Back to Sleep and Safe Sleep messages, and often the terminology we use can be unclear and inconsistent (i.e., sudden infant death, sudden unexplained infant death, sudden unexpected infant death, sudden unexpected death in infancy, etc.). There are also cultural practices and personal values that may affect adherence to public health recommendations or lead to different interpretations and perceptions of these messages.
Although challenges exist, there have been many successes at the programmatic level. Some of these successes include improved health education campaigns to disseminate prevention messages, an expansion of the Back to Sleep campaign to include additional environmental risk factors, and an increased awareness of infant sleep environment and its contribution to infant mortality. Additionally, programs are beginning to more effectively address the role of cultural competency when creating prevention messages. On a larger scale, there is an overall shift towards an integrated systems change approach to address SIDS, SUID and sleep-related infant death.
Recommendations for SIDS and SUID Prevention Messaging
Creating back to Sleep and Safe Sleep messages that are clear and consistent is essential for preventing infant death. It is also important to stress the preventative nature of SUID (i.e., it is not an unavoidable event). Messages from all sources (media, health providers, public health, advertisers, etc.) should be consistent in order to increase the credibility and power of the information, and these messages should be reinforced whenever and wherever possible.
AMCHP would like to thank the following contributors for making this feature story possible:
Centers for Disease Control and Prevention
800-CDC-INFO (800-232-4636) TTY: (888) 232-6348
Mary Adkins, RN, MSW
Program Director, Tomorrow's Child
Eve R. Colson, MD
Associate Professor, Pediatrics
Yale University School of Medicine
Sandra J. Frank, JD, CAE
President, Association of SIDS and Infant Mortality Programs
Rachel Y. Moon, MD
Children's National Medical Center
Professor of Pediatrics
George Washington University School of Medicine and Health Sciences