Back to Sleep

[TiffyRN, BSN, PhD]

Ok, so one of our neos tells us our unit is 2 years behind "the rest of the world" because we are not enforcing the AAP's standards for "Back to Sleep" in our unit. As in she doesn't want feeder growers, even those still in isolettes swaddled and doesn't want rolls placed in the bed (the ones I'm talking about are blanket rolls covered by a "bottom sheet" blanket that is tightly tucked around the mattress). She wants these babies placed like the pictures on the "Back to Sleep" pamphlet which I am trying to attach. First off, I can't imagine trying to keep some of our smaller open crib kids warm without swaddling much less keeping any kinds of OG/NG tubes in.

Now I'm all about teaching the parents about back to sleep and starting to put them on their backs as they move to nipple all feeds, but no swaddling or boundaries when I have 4 kids to keep happy?

So, are we really 2 years behind the rest of the world? If my fellow NICU nurses out there wouldn't mind responding and providing location (even as vague as "South", "East Coast") I would really appreciate it.

[BabyNurse513]

I have worked in 3 NICU's, one in the midwest and 2 on the east coast. In my experiences they have all generally waited until we knew discharge was approaching and then we would remove all rolls, lay the head of the bed flat and put the baby on thier backs to sleep. Until then though, rolls, swaddling, and prone positioning were fine.

[cathys01]

We keep all babies with HOB elevated and with boundary rolls...all the way up until they get discharged. Part of the discharge teaching, however, is about "back to sleep". We explain to parents that yes, in the hospital we reposition the infants every 3 hours (with cares), but we also have the babies on EKG monitoring...but that they should use only back to sleep at home.

[Jolie, BSN]

Sounds like your neo needs a lesson in developmentally appropriate care. These babies need swaddling and containment.

[TiffyRN, BSN, PhD]

Sounds like your neo needs a lesson in developmentally appropriate care. These babies need swaddling and containment.

She's a talented MD, but she gets on these kicks, and the latest is this Back to Sleep campaign.

But I agree with you.

[preemieRNkate, RN]

I'm in NY. Our feeder-growers and FT babies that are in open cribs are flat with no rolls, but we still swaddle. When making an isolette for a FT baby that is not swaddled, I still put a roll, otherwise I find the baby horizontal at the bottom! Honestly, I don't think they would stay warm enough in an open crib without swaddling in just the hospital t-shirts and a diaper. We teach back to sleep to our parents as part of discharge teaching, and tell them that they shouldn't have extra blankets, stuffed animals, etc. in the cribs at home.

[djccrn]

Back to sleep started in 1992 with a big countrywide push in 2003.

Do you remember the saying actions speak louder than words?

I feel we are doing a huge favor to our parents if we get babies acustom to sleeping on their backs without rolls prior to discharge. The AAP says we should dress infants to stay warm rather that use blankets, meaning t shirt and thick sleeper with socks. If a blanket is needed infants are to be wrapped no higher than their axilla and a top blanket should have it's edges tucked under the mattress edges. The kids do stay warm. We are to position the babies so that their toes touch the bottom of the crib to prevent snuggling down into the blankets. Our preemies are @ a higher risk for SIDS in general. Dont we want the kids to grow up after so much of our hard work went into them living past the first few months?

[crissrn27, RN]

We swaddle and use rolls in well newborn. Had this problem last night with parents asking should we put him on his back to sleep or his side like you guys do? It is kinda hard to explain that we want them to put baby on his back but we can put him on his side with rolls and swaddle them. But they are so much happier swaddled. Don't really know what the answer is here. I don't see our hospitals stopping the swaddling and rolls anytime soon.

[Elvish, BSN, DNP, RN, NP]

Shoot, without swaddling I'd go insane in the nursery. Babes love the swaddling, reminds them of being in utero. When I swaddle, I swaddle with hands up near the face so that if they have to flail etc. in resp distress, they can.

Preemies tend to sat better etc. on their tummies, if I'm not mistaken. Somebody please correct me if I am.

The Back to Sleep campaign has its merits and has saved a lot of lives, to be sure. But it's for healthy term newborns, not preemies. I do put babies on their backs in their bassinets but I sure as heck swaddle them too. It's worked so far.

[RainDreamer, BSN, RN]

Some of our feeder/growers are in the intermediate nursery for MONTHS!

I've been taking care of a kid that was a 28-weeker .... and has been a feeder/grower now for almost 2 months, he was on full feeds after about 2 weeks in the unit. I can't imagine not having any sort of containment for such little ones like that, he was like 1200 grams when he went to the step down unit.

Does she mean kids that are big enough to nipple all their feeds? If that's the case, then yeah we usually put them on their backs to sleep, don't swaddle tight, and keep their beds flat. But by the time they're nippling everything they're getting ready to head out the door!

Until then, we still swaddle, still use boundaries, still raise the head of their beds, and still put them on their bellies/sides/whatever. We tell the parents when they get home they won't be putting the babies to sleep on their bellies obviously ..... but at the hospital they are being closely monitored and they are on monitors.

That doctor should go into every one of those homes that the baby will be going to and making sure that NO ONE smokes in that house .... because as we all know, that's a huge SIDS risk right there. 'Back to Sleep' is good, but it's only one facet of SIDS.

[justjenny]

I am in Mich. and we put ALL babies over 32 weeks "back to sleep" This includes babies with N.C., etc. NO prone positioning, etc. without a specific positioning order. We can swaddle the babies in a crib with ONE blanket - no extra rolls, nothing. If they are on a warmer for close obs. then we use rolls for containment, etc. since we cannot swaddle them (ie: they are tachypnic, watching their belly, etc.)

The rationale is that we are D/C babies soon after 32 weeks and the parents copy what they see/learn in the hospital. If we are placing extra blankets in the bed, placing prone, etc. no matter what we tell the parents to do, they will copy what they saw in the NICU or SCN.

Jenny

[dawngloves, BSN, RN]

:yeahthat:

For the past 5 years all our babies that are weaning to or in an open crib are put on their backs. And swaddling them is a form of developmental care.