babyguide 2008 back to index [ Sleep Safety ] Resting Easy TFMIR Working to Promote Safe Sleep Environments by Nicole Macia Sleep can sometimes be a not-so-safe activity for infants. According to the the Health Department’s Tulsa Fetal and Infant Mortality Review Project (TFMIR), there were a total of 213 resident infant deaths in Tulsa County between 2002 and 2004, with a total of 33 sleep-related deaths over the three years. Twenty-eight of these deaths were considered a result of non-safe sleep environments. Because well-meaning parents may inadvertently put their infants at risk when they put them down for sleep, TFMIR is working to ensure that Tulsa County infants rest easier – and safer – by educating parents about safe sleep practices. The project takes on the grim task of studying infants who were born and then died in Tulsa County in order to enhance the health and well-being of women, infants and families. With permission, data abstractions of hospital records, parent interviews and other relevant documents are conducted of all babies one year of age and under, and no client information is shared. “We look to see what is contributing to these infant deaths,” says Pam Rask, manager of “It’s All About Kids” school health program and TFMIR. “We look at what kinds of issues we see in the community and determine where we need a system change.” Recommendations are made by a case review team and are given to a community action team to develop systemic changes. “We are seeing a lot of deaths that occur as it relates to non-safe sleep environments...such as parents not having a crib for the baby,” says Rask. “We can target our strategies and interventions based on why infants are dying in our community and [use what we learn] to improve our birth outcome and reduce infant mortality.” Non-safe sleep environments can refer to co-sleeping with an infant, an infant’s sleep position, or using an inappropriate crib for the baby. To get the word out, about the importance of practicing safe sleep habits, TFMIR is launching a “safe sleep” campaign in collaboration with the Oklahoma State Department of Health. “Parents just need to realize what the safe sleep guidelines are,” says Rask. “You can keep your baby close to you, but still in a safe environment. We want this info out…we want parents to know what a safe sleep environment is.” Rask suggests making sure there is no loose bedding or items placed in the crib, and it is advised to have bumper pads that are well anchored. It is not recommended that parents sleep with their infant because they may accidentally roll over on the baby. Other guidelines include placing infants on their backs for their naps and at night, quitting smoking and avoiding second-hand smoke, removing pillows and blankets from the crib or other sleep areas, and using one piece of sleep clothing. The crib should also have a firm mattress covered by a fitted sheet.  TFMIR is making a positive difference with the help and cooperation of medical, social service and other community agencies. Tulsa County’s infant mortality rate has decreased by 26.7 percent in 2004. “As a grandmother and parent, I think one infant death is too many. We need to do whatever we can to prevent these infant deaths, especially knowing these babies are dying in unsafe sleep environments,” says Rask. “Those can be prevented.” Sidebar: The Safe Sleep Top 10 • Always place your baby on his or her back to sleep, for naps and at night. • Place your baby on a firm sleep surface, such as on a safety-approved crib mattress, covered by a fitted sheet. • Keep soft objects, toys, and loose bedding out of your baby’s sleep area. • Do not allow smoking around your baby. • Keep your baby’s sleep area close to, but separate from, where you and others sleep. • Think about using a clean, dry pacifier when placing the infant down to sleep. • Do not let your baby overheat during sleep. • Avoid products that claim to reduce the risk of SIDS. • Do not use home monitors to reduce the risk of SIDS. • Reduce the chance that flat spots will develop on your baby’s head—provide “Tummy Time” when your baby is awake and someone is watching.