is something that we're going to be talking a little bit more about today and really hoping to do three things to first of all educate parents and caregivers about this syndrome to offer some tips for providing safe sleep for your children third to prevent this avoidable situation where an infant becomes and that coming in and say sleep situation is the leading cause of death for children under the age of five and i'm going to be join today by some experts will help us look at that and also think about the fact that one of the reasons we launched this campaign every winter is that there are some factors associated with winter cold extra heated houses those sorts of things they can raise the risk of this situation occurring so i'm enjoying the today bye to my immediate left to rick barry the director of operations for a trinity ambulance company beside rick we have julia ready a system specialist and trainer with the institute for health and recovery and finally on the and in i'm sorry who is the nurse manager of the special care industry at winchester hospital so thank you all for being here with us this morning and before we dive into the topic a little bit i know for and it's probably a that thanks as system specialist and coordinate are for the perry natal substance use system i'm on a contract with the bureau of substance abuse services at the department of public health and part of that role is providing materials resources and trainings to our continuum of care for treatment services for perinatal women which includes residential treatment services for women and their babies so safe sleep has come up most recently as an issue in the residential treatment programs how we can provide consistent safe s in those contexts and it you said a lot of time with babies so you spend a lot of time for a lot of years with babies so i am a nurse manager for the special care nursery as well as the pediatric units at winchester hospital so it is an obvious connection you know all all of the teaching that goes out at the time of birth even prenatally around save sleep is key for some families who bring their babies back in for various reasons to the pediatric for better newborns  able to do teaching for families who didn't perhaps leave winchester hospital with their baby reinforce that safe sleep teaching there's a lot of focus throughout maternal child health at winchester on safe sleep so i mentioned a little bit earlier and when i first started hearing the two terms i thought oh maybe they just changed it up a little bit my understanding at this point is that so would as you said sudden unexpected infant death is sort of an umbrella term for any death of an infant less than a year that is that is unexplained sids is sudden infant death syndrome which i think we're more familiar with and that is categorized by an investigation has happened they've looked at everything and at the end of the day is still in you know they're not able to determine what the death is some of the other things that might fall under so what are things like a fixation or strangulation and by that i mean by the bed clothes or by unfortunately the pads that are lining the grip things like that now when is the baby most at risk and when if ever does that risk start to decline a little bit i think the highest risk are right around three months of age but it really exists from the time that they're born you know there are unable to move move their heads they don't have any head control and really until they're able to move themselves independently so somewhere in the up to a year as is generally the vulnerable period but i would say if the first nine months of life are definitely the most vulnerable period now do you mentioned you work with folks who are in treatment and recovery and we know talk about a lot of factors that a change the issues when you're dealing with substance abuse either prenatally or in the key here i've been in food and you know we talk about prevention i know a lot of your work focuses on prevention that begins before the baby's born the prenatal steps that someone can take to ensure that their baby is healthy in general and less susceptible to sue it's so if you talk to us a little bit particularly as we've been looking at this opioid cases and unfortunately seeing this is an area where women are catching up to men in the numbers and women in the childbearing years using more and more opiates what kind of risks does the baby face with prenatal use so that as a man was talking about i like the triple risk model in terms of understanding to do it so the american academy of pediatrics has a model that includes intrinsic or physiological vulnerabilities and then kind of x turn to learn fire mental vulnerabilities such as unsafe sleep and then critical developmental periods so that isn't to say a very unsafe sleep situation can overwhelm any baby's ability to breathe but i do think that when you're talking about the route of prenatal substance exposure and how that increases the risk of infant death you're talking more about the physiological vulnerabilities so the effects that prenatal substance exposure has on a developing in princeton's that particularly in nicotine we see a lot of that so we're seeing now effects of nicotine exposure prenatally on the development of the brain stem and that has actually been found in up to seventy percent i think of of infant deaths autopsies  when it comes to opioid use i think the biggest risk factor is when a woman ops out of consistent prenatal care so no matter what a woman is using if she can engage in high quality prenatal care and cure some of these messages about safe sleep and safe care that can i think medicate a lot of the risk that opiate exposure would have on people development so when you talk about for instance nicotine or other substance use most of the time i think people need i need not to do use those substances during pregnancy so i'll deliver a healthy baby right but what you're talking about is it's not just getting that baby to the delivery date it's how it can affect that baby going forward right it is so in terms of nicotine exposure there is what we call a dose dependent risk which means reduction in nicotine use or tobacco use during pregnancy can actually help fetal outcomes so in terms of tobacco use we can talk about you know reducing use is beneficial not that there is a safe level of nicotine use during pregnancy but less is better in terms of alcohol use the impacts on infant development which can often result in fetal alcohol spectrum disorders that can be physiological neurological cognitive social that is less were less able to tie a safe dosage bound to or timing of drinking to infant outcomes that we say there's no healthy amount of alcohol use during pregnancy but when a baby is born is that what you're trying infant here so then you come into things like having a safe and stable place to live having good contact with postnatal care and behavioral supports if you need that nutritional support so engagement with wic or e i early intervention services visiting nurses then you get into more of the social constructs around addiction which can lead to discrimination and fear and shame and cause women not to engage in services that they have every right to access and that can actually be more protective than staying sober just her pregnancy so there's also a connection between the use of substances during pregnancy and for instance a baby being born prematurely right as goes up baby being born very tiny right risk goes up and those are factors that can affect a baby susceptibility to  syndrome it's hard to distinguish between the cause being soley the substance of exposure and all of the other social determinants of health so you have a lot of times poly substance use so you'll have opiate use but you also might have to back the use so these studies are very difficult to design because most women want healthy babies most women want to do the right thing people don't want to put their babies in jeopardy  it's difficult to say that a substance causes even lower and later something like that without taking into account the overall situation we often say for instance with opioid use it's actually the best practice for a woman to use opiate agonist medications such as methadone or people morphine during pregnancy if that's going to help her stabilize her exposure to opiates so it's not as much the risk to opioid exposure as much as it is the risk of needle use the risk of overdose the risk of withdraw all that puts the fetus in danger now is some of the confusion i think about save sleep tends to date back to kind of generation ships about how the safe way to put a baby and i remember when i had my first child the doctors in the hospital told to put that baby down on their stomach hips and that thinking has changed has it not now is the practice is the best practice is putting a baby on its back absolutely the best practice is putting the baby on its back and it is confusing because you know obviously we all learn from our families and so you know grandparents still sort of have in their mind set that that's the right way to do it but the safest way to put a baby is on his or her back in a crib with nothing else in the crib so that the baby is upright and i know one of the concerns that people have is well what if my baby spits up but honestly the way that the baby's anatomy is set up it is actually safer for the baby to be flat on his or her back even if they do vomit they have a better protection of their airway in that manner than they would if they were face down there's also the fear of you know attracting c o two if you're lying face down and that risk of creating that little air pocket ok c increased is it not by the use of things that look very nice sometimes when you're getting in there are three ready things like those memory cushions an air mattress kind of thing the it's light into the sheet they create those little pockets that the baby can get their face in right anything that is not a flat surface and you know if they can be some softness to it just you know but it is just generally a firm soft surface you don't want memory foam you don't want air you don't want anything that the b b c going to sink into and then that leaves an opportunity for a collection of c o two now rick talk to us a little bit about some of the other things that when you're setting up that nursery or putting the baby down to sleep somewhere you might not be thinking about is posing a danger particularly to a baby who you think is not moving around so things like woods or whatever one of those kinds of things we will be looking at and i think people recognize the danger of the chords but as as and said the bumper pads something that we've been traditionally put in a crib because we want to keep the child safe was pose a very dangerous situation for the baby unfortunately and interesting drew we've talked about tobacco use the american academy of pediatrics has seen an increase in sudden infant death syndrome in a home with a child exposed to secondhand smoke secondhand smoke them anyway right so it was the mother necessarily the mother and there's a concept now of third hand smoke that when you come in that smell that we're all familiar with that you know this mean you haven't smoked you've been with someone somewhere and you've gotten smoke basically you know as inside anything that they could be near the crib that the child could become entrapped in because they don't have that muscle control to be able to remove the house or from them so a blanket that could be over their face a stuffed animal even a small one with their face could increase the risk of a of a sudden unexplained infant death now you mention the blanket and i know you know everyone particularly as we enter the new england winter and it's cold and it's crappy and specially with a baby in the house your instinct is to keep jacking the heat up put another blanket on the baby put something put an extra blanket in the crib to have if it gets colder during the night if you talk to us a little bit about the the risk just of overheating it's based by an infant and again the american academy of pediatrics has drawn a correlation between an overheated have the baby have one more layer than an adult would wear to be comfortable so for a baby to be in a crib and sixty degree room with their one c on in underneath a set of long pajamas is adequate for the b b and if you do use a blanket they recommend that it's a of the goes no higher than the baby's chest now we're talking obviously in these situations but talk a little bit about putting the baby in that crypt baby goes in for the night there in the crib the bassinette that sort of thing but as a first responder can you talk to us a little bit about some of the other situations where the baby's been somewhere else that these tragic calls and you see the devastation we have somebody just didn't get the baby back to the crib by the bassinette yeah there's you know that very dangerous situation for a baby that is left on watched  maybe you're going to nod off as you're holding the baby and you can obstruct the baby's airway so you know certainly the only safe place for the baby to be is in the crib and absolutely there's a there's a very high risk for sharing a bed with the baby and then we think that might be a safe environment for them that's absolutely a very big risk factor so you know the very common scenario that every parent knows babies that up a lot of times during the night is eating infrequently and you just decide to take the baby back into bed thinking you're going to stay awake or you're not going to be close enough to the baby you've got the baby kind of wedged into the middle they'll be perfectly fine same risk factor there when you do that very very high risk factor and we have a different  of bed coverings than a baby should have the pillows in the bed the depth of the mattress of the bed in you know the parents themselves just being a hazard nodding off or maybe rolling over on to the b and it happens more often than  mentioned the couch the dangers posed there with the curves increases that a baby can get their face into where the back seat meets the back of the crib so for the quarter is that sort of thing you know in between the cushions any of these things you know the coach isn't flat it's designed for an adult to sit on comfortably so the baby you know will will naturally roll into those those areas those crevices and maybe obstruct their airway so the coach is not a good situation for baby and that certainly can arise particularly in the situation maybe dads decided to give mom a little bit more sleep takes the baby out into the living room to watch some television maybe settles in on the couch the recliner wherever that may be those guidelines tell us and this i think is you're a parent or a caretaker for children is so compelling and so hard to avoid that if you have a baby in its own separate sleep space sharing a room with its parents for the first year of life you reduce their risk of sudden unexplained infant death by fifty percent right in quick i mean right away whatever risk your baby faces you can cut that happen just by having them in that separate space and still having the same comfort of knowing where your baby use close to you being able to go into care with a baby with a baby as needs in the middle of the night without disrupting the rest of the host world so do you mention you know some of the things that i think we want to call attention to the risks posed to babies when they're caretaker maybe using some sort of substance not just the physiological piece but in terms of attention right and being alert to what the baby's needs architecture is just a little bit about that right sure so when you're thinking about drug use alcohol use and even some medications that people are taking perhaps appropriately according to their prescription a lot of those do cause s natural tiredness of early child care and in combination with a sedative even if it's a prescribed medication then you start to run the risk of not rouse saying when your baby has rolled into an unsafe sleep position or in other ways needs your attention when it comes to a drug that's being used in such a way that it might cause unconsciousness or overdose then we like to talk about harm reduction strategies so always using with someone who is sober in the space who can take care of you or the baby should that need occur and then entering into treatment as quickly and as as as possible so for a woman when she enters into treatment then she's getting access to supportive care and to some of these safe sleep messages and that is kind of the most important thing so that you know we don't want to delay treatment because of discrimination because of fear because of shame we want to always encourage a woman to access the treatment system sas has a continuum of care they license treatment programs all of that the state pregnant women in the state get priority access to treatment so they don't have to wait they  number the waiting list so that's what we encourage and then in terms of second hand smoke and third hand smoke we talk about smokers hygiene so always smoking outside away from the baby when you come in changing your coat washing your hands washing your hair trying to reduce as much as possible exposure to second hand and also that kind of chemical residual matter they know we're looking at some of the things we know about how you can reduce the risk winchester hospital has launched a couple of pilot programs that write to get information to different practices to new parents can you tell us a little bit about those so first of all we decided to give every parent that comes through winchester in any of the nurseries a sleep sack which is designed to safely provide a safe sleep environment for the baby so we're talking a little bit earlier about how do you keep a baby warm enough it's it's chilly it's no england and totally agree with everything you said so you can either put one of those blankets sleepers on which are kind of thick and warm or you can put one of these on which allows the baby to have their hands there is zipped in they're able to be wrapped so that they can keep their hands close but they can get to their to their fingers and thumbs for developmentally based care and yet it's it's warm enough and so it's sort of like wearing a blanket if you will but it's a safe blanket because it's you know you're wearing it your head comes through here your through here there's no way for it to come up and cover your face they come in premature sizes and they come in full term and we have this is a late one but we also have them the much warmer ones so we have are working with the halo company to provide every parent that leaves with that and every baby that's in the hospital at the time with their own special care of the well nursery we have them in that unit and they are put on the babies so they utilize so that parents can watch us provide care with them they're also given when they go home and we're about to launch a pilot for the the baby box which is going to address the situation that that we've been talking about what how do you keep the baby safe you want the baby in bed with you know but you know unfortunately there have been multiple occasions in the last year where parents have literally rolled over and woken up in the morning and the baby has expired underneath them and their whole goal is to keep the baby safe in the bed with them so this is a very simple call the baby box that we are going to do a pilot and have parents utilize something like this box to either have in the bed between them so the baby's easily accessible they can hear the baby but the baby has no risk of being rolled over the indoor to your point that's coming out he's going to watch the football game you put the baby up there you fall asleep and if this happens that the baby is trapped here between the father's head and neck in this case you have your box you take it with you you put next to your recliner the baby safe you can see the baby moms get a little sleep but nobody's running the risk of having a problem so to go back to the sleepers for a second someone put your baby in a diaper or a t shirt are ones the you know and then that goes on over there right perfectly adequate in the winter because i think you're right people do think well they just don't warm enough they really are you know save the beautiful quilt that you got from so and so when you are visibly looking at your baby in the baby is having tummy time that's when you can use that nurses could ever do again yet you go anyway and the nice thing about this too is that it slips from the bottom so you can quickly change the pants and without getting the baby all discombobulated tuck them back in sit down and wrap your baby up and you're good to go and the box is very he gets up and wants to go into the living room or whatever they just pick that up bring it with them put the baby down inside right exactly as little handle i mean obviously you would not take the baby in until you got to where your destination was but it is very lightweight and comes  mattress and you know again it's a firm mattress so it's it's totally safe environment now you know what a lot of the work that we've been doing in this topic is obviously focused on prevention and much of that has looked to first responders because in many respects you have an opportunity to go into homes often before something tragic happens and be able to make some observations it's a little bit about how you see your role sort of is that  houses in order to assist them regardless of what the initial call is if we see hazard that we can identify in have a coaching moment with the family whether it's this hazard whether it's a trip hazard for the elderly you know we go from being the traditional reactive service where somebody calls number one we show up and now we can go to a more progressive proactive role so it's a good opportunity to be an advocate for the community in a coach for the community and some of the best practices and also one  been working at is making sure parents get that information to their caretakers whether it's grandparents or others or in the case of a paid caretaker just really knowing that they have the same information about safe sleep it's actually a higher risk if a baby is consistently put on their back and then is put on their stomach once so we have to be very careful of babysitters and grandparents and daycare providers providing this consistent message which should be modeled in the hospital before discharge and then continued through any home visiting service or any other service provider that's modeling safely so that's an important point even if you're doing all the safe sleep practices at home and baby goes up to a caretaker or somebody comes in to sit for the child and does something different that is poses an additional risk to your baby and there's a very nice brochure that's addressed directly to grandparents that we give out the talks of office because as we talked about at the beginning it is a huge learning curve for them and sometimes i think i raise my kids that way and they're fine exactly right well unfortunately we are out of time i'd like to thank you all for being here today and enjoy your i think we've shared some important information with our viewers here today and they give you for tuning in to this you know in middlesex county we have eighty five thousand children under the age of five and as the chief law enforcement officer one of my concerns always is their safety and protection so we hope you've learned some things today if you have a new baby or expecting a new baby or care for a new baby please visit our web website which is middlesex v a dot com you'll be able to see more information on the tab about save sleep pulldown in use any of the resources that are available there the most important pieces preventing this unexpected death of an infant thank you so much