know i'm is a little sex district attorney marian ryan and thank you for turning into tuning into our office out of middlesex update the topic of our show today is infancy of sleep awareness tragically across the united states over two thousand incidents die every year from sudden unexpected infant deaths is in fact the leading cause of death in children under the age of one and as the district attorney my office responds to every and attended death across the county including tragically those of infants and what we know is that over the past five years our child atallah to review team has investigated nineteen cases of th sudden unexpected infant death in this county the good news in all of this is that both our experience as well as the medical data indicates that there are many interventions and step preventive steps that we can take to reduce this number and that's what we're going to be talking about today and it's a part of my safe a b safe kids task force which in the summer of two thousand and fourteen launched our safe sleep awareness campaign and they'll be a variety of activities and informational postings throughout the year speaking to this issue in today's program is a positive first step in many of those efforts and joining me today are three well respected in the singlish members of the massachusetts medical system and on the end sharon fitzpatrick the nurse manager for the special care nursery at winchester hospital thank you all so much for being here today to talk about this important topic and i'd like to start by getting to be an opportunity to tell  viewers a little bit about yourselves and what your responsibilities are and dr sanjay as if we could start with you here i'm what's called a neonatologist which means i'm a pediatrician with a subspecialty in the care of you born infants i and cambridge hospital and care for instance there i often refer to myself as a baby doctor and you know deal with koski and the father of six children and i also have a new asked i'd like to ask you to define for our view is acronym that they may have heard before sids and tell us what that is and then also how it differs from something they may not have heard as much about that in that syndrome and what's different it's a great question i think there's a lot of confusion about the two different terms so first i'll talk a little bit about su id which is sudden unexpected infant death syndrome and i say the way to distinguish between these two concepts is s stance is the broader concept of which sits is a subset so since which is the term i think most people are familiar with stands for sudden infant death syndrome the difference is as i said s e y d is a much broader concept and sudden unexpected infant death syndrome is defined by an infant who dies in the first year of life suddenly and unexpectedly for which there is no obvious cause prior to the investigation and it's a broad category of possibilities of which sids is the largest subgroup sids sudden infant death syndrome refers to infants who die in the first year of life suddenly and unexpectedly for which there is no known cause following an investigation that includes an autopsy and investigation at the scene as well as in detail the medical history and when is a baby most at risk for sudden unexplained  infants are at greatest risk in the first four to six months of life about ninety percent of sids will occur in the first four to six months of life but it's important to keep in mind that the infants are at risk for the entire first year of life so safe sleeping practices must continue for the entire first year of life so it's not until a baby reaches their first birthday that that risk really starts to decline that's correct and one of the ways we know to reduce sudden did infant death is to think about the way we put a baby down to sleep is that correct and there always seems to be a lot of confusion and i'm sure the doctor with guys because to tell us a question or racial lines because the way you should do that properly has approved crib and have a fitted tight fitted sheet on it no bumper pads no extra materials blankets or anything in the crib with the baby so that's different that when many of us who have older children learned which was put the baby down on their their stomach they're re breathing and building up carbon dioxide in the more chances of suffocation if they're on their stomach now there are any scenarios in which a child should be put down on their stomach there are babies that's been diagnosed with mentioned some of the things that are important not having lots of blankets and toys and things in the crib but we know from the research and certainly you know from your practice that the real reduction of risk prevention work begins when someone is pregnant right is that right  what are some of the steps that an expectant mother can take you know as an obstetrician you know i have a great opportunity to really help and educate my patients because they come to see me like twelve or thirteen times during their prenatal course so one of the things that i have the opportunity is really time to get some of that misinformation some of those changes that have occurred over the generations you know that new information out to these new moms you know one of the things that i found most striking the biggest change was with the crips you know now we have crews that have four you know sides that are that a stationary there's no more sides that go up and down because they found that babies were getting their heads caught in between that mattress and that side that went up and down so i'm able to really help patients to kind of sift through all the social media and all the advertising you know some of these bumpers that we see in some of the cribs still today in some of the stores that these moms a shopping at show lots of fluffy blankets and bumpers that really could be a suffocation risk so that crib that's been to the family for a long time or that you what do use it grandma's house or whatever really that may not be a good idea and you want to be doing it we'll check of today's information and how safe that is that's right and as an obstetrician sometimes just mentioning whether or not they realize that they have been changes is a big step for us are there certain medical conditions either in the expectant mother or in the new boy that make babies more prone to this risk in this shown as they do retrospective studies and do some of these investigations that certain groups really kind of fall out as high risk groups some of them are social or behavioral issues like no prenatal care or an adequate prenatal care some of it could be like low weight gain during their prenatal course to some medical conditions to like anemia or placental that puts them at more risk now jack to use it as you we talked about the importance of the crib setting but you certainly see and we know from our investigations that there are other sleep scenarios that put a child at much greater risk could you tell us a little bit about some of those absolutely as pediatricians we recommend that when babies are ready to go to sleep that they should be placed in their own best netter cream with no other loose objects around and it should be a space where it's just for them  infinite alone in a safe space there is a concept of something that's called bed sharing in which an infant instead of being placed safely in his or her crib or bassinet is placed first put to sleep in a regular bed along with other people c other siblings other children other adults and obviously the baby's at risk for lots of problems that way there's a risk of someone rolling over on top of the baby leading to suffocation there's a risk that the baby could get  places like between the wall between the mattress there's a risk that soft objects could wind up obstructing the baby's ability to breathe so we do not as pediatricians recommend bed sharing at all and it is a source of inadvertent suffocation and ultimately death now dr mccarthy i know when when my children were young and i especially here in boston where it's cold most of the year i was constantly worried about my babies being cold and i think so many parents hav everywhere reaction to try to put an extra blanket on the baby turn the heat up in the car turn the heat up in the house and can you tell us how overheating what it is first of all and then how it affects the baby's risk well you know newborns don't really regulate their temperature as well as mature humans so when they first born if you put them the better especially here in new england especially after this winter that we just had being so cold still cold even this spring we tend to overdress we tend to wrap the babies up in too many clothes or too many blankets and then the baby's body temperature can really rise can really increase in the actually get warm and that puts the babies at increased risk for four sudden death so really the best thing is  to have that crib that's without anything in it really with a firm mattress and in a tight sheet over it or a tight fitted sheet that fits it well and then have the baby in lightly swaddled in a blanket or if you don't like that they have those little baby sacks that the babies sleep in which are also very safe and regulate their temperature safely and i'm sure at the hospital you see particularly this time of year parents who always want to just do that extra blanket and then have what's happening at the hospitals to help educate people about that we do have educational programs and we have posters around and on discharge we do do reinforce to the parents about safe sleep and we know that people mimic you know professionals so we try to set an example for them to follow by putting the babies on their backs to sleep not having extra bank blankets and toys and such in the cribs in just sitting having learned by keep their baby safe when they go to sleep and one of the things we recognize is that all breastfeeding and all parents of young children are chronically sick and i think if you help here that i was in a meeting with you and someone said if a mother is sleepy and you basically said that women aren't and so we do recognize that all parents of young children and all breastfeeding moms are chronically sleep deprived and so we try to educate parents to try to prospect a plea think about what are you going to do when you're in the bed with  me in the middle of the night and you're at risk for falling asleep and we ask the parents to be vigilant with each other but this safest best place for a baby to go to sleep and when you're designing your nursery what you want to do and here's a picture of what we're talking about which is you want to have back with no other loose objects around now it's often hard to resist especially with a first child or a first grandchild you go into the stores and you see cribs with all kinds of things all kinds of fluffy things and characters it's hard to resist the pull of that and one of the things we've talked about is taking those items and putting them somewhere else in the nursery and i know you'll be able to see it some point we have in the front of our table some of the high school students across the county designed a poster just showing how you can move some of those objects so that the crib itself is as you've described it just very plain and there's just a sheet and that's all that's in the crib with the baby now does it as if a baby does survive has an episode of this overheating or suffocation and they survived that incident what kind of short term and long term medical consequences does that have so whenever uh patient whether it's a baby or a child has a period of either little oxygen are no oxygen we are always concerned about damage to major organs particularly the brain so whenever somebody has a period of time particularly in bend with either no oxygen or low oxygen there is potential damage to the brain and any of the other major organs of the body like the heart and the kidneys so one of the short and long term consequences is neurologic damage in the short term sometimes these infants are in intensive care units on ventilator sometimes they're never able to come off the ventilator but in the long run if they do survive we worry about long term brain damaged developmental delays the possibility of deafness blindness inability to walk or talk so pretty s sequelae period of time with either little or no oxygen the doctor which has these doctors sanchez talked about how they talk with parents as they're leaving the hospital about how to do it and that's a moment where you're pretty overwhelmed you're tired you've got lots of things going on and as you said you have a lot longer time to speak to patients over that twelve thirteen visits especially at the end of your pregnancy when you go in every week and especially if your first baby you know quite have all of that happening at home so how important do you see what are safe baby safe kids program is doing in terms of involving o b g y n practices really in this education piece well most of the planning for when the baby comes home occurs in the prenatal course you know as you get beyond that thirty six week into that last month of your pregnancy that's where you're taking the trips to the stores making your plans on how to set up you nursery so that's a great opportunity for obstetricians and gynecologists to really get involved in that process you know we can talk to patients about the simple things that we all know about about you know not smoking cigarettes as we've been to a great association between smoking and not just smoking cigarettes but any smoke in the house and in new england you know we have fireplaces and sometimes those flu aren't really cleaned up well enough and some of that smoke gets in the house and that can affect the newborns lungs and they're not fully developed yet in they can't really handle that kind so even if there's other caregivers that you're going to have take care of you  you know to start talking about that and start making plans especially if they smoke and are going to be smoking potentially smoking around your baby so i really think the obstetrician has a great opportunity because that's where most of the plans not only in how to set up the nursery but how they're going to set up all their caregivers when the baby first comes home now sharon you talked a little bit about how important it was for parents to be modeled you know to have behavior model themselves learn from professionals how about does raises a good point it's not just mom and dad that are going to take care of that baby there's the grandparents the daycare providers babysitters all of that and particularly for instance with grandparents all of whom have different ideas and separated by a generation how important is it that that be communicated and what's a good way for people to maybe tell grandma or grandpa or we don't put the baby down on their stomach anymore and make sure they're doing that we try to stress to the parents that they need to be an advocate for their pick for their child and maybe it was a practice mom and dad their mom and dad did but it's just statistically it shows that this is the best practice to do there's a nice way to do it and we have we give out a book to it's called  sleep baby safe and sound we give it to the parents in this just a book to read to the babies and we've given it to grandparents or caregivers that are going to be caring for these children i think one of the biggest things that was stressed here was when you tired you need to put the baby down because you have dads you know holding the baby trying to give mom some rest and they're falling asleep with the baby in their arms and i think that's one of a major thing that we've tried to stress to the parents and that is unfortunately a tragic is fairly often over the last year or so really how many that people just trying to give each other help out a little bit it's two or three of the morning you think you're in the recliner or you're lying on the bed in the baby's going to go off to sleep in that baby dr sears has said rolling itself wedging its head in somewhere in beside the the parent in the quit in the chair and suffocating there i think you become much more aware of even commercials on t v showing the dad holding the baby turning the light off the light fixture off you know so it's quiet for the baby in the link you know put the baby in the crib put the baby in the crib or it's nice and safe now this is been a great opportunity to get some of this information out to do the educational piece we like to give each of you an opportunity to talk a little bit about what's been happening at your respective hospitals in working on the safe sleep practices we'll start with you dr cintas so we have a team approach to this where as dr would counsel he said it starts with our obstetric team whether it's our midwives or o b g y n who communicate with parents before the babies are born and then we follow up in the hospital and as i mentioned this is one of the things that the massachusetts department of public health made available to all hospitals which our hospital now continues to print and we've also learned to model this in the hospital in the past year at one of our quality improvement meetings i believe it was a group from south shore hospital that presented data where we were talking to parents about safe sleep but not really modeling it in the hospital so what we have done is we're making sure that we model in the hospital so when we're talking to parents about the example of a baby in his or her own ethernet with no other hospital among arbonne hospital in winchester hospital it's really about modeling it's really about everybody participating the obstetricians the pediatricians the neonatologists and modeling for the parents to see that how to place the baby down on the baby's back in that empty crib on that firm mattress that's you know well covered and we use a single pillow pillow case at melbourne's wakefield in the bassinets to keep it very simple and open no nothing around the baby no toys no stuffed animals nothing and then you know we give them lots of handouts also and a lot of you know verbal education reminding them of all the things that are in the handouts really pointing out some of the some of the key points so it really is very collaborative really multidisciplinary between nurses physicians social workers everybody just participating to make this as safe as possible and shouted at winchester has to have had a program for a long care nursery you have some of our smallest in youngest babies that are there i think we have the advantage of having them there a little bit longer and our practices have changed as we've become more aware of what what is expected and what is needed for these babies in does a lot of longevity there so nursing has had to change their practices so they're setting a good example for these parents and on the well baby side are doing the same thing they're giving out handouts they're during during the visit they're just charge teaching day reiterate you know save sleep habits and they've changed in you know how they have them in the in the cribs in the bassinet in the well baby nursery too i think by setting an example show one of the things that we didn't mention i know is that a great change is when you have multiple birth that image that many of us may have seen of twins two adorable babies are tucked into the same crib together with the private idea and that and we don't do that anymore we used to we used to i mean triplets or twins we would call bed them and we use always use the scenario over there on monitors we're monitoring them and we do not do that any longer they are in their own separate beds so at the same thing everybody should go to bed in the house in their own bed and spend the whole night in that same place well unfortunately we went out of time but i want to thank you all for being here it's been an honor to have you here today and for those watching at home i hope you've enjoyed this discussion i hope that