Nurses Setting the Stage for Safe Infant Sleep

What every postpartum nurse should know to educate postpartum patients regarding safe infant sleep in the hospital and at home Nurses General Nursing Article

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Nurses Setting the Stage for Safe Infant Sleep

It is no secret that infants love to be held. They have been snuggled close within the quiet womb for many months. The outside world is a startling and unfamiliar abyss of air. Infants do not want to be alone, untouched. Often time, we as nurses can find ourselves in a quandary. An infant needs to breastfeed, so we set the sleepy mama up with pillows and water and latch a baby to the breast. And then we leave to attend to our other patients. This is the culture, especially in Baby Friendly hospital setting where rooming-in, skin-to-skin and breastfeeding are paramount. But what happens during the time that we are not present? When we are not there to hold the hand of a new and overwhelmed parent to help make certain their baby is safe. Therefore, it is important for us to understand what Sudden Unexpected Infant Death (SUID) is, the risks involved (especially in a hospital setting) and how we can translate this information to a new parent, so they feel confident about safe sleep practices.

What is SUID and Who is Most at Risk?

Sudden Unexpected Infant Death (SUID) describes the sudden and unanticipated death of an infant under 1 year, often during sleep or in their sleeping area. SUID encompasses:

  • Sudden Infant Death Syndrome (SIDS),
  • Accidental Suffocation or Strangulation in Bed (ASSB)
  • Unknown cause of death after investigation or found in an unsafe environment at the time of death.

The designation of SUID allows for great accuracy and compilation of statistics. In the United States, 3,400 babies die each year from SUID and represents the leading cause of neonatal death. Risk factors include:

  • Prone and side sleeping
  • Bed sharing
  • Soft bedding
  • Unsafe sleep locations
  • Tobacco smoke (secondhand smoke)
  • Prematurity

Studies have shown that infants at the greatest risk are born to mothers that are of non-Hispanic Black and Native/Alaskan American descent. Greatest-risk infants are also born to mothers who had an adolescent pregnancy, were not married, and had fewer years of education. Significant risks also include gestational hypertension, born before 37 weeks, IUGR and having a twin.

The Basics of Safe Sleep Guidelines

The “Back to Sleep” Campaign has been championed since 1992, but many changes have been made in recent years. I highly encourage Nurses to read the citation for the Updated 2022 Sleep Recommendations by the AAP for detailed information, including thorough reasoning for each recommendation. Summarized below are the Guidelines from 2016:

  • Back to sleep (every sleep)
  • Firm, flat and non-inclined sleeping surface
  • Human milk consumption (associated with reduced risk of SUID)
  • Room sharing (not bed sharing) for the first 6 months, if possible
  • Elimination of objects/blankets/pillows from the sleeping space
  • Pacifier use
  • Avoiding smoke exposure
  • Avoid overheating or head covering
  • NOT using home cardiorespiratory monitors

In 2022 additional changes reflect the current parental culture and available products for consumers. The following changes are listed below because of their prominence in parental behaviors today:

  • Infant sleep products- must meet federal standards. Does NOT include inclined sleep products, hammocks, baby nest or pods, or in-bed sleepers.
  • Bed sharing- while we must be cognizant of cultural norms and the convenience of bed-sharing for breastfeeding, under NO circumstance can the AAP recommend bed sharing including unintentional bed sharing (falling asleep while feeding infant).
  • Weighted blankets, weighted swaddles and weighted clothing are NOT recommended.

What Can Nurses do to Encourage Safe Sleep?

The lengthy recommendations are overwhelming for new parents to absorb. As nurses, it is important “to set the stage” for safe sleep habits in small moments throughout their care. A 2018 study by the CDC revealed that 25% of parents left the hospital with incorrect safe sleep advice, and 20% received no teaching at all. While in the hospital, it is imperative that infants are placed supine, in the bassinet when parents need to sleep or tend to other needs. If skin-to-skin is being performed, it is important for the parent to remain awake. As nurses, we must be aware of the mode of delivery, medications received and the general well-being of the parent to ensure that we are advocating for the safest sleep practices in-hospital. These habits translate to safe sleep practices at home and should be expanded upon, with both parents if possible. It is important for nurses to understand the modifiable and nonmodifiable risk factors so that postpartum education can be customized for the parent and infant. It is vital that nurses are capable of providing safe sleep education that is up-to-date, consistent, unified, and trustworthy.

Improving the Nursing Approach

Nurses, it is essential to remove the sweetly slumbering baby from a sleeping parent’s arms, pray for a smooth transition and place the infant safely in the bassinet. Often, we are caught between following hospital policy and respecting a parent’s desire. We cannot predict or control the parent’s preferences or choices when they return home. It is imperative that nurses and nurse-leaders provide a synchronized and unified message. Recommendations for a cohesive approach to safe sleep education include but are not limited to:

  • Assess all nurse's level of knowledge regarding safe sleep practices
  • Providing education to patients that begins in labor and continues through discharge
  • Understand the barriers that parents have regarding safe sleep practices
  • Provide continual safe sleep messaging throughout hospital stay
  • Providing consistent role modeling

One of our most prized “hats” as postpartum nurses is that we are educators. We can feel confident that we have supported parents and their newborns with the most accurate information about safe infant sleep that will lead to positive behavior. We advised, we explained, we answered questions, and we served as advocates.

FACT: We are the first line of defense in safe sleep.


Nurses Leading Safe Infant Sleep Initiatives in the Hospital Setting

CDC: About SUID and SIDS

Sleep-Related Infant Deaths: Updated 2022 Recommendations for Reducing Infant Deaths in the Sleep Environment

Risk Factors, Protective Factors, and Current Recommendations to Reduce Sudden Infant Death Syndrome: A Review

CDC: Safe Sleep for Babies

A perspective on neuropathologic findings in victims of the sudden infant death syndrome: the triple-risk model

Danielle Rush BSN, RNC-EFM is a labor and delivery nurse and an aspiring nurse writer with a passion for women's health. Much of her spare time is filled with nurturing her children and cooking from scratch.

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Specializes in NICU.

We recently had a baby that was born with ALCAPA. Anomalous left coronary artery from the pulmonary artery (ALCAPA) is a congenital heart defect in which the left coronary artery arises abnormally from the pulmonary artery. Normally, the left and right coronary arteries arise from the aorta and supply blood with oxygen to the heart.

Babies that have ALCAPA act normally except for a Patent Ductus Arteriosus because the PDA allows oxygenated blood to flow through the pulmonary artery, through the coronary artery and oxygenate the heart muscle . Normally, the baby is sent home and the small PDA closes within a few months after discharged. Babies with ALCAPA are a ticking time bomb. The PDA begins to close and cause the oxygenated blood to stop flowing through the defect. For many of these babies, their initial cause of death is believed to be unsafe sleeping conditions/ suffocation.  It is not until the autopsy that the diagnosis of ALCAPA is discovered.

Fortunately for the baby I cared for had a large PDA that needed closure. It wasn't until after the PDA was surgically closed that ALCAPA was discovered on the heart echo. 

Specializes in Labor & Delivery.

My goodness I am so glad they discovered that! Makes total sense why one would believe these babies pass from SUID. So unfortunate. And the guilt a parent must feel in that situation thinking they put their baby at risk.