Fort Worth has been an
epicenter of infant mortality in Texas for years. The cause has been called a mystery, and effective prevention strategies have been elusive. Are our infants especially vulnerable, our women less healthy, or our home environments more risky?
Nationally, birth defects and prematurity-related problems account for the majority of infant deaths. Sudden Infant Death Syndrome (SIDS) is also a leading cause of infant mortality, and this is where it gets interesting. A true SIDS death, where no cause of death can be identified after an autopsy and a thorough scene investigation, is very rare. This is why the term Sudden Unexpected Infant Death (SUID) was developed by the Centers for Disease Control. SUID is now the parent category for three causes of infant death: SIDS, Unknown cause, and Accidental Suffocation and Strangulation in Bed (ASSB).
If an infant death occurs in an unsafe sleep environment, it isn’t SIDS according to the SUID classification. When an infant dies in an unsafe sleep environment, unintentional suffocation is a likely cause.
This is certainly true in Fort Worth. At the Child Fatality Review Team (CFRT) meetings where local infant and child deaths are reviewed by a multidisciplinary team of professional volunteers, the majority of infant deaths occur in the context of bed-sharing. Nearly every month, multiple infants die while sharing a bed with their parents, and these deaths are completely preventable!
Why is a physician working to prevent child abuse focused on infant mortality? In Fort Worth, some geographic hotspots for child abuse and neglect directly overlap hotspots for infant mortality. To reduce child abuse and neglect, Mothers should be encouraged to breastfeed as long as they can. To reduce infant mortality, a safe infant sleep environment is critically important. Noticing this overlap, we wondered, were the families from these high-risk geographic areas being encouraged to breastfeed AND practice safe infant sleep?
The answer was no.
A city-wide initiative to train hospital personnel on infant mortality and safe infant sleep practices ensued. Exemplifying Fort Worth’s collaborative spirit, Cook Children’s, John Peter Smith (JPS), Baylor Andrews Women’s Hospital and Harris Methodist worked together updating policies and procedures to insure safe infant sleep practices were being modeled in healthcare settings. Educational materials were co-created and co-branded so that Fort Worth families would hear and see the same message no matter where they received health care.
Some of the recommendations from the American Academy of Pediatrics (AAP) and National Institute of Health came as a bit of a shock to some. Sleep sacks have replaced swaddling in all but premature infants. Bed-sharing with infants increases the risk of both suffocation and SIDS deaths. It is not recommended for infants to regularly sleep in car seats, swings, bouncy seats, or on wedges because the semi-reclined position actually makes reflux worse and introduces other risks into the sleep environment. Empty cribs are safest, meaning no blankets, pillows, lovies, quilts, bumpers, or mobiles. A plain pacifier reduces the risk of SIDS and should be offered at every sleep time after breastfeeding is well established.
Since the initiative began in 2015, there has been a 30% reduction in SUID deaths. We can't say if standardization of policy, behavior modeling, and education through the safe infant sleep initiative caused this change, but it played a part in reducing the number of lives lost to suffocation-related infant mortality.