SLEEP PLAY EAT Kate K Chappell MSN APRN CPNPPC Victoria H Davis DNP APRN CPNP GCPH sleep Scope of the problem 3500 US infant deathsyear due to sleeprelated infant deaths ID: 621623
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Slide1
Pediatric Safety Updates: “SLEEP, PLAY, EAT”
Kate K. Chappell, MSN, APRN, CPNP-PC
Victoria H.
Davis,
DNP, APRN, CPNP, GCPHSlide2
sleepSlide3
Scope of the problem3500+ US infant deaths/year due to sleep-related infant deaths.Includes Sudden Infant Death Syndromeaccidental suffocation and strangulation in bed and undetermined/ill-defined causes
Initial decrease in the 1990s, no appreciable difference in recent years
Similar risk factors for SIDS and other sleep-related causes of infant death
(
Moon, et al., 2016)Slide4
Scope of the problemSC infant mortality rates1996: 8.3 per 1,000 among all races (5.5 among Whites; 13 among Black & other races)2015: 7 per 1,000 among all races (4.8 among Whites; 11.2 among Black & other races)
2015 SC Infant Mortality Counts
405 total
1
st
R/t short gestation & LBW (79)
2
nd
Congenital malformations (72)
3
rd
Accidents (38)
4
th
SIDS (28)
(
SCDHEC, 2016)Slide5
Sudden Infant Death Syndrome: “sudden death of an infany younger than 1 year 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.”
Sudden Unexplained Infant Death: “any sudden and unexpected infant death, whether explained (such as accidental suffocation or strangulation) or unexplained (such as SIDS
).”
(Federico, et al., 2016)Slide6
Risk factors for SUID/overlap with SIDSMore common among ethnic racial minoritiesDifference in prevalence of prone positioning and bed-sharing potential linkMalesPremature birth
Low birth weight
Recent infection
Young maternal age
Maternal tobacco or drug use
High maternal parity
Crowded living conditions
(Federico, 2016)Slide7
SC 2015 Accidental and “Sudden Unexplained” Infant Deaths38 deaths due to accidents:35 from accidental suffocation & strangulation in bed
1 from other accidental threats to breathing
2 “other accidents” (not transportation, drowning, or poisoning)
78 sudden unexplained infant deaths:
35 from accidental suffocation & strangulation in bed
28 from SIDS
4 from hanging, strangulation, and suffocation of undetermined intent
11 ill-defined or unspecified
(SCDHEC, 2016)Slide8
Infant Mortality by cause according to age
SC 2015 Counts
< 1 day
1-6 days
7-27 days
Post-Neonatal (28-364
days)
Total
Accidents
1
1
2
34
38
SIDS
-
1
-2728
Greatest period of risk for unsafe sleep-related deaths: 4-8 months old
Chart: SCDHEC, 2016; other: Moon, 2016Slide9
Progress? From 2014 to 2015 in SC Infant Mortality . . .
SC
Changes from 2014 to
2015:
Cause of infant deaths
Accidents -5% (2)
SIDS -9.7% (3)
Accidents & SUIDs:
+
4
suffocation & strangulation in bed
-
2
accidental threats to breathing
-
3 SIDS (SCDHEC, 2016)Slide10
Towards outcome equity
Infant
Mortality rates per 1,000 births
SC 2013-2015
White
Black & other races
SIDS
0.5
0.4
0.5
Accidents
0.6
0.5
0.7
Differences in
:
Prenatal
care
ResourcesStress and support
(SCDHEC, 2016)Slide11
Now, to prevention . . . 2016 AAP Guideline UpdateBack to Sleep for Every Sleep
Anatomically logical for airway
GER? Prematurity?Slide12
Now, to prevention . . . 2016 AAP Guideline UpdateUse a firm sleep surface
CPSC-approved surfaces such as . . .
What
about slings?
What
about CO2 reducing products
?Slide13
Now, to prevention . . . 2016 AAP Guideline UpdateBreastfeeding is recommended.
Reduced risk of SIDS
6 months per AAP, exclusively BM if possibleSlide14
Now, to prevention . . . 2016 AAP Guideline UpdateIt is recommended that infants sleep in the parents’ room, close to the parents’ bed, but on a separate surface designed for infants, ideally for the first year or life, but at least for the first 6 months.
What about bed sharing devices?
What about co-sleeping, bed
sharing?
Multiple
infants co-sleeping?Slide15
Now, to prevention . . . 2016 AAP Guideline UpdateKeep soft objects and loose bedding away from the infant’s sleep area to reduce the risk of SIDS, suffocation, entrapment, and strangulation.
What about bumper pads?
Safest sleep clothing plansSlide16
Now, to prevention . . . 2016 AAP Guideline UpdateConsider offering a pacifier.Not
attached to child’s
clothing
Avoid smoke exposure during pregnancy and after birth.Slide17
Now, to prevention . . . 2016 AAP Guideline UpdateAvoid overheating and head covering in infants.
No
more than 1 layer more than an adult would have in the environment
Regular
Prenatal CareSlide18
Now, to prevention . . . 2016 AAP Guideline UpdateImmunizations according to AAP and CDC recommendations
Avoid commercial products that are inconsistent with the safe sleep recommendationsSlide19
Resources for Safe Sleep EnvironmentsCribs for Kids: http://www.cribsforkids.orgFamilies receive training & may qualify for a Pack n’ PlayNational program originating in PA in 199810 SC partner coalitions
Currently seeking funding for statewide
implementation
HALOS: http://www.charlestonhalos.org/
Focus is on supporting kinship caregivers
Covering the
Lowcountry
Sister programs in Dillon and Lancaster counties
Cribs may be available as part of their program servicesSlide20
pLAYSlide21
GUN SAFETYAAP Recommendations: HCPs counsel parents and children about access in/out of home
Incorporate ?s with annual PE
Safe gun storage
Gun Storage Options (What are the Risks?):
Trigger Locks
Gun cases/boxes
Gun safes (fingerprint)
Concealed carry pursesSlide22
swim SAFETYAAP Recommendations (Pools and Spas): Never leave alone (in or near)
ADULT supervision (“touch supervision”)
Gate alarms/latches (self-close, self-latch)
Avoid “FLOATIES”
Swim Lessons
AAP Recommendations
(Open Water):
Buddy Up
No Diving
Education
http://s869.photobucket.com/user/collingwood_9/media/Animals/Dogs/dog1.jpg.html
(AAP, “Sun and Water Safety”, 2016)Slide23
swim SAFETYAAP Recommendations (Boating): Life Jacket ALWAYS
Education (drugs, alcohol)
License
Appropriate flotation devices
http://farm8.staticflickr.com/7044/6976783689_c20cd3cd62_z.jpg
(AAP, “Sun and Water Safety”, 2016)Slide24
Water SAFETYAccidents Can Happen: Puddles
Mop Buckets
Bath tubs
Showers
Sinks
Toilets
WHO Report 2014:
Drowning is among the ten leading causes of death for children and young people in every region of the
world
United States: drowning is the second leading cause of unintentional injury death in children aged 1-14 years
.
(WHO, 2016)
(AAP, “Sun and Water Safety”, 2016)Slide25
CAR SEAT SAFETY
(AAP, “Car
Seats and Obese
Children”, 2016)Slide26
CAR SEAT SAFETY tipsAAP Recommendations: The “latch” system vs SEAT BELT
(
lower
anchors and tethers for children)
system
Slouching?
Blanket rolls/diapers
No padding on back
ATTIRE
Weight Approved
Preemies
Obesity
https://d2pu2bk1b66iw6.cloudfront.net/photos/2014/12/10/6-86300-puffy-pink-baby-1418253965.jpg
(AAP, “Car Seats and Obese Children”, 2016)Slide27
Car Seat DifferencesEducate our Families:Rear Facing only22-45lbsUsually part of stroller system
Base is left in car
Convertible
Rear and/or forward facing
Can be used longer
No separate base
40-50lbs
3-in-1
Rear and/or forward facing and/or booster
Does it fit?
No separate base
40-50lbs
Car Seat
Approved Brands
https://www.healthychildren.org/English/safety-prevention/on-the-go/pages/Car-Safety-Seats-Product-Listing.aspx
(AAP, “Car Seats and Obese Children”, 2016)Slide28
“hot” news
AAP Recommendations
HCPs are key in reducing death rates
Educating ALL parents
Education Points
Can happen to anyone
Back seat checks
Car locks (?)
Placement of personal items
HEAT STROKE FACTS
Leading cause of non-crash vehicle deaths for <15yrs/old
Child’s body heats 3-5x faster than adult
End organ shut down begins at 104F
Can occur with outside temp of 57F
https://www.healthychildren.org/English/safety-prevention/on-the-go/Pages/Prevent-Child-Deaths-in-Hot-Cars.aspx
(AAP, “Prevent
Child Deaths in Hot
Cars”, 2016)Slide29
“hot” newsHeat Stroke Statistics
Total number of U.S. heatstroke deaths of children left in cars, 2016:
39
Total number of U.S. heatstroke deaths of children left in cars, 2015:
24
Total number of U.S. heatstroke
deaths
of children left in cars, 1998-present:
700
(Null, 2016)Slide30
Screen time “OLD” AAP RecommendationsLimit total amount of screen time to <1-2 hours/day
No screen time
for <2 years old
No screens in bedroom
Monitor access
Est. reasonable but firm rules
(AAP, “Media Use”, 2016)Slide31
Screen time NEW guidelines
“NEW” 2016 AAP Recommendations
HCPs and parents work together to reduce exposure
Develop “Family Media Plan”
Account for Health, Education, Entertainment
Ask 2 media ?s
Age-appropriate counseling at annual PE
Teens (increased risk for obesity, drugs, sex)
Detailed history
Patients w/aggressive behavior, obesity, drugs/alcohol/smoking, poor grades
(AAP, “Media Use”, 2016)Slide32
Screen time NEW guidelines
“NEW” 2016 AAP Recommendations
Prioritize “unplugged” time (infants & toddlers)
High-Programming (PBS, Sesame) for 18m/o+
<18m/o avoid, except video
chat
2-5y/o 1 hour/day
6y/o+, provide
boundaries
Media shouldn’t take the place of sleep, activity or hygiene
“Media free times” (
ie
. Dinner, driving)
Concerns
:
Obesity
Sleep
G&D
(AAP, “Media Use”, 2016)Slide33
Head traumaBICYCLES
2015: 80 males or 10%, 11 females or 1%, n=817
2001-2003: 5-14y/o only 48% wore helmet
ATV
2014: 93,700 ATV ER Injuries in U.S.; 26% < 16y/o
Fitted Helmets
Obey Road Rules
Education
Safety Manual
(CDC, “Head Injuries”, 2015)Slide34
Peanut Allergies
“OLD” AAP
Recommendations
2000
Children < 3y/o should avoid peanuts
2008
No evidence in delaying intro solid food past 4-6 months
No recommendation when to introduce highly allergenic foods
Peanuts
Eggs
Fish
Tree nuts
Emphasis on parents of children at risk for allergies to consult with allergen prior to starting highly allergenic foods
(
Greenhawt
, 2017)
http://www.webdonuts.com/comics/2014-10-06-Peanut.jpgSlide35
EATSlide36
Peanut Allergies
“OLD” AAP
Recommendations
2000
Children < 3y/o should avoid peanuts
2008
No evidence in delaying intro solid food past 4-6 months
No recommendation when to introduce highly allergenic foods
Peanuts
Eggs
Fish
Tree nuts
Emphasis on parents of children at risk for allergies to consult with allergen prior to starting highly allergenic foods
(
Greenhawt
, 2017)
http://www.webdonuts.com/comics/2014-10-06-Peanut.jpgSlide37
Peanut allergies“NEW” AAP Recommendations
Guideline #1
High Risk Infants (Severe eczema and/or egg allergy):
Introduce peanuts as early as 4-6 months of age
Must show successful solid food feeding prior to
Strong Recommendation for allergy testing prior to (SPT,
IgE
,
sIgE
)
sIgE
> 0.35 refer to specialist
Strong Recommendation for NOT multiple food allergy testing
Supervised feeding based on test results
6-7 grams peanut protein given in 3+ feedings/week
(
Greenhawt
, 2017)Slide38
Peanut allergies
“NEW”
AAP
Recommendations
Guideline #2
Infants (Mild to moderate eczema):
Risk for peanut allergy
Introduce peanuts around 6 months of age
Must show successful solid food feeding prior
to
No need for supervised feedings
(
Greenhawt
, 2017)Slide39
Peanut allergies
“NEW”
AAP
Recommendations
Guideline #3
Infants (Without eczema or food allergy and no increased risk):
Introduce peanuts “freely” in diet with other solid foods
Must show successful solid food feeding prior
to
No need for supervised feedings
http://1.bp.blogspot.com/-JFOjDHpAHUg/T1rNQy5cyYI/AAAAAAAAA_c/CfHucEwjfDA/s1600/Snoopy_Dancing_by_jessie4508.jpg
(
Greenhawt
, 2017)Slide40
ReferencesAAP. (2016). American Academy of Pediatrics Announces New Recommendations for Children's Media Use. American Academy of Pediatrics. Retrieved from https://www.aap.org/en-us/about-the-aap/aap-press-room/pages/american-academy-of-pediatrics-announces-new-recommendations-for-childrens-media-use.aspx
AAP (2015). Car Seats and Obese Children: Suggestions for Parents. American Academy of Pediatrics. Retrieved from https://
www.healthychildren.org/English/safety-prevention/on-the-go/Pages/Car-Safety-Seats-and-Obese-Children-Suggestions-for-Parents.aspx
AAP (2016). Prevent Child Deaths in Hot Cars. American Academy of Pediatrics. Retrieved from https://
www.healthychildren.org/English/safety-prevention/on-the-go/Pages/Prevent-Child-Deaths-in-Hot-Cars.aspx
AAP (2016). Sun and Water Safety Tips. American Academy of Pediatrics. Retrieved from https://
www.aap.org/en-us/about-the-aap/aap-press-room/news-features-and-safety-tips/Pages/Sun-and-Water-Safety-Tips.aspx
CDC. (2017). Gun Violence by the Numbers. Centers for Disease Control and Prevention. Retrieved from https://everytownresearch.org/gun-violence-by-the-numbers
/
CDC (2015). Head Injuries and Bicycle Safety. Centers for Disease Control and Prevention. Retrieved from https://www.cdc.gov/healthcommunication/toolstemplates/entertainmented/tips/headinjuries.htmlSlide41
ReferencesDowd, M. Denise, and Robert D. Sege. "Firearm-Related Injuries Affecting the Pediatric Population." Pediatrics 130, no. 5 (November 2012). http://pediatrics.aappublications.org/content/130/5/e1416.full
.
Federico, M. J., et al. (2016). Respiratory tract and Mediastinum. In Current Diagnosis and Treatment Pediatrics (Eds. Hay, W. W., Levin, K. J.,
Deterding
, R. R., & Abzug, M. J.). 23rd ed. NY, NY: McGraw Hill.
Greenhawt
, M. (2017, January 05). New Guideline for Prevention of Peanut Allergy: Where We Stand Now in Preventing Food Allergies. Retrieved February 01, 2017, from http://www.medscape.com/viewarticle/874075
Horman
, B. G. (2016, April 14). 6 Ways To Safely Store Your Firearms. Retrieved February 01, 2017, from https://www.nrafamily.org/articles/2016/4/14/6-ways-to-safely-store-your-firearms/#
IIHS. (2016). Pedestrians and bicyclists. Insurance Institute for Highway Safety. Retrieved from http://www.iihs.org/iihs/topics/t/pedestrians-and-bicyclists/fatalityfacts/bicycles/2015
Moon, R. Y.,
Darnall
, R. A., Feldman-Winter, L., Goodstein, M. H., and Hauck, F. R. (2016). SIDS and other sleep-related infant deaths: Updated 2016 recommendations for a safe infant sleeping environment. Pediatrics, 138(5).Slide42
ReferencesNHTSA. (n.d.). Prevent Child Heatstroke in Cars. National Highway Traffic Safety Administration. Retrieved from https://www.safercar.gov/parents/InandAroundtheCar/heatstroke.htmNull, J. (2016, January 30). Fact Sheet - Heatstroke Deaths of Children in Vehicles. San Jose State University. Retrieved from http://noheatstroke.org/
SCDHEC. (2016). Infant mortality and selected birth characteristics: 2015 South Carolina residence data. SC Department of Health and Environmental Control, Office of Public Health Statistics and Information Services, Division of Biostatistics. Retrieved from http://www.scdhec.gov/Health/docs/BiostatisticsPubs/IMR2015AnnualReport.pdf .
South Carolina Firearms Death Rate. (2014). Retrieved February 01, 2017, from http://
www.worldlifeexpectancy.com/usa/south-carolina-firearms-death-rate
WHO. (2016). Drowning
.
World Health Organization. Retrieved
from http://www.who.int/mediacentre/factsheets/fs347/en/