New moms are often discharged from hospital birthing centers with armloads of flyers and medical paperwork in addition to their infant child and are likely to return home exhausted and overwhelmed. Safe sleep practices may not be front and center on their minds.
A team of Rutgers University scientists has sought to clear up any confusion and promote safe sleep for mom and baby by developing a free mobile app, designed to educate parents and healthcare professionals on the steps families can take to protect newborns as they slumber. This includes placing babies on their backs — not their bellies — in a crib without any blankets, toys, or pillows; not sharing a bed with the infant; and not smoking.
The SIDS Center of New Jersey, which works with Rutgers Robert Wood Johnson Medical School and Hackensack Meridian Health, launched the SIDS Info app earlier this month, based on guidelines developed by the American Academy of Pediatrics. Safe sleep practices have been proven to significantly reduce the number of these deaths, a category that now includes accidental suffocation and strangulation, experts note.
“We wanted to provide easy access, at your fingertips, to this information,” explained Barbara M. Ostfeld, a pediatrics professor and program director at the SIDS Center, who developed the app with Dr. Thomas Hegyi, the center’s co-medical director who is also a professor (as well as her husband). “Rich or poor, everyone has a phone these days,” she said.
SIDS, or Sudden Infant Death Syndrome, was originally limited to deaths of infants under 12 months that could not be explained, even through an autopsy. But the scope has since been expanded to include unexpected deaths, like when a child is accidentally smothered when sleeping alongside a family member, or suffocated under a blanket. As a result, experts now focus on Sudden Unexpected Infant Deaths, or SUIDs.
Sixty SUID deaths in NJ each year
Nationwide, some 3,500 infants die each year of SUIDs, roughly one baby for every 1,100 live births, Ostfeld said. New Jersey’s rate is lower, with one death per 1,700 births, or about 60 infants per year. While these rates have declined, SUIDs remains the third leading cause of infant death in the Garden State, and the fourth nationwide, according to state data.
The state Department of Children and Families, which runs child health and welfare programs, includes more than a dozen safe sleep tips on its website, as well as links to other resources. Last year New Jersey became the first state to give away free “baby boxes,” cardboard crib-substitutes that have been used in other countries, as part of a safe-sleep promotion; some experts have raised concerns about the boxes, which have not been approved by consumer safety experts.
While in many cases the cause of death is never determined, Ostfeld said studies have shown some parental behaviors or social factors do impact the rates. Babies born to women who smoke during pregnancy are six times more likely to die of SUIDs, for example, and babies born pre-term, between 24 and 27 weeks of development, are at least three times more likely to fall victim. Poverty is also a factor that drives up SUIDs deaths, she said, as does a lack of access to healthcare or good nutrition. Stress related to racism also impacts the mother in ways that in turn can impact the baby’s susceptibility too.
‘Back is best’
Addressing these multi-faceted social determinants of health is complex, but safe sleep practices are not complicated. The app, available for iPhone and Android devices, aims to make it even simpler. The developers hope hospitals and other birthing centers will introduce new parents to the app and help them connect before they go home. (While the condition is now called SUIDs, the developers know SIDs was still the more recognized term and would be easier for parents to find online.)
The animated app, which downloads in seconds, features soothing music and soft colors and a female voice that walks users through eight priorities, beginning with “Place me to sleep on my back,” and “Share your room, not your bed.” It also cautions parents against overheating the infant, or swaddling them in blankets, suggests a pacifier for bedtime calming, and underscores the importance of breastfeeding, which has been shown to reduce SUIDs and provide long-term health benefits.
Users can switch the voiceover, or text, to Spanish. The app also allows parents to click on a “baby talk” feature that reinforces key points about safe sleep, from an infant’s point of view. The app, which allows healthcare providers to download safe sleep courses for free, will be kept up-to-date with protocol changes, Ostfeld said.
The developers encourage users to share the app with other family members, baby sitters and others who might be caring for their child. This can be especially helpful when trying to bridge cultural or generational differences in child care; it is not uncommon for a new mom to place a baby on its back, only to have her own mother —the well-meaning grandmother — come along later and flip the infant over.
“I’m a grandmother, and in our day, we were told to put babies to sleep on their stomachs,” Ostfeld said. “I realize that people from our generation struggle with the concept that ‘back is best.’ The app helps them remember to put this into practice.”