October is Safe Sleep Awareness Month, which aims to reduce the risk of sleep-related infant deaths. According to the Centers for Disease Control and Prevention (CDC), more than 3,700 babies in the U.S. die suddenly and unexpectedly every year while sleeping, often due to sudden unexpected infant death (SUID). The most common types of SUID include sudden infant death syndrome (SIDS) and accidental death from suffocation or strangulation.
Sanjuanita Garza-Cox, M.D., a neonatologist at Pediatrix® Neonatology of San Antonio and Methodist Children's Hospital in Texas, explains how neonatologists in the state are working to combat misinformation, promote safe sleep environments for babies and educate caregivers on safe sleep methods. Additionally, she serves as a member of the Texas Department of State Health Services' Texas Child Fatality Review team.
In 2016, the Bexar County Child Fatality Review Team, of which Dr. Garza-Cox was a member, noted that infant mortality due to unsafe sleep environments was increasing.
"My neonatology peers and I gathered to brainstorm on ways we could make an impact in our community," explained Dr. Garza-Cox. "Shortly after, we founded Baby Education for South Texas - B.E.S.T., a nonprofit organization focused on decreasing preventable causes of infant death through education and advocacy."
B.E.S.T. founding board members included a neonatologist from each of the hospital systems in the county and a medical examiner. The group's first task was to lead their hospitals to standardize modeling and education while achieving National Safe Sleep Hospital Certification.
Dr. Garza-Cox explains, "We used to label all unexpected infant deaths as SIDS until we started recognizing that the majority of deaths are related to the sleep environment and SIDS are the minority, deaths with no other causes after a full evaluation."
Standardizing how their hospitals modeled and explained safe sleep habits was a key first step.
"We decided to lead our hospitals into getting Safe Sleep Certification and for nursing staff to focus on modelling safe sleep in the newborn nursery and in the neonatal intensive care unit," said Dr. Garza-Cox. "Infant safe sleep education needs to begin during prenatal care, but what we do in the hospital matters," she said, explaining how if a parent sees a nurse putting a baby on their belly, putting a pillow with their baby or wrapping them loosely, they may imitate that practice, which is not recommended, at home.
B.E.S.T. has grown with the help of community partners to cover more of Southwest Texas. While safe sleep remains at the core of its mission, it also works to educate parents and health providers on other safety issues that could result in infant deaths.
"We focus on safety for infants and to keep the family healthy," explained Dr. Garza-Cox. "One of our big initiatives is safe sleep, use of car seats, as well as pool safety, the leading causes of death seen in Texas Child Fatality Review."
As hospitals throughout the country became safe sleep certified, the numbers of sleep-related deaths started to decline. However, there has been an uptick in recent years.
In addition to re-energizing the in-hospital efforts, B.E.S.T. is now working to educate parents before their baby arrives using educational videos introduced by their prenatal providers. "We have several obstetrician-gynecologists who actually do education through an app," shared Dr. Garza-Cox. Patients get points for every video they watch, and the points earn prizes at the end of their pregnancy.
The group is also focused on creating educational materials for pediatricians and family medicine physicians in the region.
"We need to touch to every single office in our counties to make sure that they are doing the education, ensuring that the materials they have in their offices are consistent with safe sleep practices. The last thing you want to do is have a poster in the office that is showing an unsafe practice," said Dr. Garza-Cox.
While B.E.S.T. works to raise awareness of safe sleep practices locally, Dr. Garza-Cox points out that there is more to be done at a national level with major retailers selling baby products that may be unsafe and influencers on social media promoting practices that are not recommended. Dr. Garza-Cox advises parents to carefully review any sleep products to ensure they meet American Academy of Pediatrics' safe sleep environment standards.
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