Reducing the risk of sudden infant death syndrome through safe sleep practices

Sudden infant death syndrome (SIDS) is the unexplained sudden death of an infant under one year of age. In Taiwan, although the number of SIDS cases decreased between 1997 and 2003, the ratio for the number of such cases to infant mortality has been consistently increasing. Even though the cause of SIDS is unknown, risk factors have been identified in the literature on the subject. Nurses may help in reducing the risk of SIDS by educating parents about the risk factors. The purpose of this paper is to describe SIDS and to recommend nurses to implement the new recommendations of the American Academy of Pediatrics (AAP) to reduce the risk of SIDS. Released in 2005, these emphasize the importance of the prone position, the use of a pacifier during sleep, and the dangers of using soft bedding and of bed sharing. Side position is no longer recommended as a rational alternative of prone position. The recommendations also indicate the need to educate secondary caregivers and health care providers about SIDS.     

4th Austrian SIDS Consensus-Consultation and the Viennese SIDS prevention campaign "Secure Sleep"

Despite numerous investigations the pathophysiologic mechanisms of SIDS have not been fully elucidated. In large epidemiologic studies highly variable SIDS mortality rates were noted between different countries and cultures. This presumably is due not only to differences in diagnostics and classification of SIDS but also in lifestyle and newborn care. The common denominator is the identification and prevention of the main risk factors: smoking, sleeping in the prone position, over-heating, wrong "bedding". SIDS prevention campaigns that have focussed upon these risk factors have led to a dramatic reduction in the incidence of SIDS. In preparation for the SIDS prevention campaign of Vienna ("Safe Sleep") the content, strategy and procedure of the Austrian prevention campaigns were analysed. The current focus is to convey a clear and uniform message in personal conversations before and after birth of the child. These conversations with parents are the most important tool to detect SIDS related anxiety and a possibly increased risk of SIDS. In the last 30 years various polysomnographic parameters were published that were associated with an increased risk of SIDS. Today there is international consent that polysomnography is not an efficient screening method to demonstrate increased risk of SIDS. Therefore the use of polysomnography, besides research purposes, has been limited to investigating clinical symptoms of infants and children. Concerning monitoring it is important to note that--in contrast to the undisputed importance of monitoring breathing disorders--the effectiveness in SIDS prevention is unproven. State of the art are instruments that monitor heart and breathing rate and have adequate storage functions. The duration of monitoring should encompass the symptomatic period as well as a safety period of three months. The monitor should not be routinely prescribed for a year. The guiding principle is "As short as possible with stringent indication". Prerequisite for the monitoring is good instruction of the parents and a continuous consultation by competent outpatient clinics.     

Barriers and facilitators in the delivery of environmental risk reduction by public health nurses in the home setting

ABSTRACT Objective: The goal of this study was to identify the factors that contributed to or detracted from the ability of public health nurses (PHNs) to deliver environmental risk reduction (ERR) in the home setting. Design and Sample: Structured one‐to‐one interviews were conducted with 10 PHNs from 2 county health departments in the western United States that were delivering an ERR intervention in a randomized clinical trial. Results: Barriers to incorporating ERR into PHN practice were: a change in the perceived mission of public health, nurses' lack of environmental health (EH) training, the absence of a strong relationship with EH, the multidimensional role of PHNs, presentation of nurse participation by management, incorporation of ERR visits into nursing schedules, and challenges engaging parents in EH. Facilitating factors included: training and support, opportunities for capacity building, belief that ERR is important, building a more visible face for PHN, and personal interest in EH and ERR. Conclusions: Adapting PHN practice to include ERR strategies is feasible, but not without challenges. With adequate training, time, and institutional support, multiple challenges can be overcome. PHNs are well positioned to improve the health of families and communities by integrating ERR into their scope of practice.     

Predictors of psychosocial distress after suicide,SIDS and accidents

This article compares the outcome and predictors of psychosocial distress of parents bereaved by young suicides, sudden infant death syndrome (SIDS), and child accidents. One objective is to explore whether suicide bereavement is more difficult for those left behind than other forms of bereavement. Data have been collected from 140 families, consisting of 232 parents, by the use of the Impact of Event Scale, the General Health Questionnaire, and the Inventory of Traumatic Grief. Qualitative aspects of bereavement are assessed by in-depth interviews with family members from 40 families. The results show that the similarities between the samples on outcome and predictors are more striking than the differences, which is explained by the common traumatic aspect of unexpected and violent deaths. One and a half years post-loss, 57-78% of the survivors scored above the cut-off levels for traumatic grief reactions. Although no significant differences are found between survivors of suicide and accidents, both groups evidence significantly greater subjective distress than the survivors of SIDS. Self-isolation is by far the best predictor of psychosocial distress in all three samples. Rather than focusing on the exceptional position of suicide survivors, it seems important to call attention to sudden and traumaticdeathingeneral as a factor to be associated with post-traumatic reactions and complicated mourning.     

Public health nurses as social mediators navigating discourses with new mothers

Public health nurses (PHN) have had a long history of working with new mothers in the community. Their practice includes collaboration, building therapeutic relationships, mutual goal setting, establishing trust, supporting clients’ strengths, empowerment and social justice. The wealth of information that new mothers receive both solicited and unsolicited may come from many different sources such as medicine, midwifery and those created personally by families. Although much of the information on mothering is presented with the intent of helping, it can also be hegemonic and oppressive depending on different discourses, stereotypes and myths of mothering and therefore may cause confusion, guilt and uncertainty. Public health nurses often address conflicting social, cultural and personal discourses about mothering practices in order to support an empowering mothering experience. The term ‘social mediator’ was purposefully created in an attempt to describe the unique work of PHNs that this author has witnessed through her own research and practice as a PHN. This paper will present a discussion of the author's own work and research findings that will suggest how feminist poststructuralist theory may be used to guide and understand information exchange between PHNs and mothers as they mediate different social, cultural and personal discourses on mothering.     

Bereavement care for families part 2: Evaluation of a paediatric follow-up programme

In North America, parents are not expected to outlive their child. When they do, neighbours, co-workers, friends and family do not know what to say or do resulting in parents feeling isolated in their grief and left alone to find the support they need. The Paediatric Palliative Care team at Capital Health's, Stollery Children's Hospital (Stollery) in Edmonton, Alberta, Canada began a programme of bereavement follow-ups in April 2002 to offer support to families who had experienced the death of their child. In Part 1 of this article (deJong-Berg and deVlamming, 2005) implementation and the current state of the programme is outlined, and in Part 2 we present the results of the programme evaluation conducted in spring, 2005. Eighty-one families were invited to take part in a satisfaction survey to determine the helpfulness of this bereavement follow-up programme. Twenty-nine parents, representing 21 families, took part. Parents reported that written information received was useful and that they felt supported knowing a resource was available. They also felt also felt that the programme extended the care given by the Stollery staff throughout their child's illness and death. This article reports the findings of the programme evaluation and discusses the implications for practice and future research.     

Multidisciplinary simulation in pediatric critical care: the death of a child

Health care providers are trained to care for the living. They may complete their education and enter the workforce without ever experiencing the death of a patient. Inexperience with the different roles of the multidisciplinary health care team is common. Moreover, the death of a child has a profound effect on parents and staff. In such situations, the expertise of the multidisciplinary team can make a difference. A multidisciplinary education project that uses high-fidelity simulation based on pediatric death and dying was developed to provide an experience during which health care practitioners could practice communicating with families about the death of their child and dealing with different grief reactions.     

Maori Men and the Grief of SIDS

The loss of a baby is always hard to cope with and the grieving process is likely to be difficult. Interventions to work with Sudden Infant Death Syndrome (SIDS) families have improved grieving outcomes for many but the needs of Maori fathers are not well understood or catered to by existing services. This article presents narrative data from Maori fathers who have lost a baby to SIDS and analyzes these narratives in the context of the literature and of traditional Maori constructs about grief. The authors document a rarely discussed Maori concept, “the attainment of mauri tau,” as the desired outcome of the grieving process; and begin a discussion around the changing face of the Maori grieving process and its implications for the grieving practices of Maori men.     

Survivors' guilt following sudden traumatic loss: promoting early intervention in the critical care setting

Survivors' guilt is a pervasive mental health issue that is often initially manifested by family members in the critical care unit. With increased awareness and enhanced targeted assessment, critical care nurses are in a unique position to begin the initial processes of adaptive coping and functional grief and bereavement in surviving family members. Because the trajectory of grief and bereavement are often complex and long term, the additional complication of survivors' guilt can lead to many psychosocial and physical manifestations and sequelae. However, with early identification and intervention relative to the underlying factors of survivors' guilt, including appropriate referral and psychoeducational intervention and resources, critical care nurses can enhance and extend their care to families in the throes of significant and sudden loss and intrapsychic trauma.     

Adolescent coping with grief after the death of a loved one

The purpose of this article was to describe adolescent coping after the death of a loved one. Data were obtained by two self-report questionnaires filled in by 14-16-year-old pupils in two secondary schools in Finland. The sample consisted of 89 adolescents (70% girls) who had each experienced the death of a loved one. The instrument used in the study was developed by Hogan and DeSantis. The article reports the responses to two open-ended questions. The data were analyzed using content analysis. The most important factors that helped adolescents cope with grief were self-help and support from parents, relatives and friends. However, the official social support system was not experienced as very helpful. No one reported help, for example, from school health services. According to the adolescents, fear of death, a sense of loneliness and intrusive thoughts were factors that hindered coping with grief. Some respondents felt that parents or friends were an additional burden on them. The results are discussed in terms of identifying the different impact of social support, the importance of self-help and professional help. Knowledge of factors that have an effect on adolescent coping with bereavement is important for families, effective nursing practice, school health services and parents.     

Competency in end-of-life care: last hours of life

Clinical competence, willingness to educate, and calm and empathic reassurance are critical to helping patients and families in the last hours of living. This review adapted from the Education for Physicians on End-of-Life Care (EPEC) Curriculum describes the predictable course that occurs as well as approaches to management. Management principles are the same at home or in a health care institution. However, death in an institution requires accommodations to assure privacy, cultural observances, and communication that may not be customary. In anticipation of the event, it helps to inform the family and other professionals about what to do and what to expect. Care does not end until the family has been supported with their grief reactions and those with complicated grief helped to get care. Care at the end of life is a core competency.     

Living and coping with excessive infantile crying

AIM: The aim of the study was to elicit from parents how they lived and coped with a baby who cries excessively. It sought to identify factors which made coping more difficult, as well as interventions perceived by parents to be effective in improving the situation. BACKGROUND: The excessive crying of a baby can be one of the most trying aspects of parenthood. Although there have been many studies into the cause and treatment of the problem, these have produced little convincing evidence and even less agreement among investigators. In the light of this an alternative approach is to provide effective support to enhance coping until the crying abates. DESIGN: This study was based in pragmatic ethnography and followed an adapted grounded theory approach. A total of 25 adults from 14 families participated, recounting their experiences with 20 babies who either were currently crying excessively or had done so previously while less than 1 year old. Data was collected by a factual questionnaire and tape-recorded focused interviews conducted in the family home augmented by periods of participant observation. OUTCOMES: Almost every aspect of family life was disrupted, resulting in strained relationships, feelings of guilt, and concerns about losing control. Repeated attempts had to be made to establish a diagnosis and to find a cure. Such attempts failed, leading to a repeated cycle of hope and disappointment. The greatest potential to effect a positive impact lay in the supportive role of health visitors. They needed to visit frequently; stay for a prolonged period; demonstrate engagement with the family and its difficulties; and impart specific messages with conviction and sincerity. CONCLUSION: A specific, vital role was found for the health visitor in supporting parents through this problem, and aspects of the role were identified in which further study is indicated.     

SIDS and tourette syndrome: Is there an etiologic relationship?

SIDS has been repeatedly linked to the presence of prolonged sleep apnea and defective arousal mechanisms. Multiple cases of SIDS may occur in some families, and siblings of SIDS infants are at a 3 to 10 times greater risk of SIDS than the general population. This suggests genetic factors can play a role. Sleep laboratory studies of adults with Tourette syndrome (TS) show that 23% have sleep apnea and 29% have abnormal arousals. Disorders of arousal such as enuresis, sleep walking, sleep talking, and night terrors are common in children with TS. We report seven TS families in which one or more close relatives died of SIDS, or had apparent life-threatening episode (ALTE) and required apnea monitoring. Serotonin is the major neurotransmitter involved in sleep regulation and abnormalities of serotonin have been implicated in both SIDS and TS. These and other observations suggest that the Tourette syndrome gene (Gts) may be the genetic factor contributing to an increased risk of SIDS.     

Social Justice or Market Justice? The Paradoxes of Public Health Partnerships with Managed Care

Public health is increasingly joining forces with managed care, yet the effect of this partnership on public health nursing (PHN) has received little scrutiny. The feasibility and consequences of a public-private alliance raise questions about whether the mission of public health can be sustained in a managed care system and whether managed care's approaches to health care are conducive to providing population-oriented care. Expanding the links between PHN and private organizations is both problematic and promising. Managed care organizations have much to offer, including coordination of services and comprehensive care. However, they may also restrict coverage and create bureaucratic obstacles to obtaining services. The growth of for-profit health care corporations evokes questions about ways in which concern for communities and populations collide with stockholder interests. The task for PHN is to recognize and to dialogue about these complexities so that nursing's voice can be heard as solutions to these dilemmas are created.     

Distribution of prenatal and postnatal risk factors for sudden infant death in Budapest.

OBJECTIVE: To study the distribution of prenatal and postnatal risk factors for sudden infant death syndrome (SIDS). DESIGN: A questionnaire-based survey for SIDS risk factors; family interviews were performed among the parents of SIDS victims and symptom-free infants. SETTING: The survey was conducted in paediatric primary health care units in Budapest, Hungary in the period 1996 to 1998. SUBJECT: Eighteen SIDS cases and 74 symptom-free healthy infants aged 7-365 days were investigated. MAIN OUTCOME MEASURES: Occurrence of risk factors and impact of social environment were analysed using conditional logistic regression. RESULTS: In this study, the classic risk factors of small birth weight, maternal smoking, bottle-feeding did not reflect differences between the investigated groups. The prone position did not demonstrate a difference between SIDS cases and controls (p = 0.86). Short intervals between pregnancies (OR = 4.8, CI = 1.2-19.9, p = 0.025) and social disadvantage (OR = 6.7, CI = 1.3-35.7, p = 0.015) indicated significant differences between SIDS cases and controls. CONCLUSION: The outcome of our survey shows that infants from a lower social and economic environment may be at higher risk for SIDS.     

SIDS related anxiety--a risk factor analysis

BACKGROUND: The growing public interest in the Sudden Infant Death Syndrome (SIDS) has led to a new psychological problem--SIDS related anxiety (SRA). General public awareness, unfavourable experience in the past, present problems with the infant or insufficient support from the family may lead or contribute to SRA. OBJECTIVE: The study was conducted to explore which of these factors contribute most to the development of SRA. PATIENTS AND METHODS: Families visiting our outpatient clinic during 18 months were interviewed by means of a structured questionnaire. We assessed demographic data, obstetric history, experience of child loss, pregnancy and delivery complications, infant morbidity, family-child interaction, family support and the relation of each of these single factors to SRA. RESULTS: Of 169 families, 58% (98/169) admitted to suffer from SRA and 21% (32/156) from severe SRA. We found a strong and significant relationship between previous experience of child loss and SRA (OR: 2.95, 95% CI: 1.43-6.09, P < 0.005) and between pregnancy complications and SRA (OR: 2.19, 95% CI: 1.18-4.08, P < 0.05). There were no significant relationships between SRA and either delivery complications, child morbidity, impaired family-child interaction or insufficient support from the family. CONCLUSIONS: SRA occurs in an unexpectedly large proportion of families visiting a SIDS counseling clinic. SRA must be taken seriously, and psychological or psychotherapeutic help should be offered. Prevention of SRA should include psychological care for families who experience loss of children or high-risk pregnancies.