NPM #5 Safe Sleep – Promote safe sleep practices among newborns to reduce sleep-related infant deaths.

 

According to the American Academy of Pediatrics (AAP), throughout the first year of life, sleeping babies die accidentally from: suffocation, smothering, wedging, being trapped under someone else while sharing a bed, being placed to sleep on a surface not intended for an infant, and Sudden Infant Death Syndrome (SIDS). Infant deaths due to unsafe sleep practices continue to be a significant contributor to infant deaths in the US and Missouri. The AAP has issued evidence-based recommendations for a safe infant sleep environment. The recommendations are based on epidemiologic case-control studies of infants up to one year of age. Even though Safe Sleep was not selected as a top priority during the 2016-2020 needs assessment, Missouri selected the percent of infants placed to sleep on their backs as a State Performance Measure. According to the 2020 Pregnancy Risk Assessment Monitoring System (PRAMS), there was a 7.48% increase in Missouri mothers (84.8%) who placed infants to sleep on their backs from 2016. This exceeded the HP2020 goal of 75.9% and was higher than the 2020 overall rate (79.5%) for PRAMS sites*. PRAMS data indicate younger mothers are less likely to commonly place babies to sleep on their backs (Figure 2). Though there was a racial difference for 2020 (Figure 3), there was a 5.8% increase from the 2019 percentage for Non-Hispanic Black women (65.2%). College graduates were the highest proportion of mothers who laid infants to sleep on their back (89.9%). Those with private insurance had a higher percentage of infants placed to sleep on their backs (89.5%) than those on Medicaid (80.4%). Continued education and outreach is needed to increase awareness among mothers and caregivers who are not practicing safe sleep.

 

 

 

Safe Sleep Initiatives

 

Resources

The Bureau of Community Health and Wellness (BCHW) serves as the state lead for Safe Kids Worldwide to implement and facilitate accomplishment of common goals and objectives concerning childhood injury prevention. BCHW provided funding for 10 Safe Kids (SK) coalitions that serve 59 counties. All 10 coalitions provided unintentional injury prevention services to children aged 0-19 years. The SK coalitions are led by a variety of agencies including local public health agencies (LPHAs), non-profit entities, and local hospital systems. The SK coalitions address priorities including crib safety and safe sleep based on community needs. The SK coalitions worked closely with law enforcement officers, fire fighters, paramedics, medical professionals, educators, businesses, public policy makers, and most importantly parents, children, and adolescents. Through this network, more than 450 cribs were provided along with AAP safe sleep education and training. In addition, 126 safe sleep events and trainings were held to reduce the risk of infant injury or death due to unsafe sleep environments. These events and trainings reached more than 1,300 participants such as expectant parents, new parents, caregivers, relatives (such as grandparents), foster parents, first responders, and public safety officers. The SK coalitions continued to conduct media campaigns with safe sleep promotion messages and work with policy makers to address gaps in policies that could prevent safe sleep injuries. These activities were supported with Title V MCH Block Grant funds and other funding sources.

 

SSM Health Cardinal Glennon Children’s Hospital, the site of the SK Coalition in St. Louis, provided a one-hour Safe Sleep Training developed by the co-chairs of the SSM Health Safe Sleep Champion committee. Over 1,000 first responders, including law enforcement, health care providers, first responders, emergency medical services personnel, firefighters, and other public safety professionals received training on evidence-based infant safe sleep recommendations. The training was available in-person and virtually through Cardinal Glennon’s Arlo training website. As first responders respond to many non-emergent situations, they can assess potential unsafe sleep environments if a child’s home. The goal of the training was for first responders to understand the importance of infant safe sleep, have the knowledge needed to identify an unsafe sleep environment and be able to provide evidence-based safe sleep education to caregivers in the communities they serve. The ultimate goal was to prevent tragic infant loss related to unsafe sleep practices. Pediatric residents, advanced practice nurses and all new employees at SSM Health Cardinal Glennon Children’s Hospital were also trained as Safe Sleep champions.

 

In addition to training healthcare providers, first responders, and public safety professionals, the Cardinal Glennon Safety programs offered monthly Baby Safety 101! classes for caregivers and monthly virtual infant CPR classes where safe sleep education was provided. Cardinal Glennon also partnered with community agencies to provide the Baby Safety 101! classes within the community in an effort to reduce barriers for the most vulnerable populations. Upon completion of the class, if the caregiver needed a safe sleep environment but lacked the means to purchase one, it was provided at no cost. The safe sleep environment included a portable play yard, fitted crib sheet, sleep sack, bulb suction syringe, pacifier, and the “Sleep Baby Safe and Sound” book by Charlie’s Kids Foundation. Caregivers were also provided a bag of home safety resources and an informational folder on safe sleep.

 

The Title V MCH and the Maternal, Infant and Early Childhood Home Visiting (MIECHV) funded home visiting services, organized in the Department of Elementary and Secondary Education (DESE), Office of Childhood (OOC), were offered in 26 counties and served 1,008 families in FY21 through four evidence-based home visiting models:

• Nurse Family Partnership;
• Healthy Families America;
• Parents as Teachers; and
• Early Head Start Home Based Option.

 

All Title V MCH funded Home Visiting Program contracted home visitors actively promoted and provided resources on the ABCs (Alone, on their Back, in a Crib) of Safe Sleep. Home visitors also promoted safe sleep for families who did not have and could not afford a crib by obtaining portable cribs through the Safe Cribs for Missouri program or other local resources. The Home Visiting Program continued to update and provide all contracted home visitors with information on how to obtain portable cribs and create safe sleep environments as recommended by the AAP. This information was shared with contracted home visiting agency staff for distribution to enrolled families through a variety of ongoing communication including: postings within the continuous quality improvement Missouri Home Visiting Gateway Website on the Home Visiting Program’s web-based data collection system platform, the Weekly Update emailed to each contracted home visitor and supervisor, monthly subrecipient monitoring calls with contracted agencies, and during annual home visiting professional development events.

 

The Home Visiting Program collects data on the percentage of infants enrolled in home visiting who are always placed to sleep on their backs, without bedsharing, or without soft bedding. This data is collected at birth and up to twelve months of age. In FY21, the combined percentage was 78.6% (217/276). The Home Visiting Program included articles, webinars, and other resources on safe sleep in seven Weekly Updates on 10/2/20, 10/9/20, 10/30/20, 12/11/20, 1/29/21, 6/4/21, and 6/18/21. Safe sleep was also promoted in the first quarter Home Visiting Program’s continuous quality improvement Newsletter, Quality Outlook, during SIDS Awareness Month.

 

The Safe Cribs for Missouri Program provided portable cribs and safe sleep educational resources to participating agencies. In addition to the National Institute of Child Health and Human Development SIDS risk reduction online education program, the Safe Cribs for Missouri Program continued to evaluate and provide access to other evidence-based resources for safe sleep educators. All education programs and resources complied with the evidence-based AAP safe sleep recommendations. The Safe Cribs for Missouri Program also continued to collaborate with the Department of Social Services (DSS)-Children’s Division (CD), the DSS Child Fatality Review Program and the Children’s Trust Fund (CTF) to develop part 2 of the online safe sleep training for CD staff who work directly with families. As a member of the States Safe Sleep Coalition, the program continued to collaborate with CTF, CD, Infant Loss Resources, Inc., pediatric hospitals, and other coalition members to implement the new strategic plan to reduce sleep-related infant deaths. The strategic plan was developed with the guidance of the National Institute for Children’s Health Quality.

 

The Safe Cribs for Missouri Program continued to work with Safe Sleep Coalition partners to provide safe sleep education and technical assistance to hospitals. Resources included the new safe sleep video, the “This Side Up While Sleeping” t-shirt, and other educational materials available from the DHSS at no charge. In addition, information about the National Safe Sleep Hospital Certification Program was provided. The Safe Cribs for Missouri Program also continued to collaborate with the Safe Sleep Coalition partners to develop a way to recognize hospitals that achieve National Safe Sleep Certification.

 

The TEL-LINK Program helped improve MCH by providing health care service referrals to increase access to care for any Missourian who needs assistance. The program promoted this service through search engine campaigns to provide outreach to the underserved population. TEL-LINK provided referrals to a wide range of services related to safe sleep including safe crib providers, WIC clinics, child care facilities, and many more.

 

The MCH Services Program continued to contract with five LPHAs that selected the priority health issue to promote safe sleep practices among newborns to reduce sleep-related infant deaths.

• Benton County Health Department implemented a Safe Cribs Program that provided a safe sleep environment and education to parent(s). This resulted in an increase in the number of infants placed to sleep on an approved sleep surface as well as an increase in the number of infants placed to sleep on their backs.
• Scott County Health Department collaborated with the WIC program to implement a safe sleep survey to be administered to WIC participants that were either at 35 weeks gestation or more or had an infant up to 3 months of age. The Safe Cribs Missouri Program paired with safe sleep education was implemented to promote safe sleep practices. This resulted in an increase in the number of infants placed to sleep on an approved sleep surface as well as an increase in the number of infants placed to sleep on their backs.

 

The DHSS continued to participate in the Maternal and Child Learning and Action Network (MC LAN) to assist with implementation of infant morbidity/mortality reduction initiatives throughout the state. The MC LAN launched a Missouri Neonatal Abstinence Syndrome (NAS) collaborative in year 2021, which coincided with implementation of the Obstetric Care for Women with Opioid Use Disorder. Throughout the next two years, participating organizations are focusing on changing the model of care for substance-exposed newborns, including: supporting the mother-infant dyad and the mother as “medicine;” incorporating the functional assessment model Eat, Sleep, Console into practice, establishing Safe Plans of Care for the mother and infant, and accessing training on stigma and bias reduction. Similar to the maternal projects through the MC LAN, participating hospitals will be required to submit data through MHA for progress and outcomes monitoring.

 

The Mothers, Infants and NAS ECHO (Extension for Community Healthcare Outcomes) was created by the University of Missouri’s Telehealth Network and the Missouri Hospital Association to support rural health care providers in caring for the mother-infant dyad with substance exposure. The ECHO started in FY21, regularly occurs bi-monthly for one hour, and includes a brief didactic presentation, sharing of case studies, and discussion with a multi-disciplinary panel of experts for enhanced collaborative learning. The MCH Director and Maternal/Infant Mortality Coordinator participated in the EHCO. The objectives of the ECHO are to:

• Improve identification of mother-infant dyads affected by substance use disorder (SUD) by implementing validated screening techniques, guidelines and referrals;

• Support implementation of the Eat, Sleep, Console (ESC) non-pharmacologic care model for optimal health and psychosocial outcomes;
• Provide guidance for use of pharmacologic interventions for infants with in-utero exposure from maternal substance use;
• Identify a framework to connect hospitals with internal and external support/resources for the mother-infant dyad; and
• Ensure mothers with SUD receive appropriate pain and withdrawal assessment and treatment after delivery to stabilize symptoms, promote recovery, and support optimal family function.

 

Collaboratives

The MCH Director, MCH Services Program team, and Office on Women’s Health (OWH) continued to participate in, as well as be a resource for the local and regional infant mortality initiatives, including Generate Health and FLOURISH in St. Louis, Nurture KC in Kansas City, and the Missouri Bootheel Regional Consortium (MBRC)-Bootheel Babies & Families initiative in the southeast region of the state. Nurture KC and MBRC are the two Healthy Start Grantees in Missouri.

• St. Louis: Generate Health’s initiatives focused on five strategic priorities, including: health equity, maternal and infant health, perinatal behavioral health, immunizations, and making change happen. With Generate Health as a backbone organization, FLOURISH is a collective impact initiative aimed at making St. Louis a place where healthy babies and families flourish. FLOURISH focused on six priority issues: coordinated quality care, safe sleep, housing, transportation, home visitation and behavioral health.
• Kansas City: Nurture KC’s focus was on traditionally low-income families residing in hard to reach neighborhoods. They have a special emphasis on cultural competency and strive to help people of all racial, ethnic, and socio-economic backgrounds. Nurture KC had a special focus on safe sleep and coordinated the Safe Sleep Task Force, a group of committed volunteers working to reduce infant deaths through education on safe sleep practices. Nurture KC also provided eligible families with cribs.
• Southeast Missouri: Bootheel Babies & Families had three key focus areas including healthcare, safe sleep habits, and substance misuse. Unsafe sleep was the primary cause of infant mortality in that region of the state. They also continued to organize and host the annual low birth weight conference, bringing together community members, partners, and organizations, as well as national speakers.

 

Child Care Providers

The Department of Elementary and Secondary Education (DESE), Office of Childhood (OOC), Compliance Section is responsible for licensing and regulating child care programs. Through ongoing regulatory inspections, the OOC continued to verify compliance with licensing rules regarding infant safe sleep. The OOC educated child care providers about infant safe sleep practices through technical assistance and training. Section 210.223.4, RSMo requires all employees of licensed child care facilities who care for infants under one year of age, and any volunteer who may be assisting at the facility to successfully complete department-approved training on the most recent AAP safe sleep recommendations prior to initial licensure, within their first 30 days of employment, and every three years thereafter. The OOC continued to review and approve safe sleep training, and ensure training is available via a variety of delivery systems in order to increase licensed child care providers’ knowledge of infant safe sleep practices. During child care inspections, OOC staff reviewed training records to ensure all required staff and volunteers had successfully completed department-approved trainings on safe sleep for infants within the required timeframes. Child care providers are required to share their approved safe sleep plan that meets the AAP guidelines with families upon enrollment. By providing new families with the policy that meets the current AAP guidelines, child care providers were able to further advance the educational outreach to families with infants.

 

The Child Care Health Consultation (CCHC) Program continued to assist licensed child care providers in meeting the safe sleep training requirement set forth in the Missouri Revised Statute 210.223.4, and continued to provide training and consultation regarding safe sleep practices to both regulated and unregulated child care facilities. Consultants provided 27 hours of department-approved safe sleep training and 5 hours of consultation related to safe sleep practices, policies, and procedures for child care facilities. As a result of the trainings, the CCHC Program reported increases in the proportion of:

• Child care providers and community partners (LPHAs) that provided safe sleep trainings to parents/guardians and child care providers in both regulated and unregulated child care environments;
• Child care providers that reported increased knowledge of safe sleep practices, including importance of having infants placed to sleep on their backs, having infants placed to sleep on safety approved sleep surfaces, and having infants placed to sleep without soft objects or loose bedding;
• Distributed educational materials about sleep-related infant deaths and safe-sleep practices to child care providers and parents/guardians of children in child care; and
• Child care providers with increased knowledge regarding which infants and home environments place infants at the highest risk for unsafe sleep environments and sleep related deaths.

 

The capacity of LPHAs to deliver CCHC Program services was severely impacted by the ongoing COVID-19 pandemic. The CCHC Program encouraged family attendance during program trainings and consultation, increasing access to evidence-based information regarding safe sleep practices for child care providers and families. The CCHC Program also provided training for child care providers to help them address parent/guardian concerns with safe sleep procedures implemented in the child care setting.

 

Breastfeeding

 

Hospitals

The State Breastfeeding Coordinator continued to collaborate with the Missouri Breastfeeding Coalition on statewide initiatives, including the Missouri “Show-Me 5” Hospital Initiative and the Missouri Breastfeeding Friendly Worksite and Child Care programs. In collaboration with BCHW, the Missouri breastfeeding coordinator hosted a series of eight webinars with speakers from Missouri Baby Friendly hospitals to encourage other hospitals to implement the Missouri “Show-Me 5” and Baby Friendly Hospital practices. These webinars took the place of the MotherBaby Summit, which was canceled due to Covid-19 and staffing changes. Funds from the State Physical Activity and Nutrition (SPAN) grant from the Centers for Disease Control and Prevention (CDC) were leveraged to support the webinars. Webinar participants reported that they found the series helpful as a way to learn from their colleagues in other hospital systems and motivate hospital administrators to make positive policy changes. The Missouri Breastfeeding Coalition Board identified lactation training for nursing staff as a major need in Missouri and an important barrier to Baby Friendly Hospital designation. Statewide training for all health care providers in Missouri continued with the ultimate goal to increase the number of International Board Certified Lactation Consultants (IBCLCs) in the state. Basic and advanced lactation training was offered at no cost to WIC local agency staff, hospital nurses working with new mothers and infants, and community partners working with breastfeeding mothers, including three intermediate virtual courses and one advanced virtual course. The department conducted a survey in 2021 of participants who had taken this course in 2019 and 2020 and found that out of 38 respondents, 16 planned to become an IBCLC, and 11 of those reported that they sat for and passed the exam after taking the course. It normally takes several years for a person to achieve the goal of becoming an IBCLC, and the department is very pleased to report these results.

 

Local Public Health Agencies (LPHAs)

BCHW, through Preventive Health and Health Services Block Grant funds, will assist LPHAs in building their capacity to achieve policy and environmental changes that increase access to healthy foods (including breastfeeding support). The primary objective of services provided by contractors is to increase the capacity of community coalitions within their service area to make measurable improvements in chronic disease related health outcomes.

 

The Missouri WIC Program provided additional funding through the Breastfeeding Friendly WIC Clinic Program to 53 local WIC agencies that provided breastfeeding support beyond what is federally required through the WIC program, which included providing after hours support, classes, support groups, breast pumps and working with other community partners to increase breastfeeding awareness. The state also provided education to local WIC agencies and health department professionals on breastfeeding and worked to increase the number of IBCLCs and trained peer counselors that provided mother-to-mother support in these facilities. They also encouraged partnerships with health care providers and other community organizations. Many of the local agency staff who work in WIC also partner with or work directly on MCH initiatives, and serve many of the same participants.

 

The MCH Services Program supported LPHA efforts to promote breastfeeding initiation at birth and continuation of exclusive breastfeeding through the first six months of life, and continuation of breastfeeding as long thereafter as mother and child desire, including:

• provision of breastfeeding peer counseling;
• breastfeeding support groups;
• individual, community, and provider education;
• breast pump loan programs; and
• promotion of breastfeeding friendly worksites and child care centers

 

Breastfeeding Friendly Sites

BCHW partnered with the Missouri Chamber of Commerce, the Missouri Chapter of Society of Human Resource Managers, and the Missouri Council for Activity and Nutrition’s Worksites workgroup to educate employers on the Affordable Care Act (ACA) provision for employers to provide workplace accommodations that enable breastfeeding employees to express breast milk. DHSS continued to recognize employers achieving criteria for the Missouri Breastfeeding Friendly Worksite program. Many local breastfeeding coalitions and LPHA WIC peer counselors continued outreach to businesses about the importance of worksite lactation support. This outreach was hampered by the difficulty of contacting businesses in person during the pandemic and by limits on staff time, as many staff were pulled away from normal duties to respond to the pandemic.

 

Collaboration continued with the Missouri Breastfeeding Coalition and local breastfeeding coalitions to promote the Breastfeeding Friendly Child Care Program. Similar to the “Breastfeeding Friendly Worksite Award,” the “Breastfeeding Friendly Child Care” award recognizes child care facilities who meet advanced criteria on breastfeeding support. The CCHC Program provided consultation and continuing education training to child care providers that promote child care facilities as breastfeeding friendly; both for parents of children enrolled who are breastfeeding, and as a breastfeeding friendly workplace for employees who are breastfeeding. LPHAs utilize the CCHC program as a partner in promoting the Breastfeeding Friendly Worksite award and as an important source of training. An online training is available for this program due to high provider demand. Both of these award programs are low cost, efficient, and provide a realistic means to sustain support for breastfeeding families.

 

Partnering with Child Care Aware, the “Breastfeeding Friendly Child Care” award, and corresponding online training was promoted and those who meet the criteria to earn the award distinction were recognized. Plans to further promote the award to parents and providers are being implemented. DHSS and Missouri Council for Activity & Nutrition (MOCAN) ensured that these two awards are highlighted during all worksite wellness outreach efforts. The MOCAN worksites workgroup encourages businesses to implement a wellness program for their staff. The WorkWell Missouri Toolkit was developed to assist employers with reducing risk factors for chronic diseases, poor nutrition (including breastfeeding support), inactivity, stress, and tobacco use. The Toolkit is designed to help organizations assess and improve workplace wellness policies and practices. MOCAN members promote this toolkit as well as partner with organizations assisting businesses in the state to improve health.

 

Resources for Parents

The Bureau of Genetics and Healthy Childhood (GHC) Newborn Health Program participated in statewide educational activities to increase awareness and promote recommended MCH practices, including breastfeeding. The Newborn Health Program also provided Missouri’s prenatal and newborn health book, Pregnancy and Beyond, free of charge. Additionally, the program provided other educational literature to raise awareness and educate Missourians on the importance of breastfeeding and direct the public to resources that assist with breastfeeding. In addition to print materials, the Newborn Health Program maintained websites that provided electronic access to similar breastfeeding information/resources. Approximately 24,000 books were distributed in FY21. Starting in FY2022, the program will track the distribution of these materials and obtain feedback from its partners on how the materials are used and ways to improve the materials.

 

The Title V MCH funded Home Visiting Program’s contracted home visitors provided education, resources, and support to enrolled prenatal participants to promote breastfeeding initiation and sustained duration. Annual performance measure data was collected on the percent of infants who were breastfed any amount at 6 months of age among mothers who enrolled in home visiting prenatally. In FY21, this percentage was 8.9% (6/67). During FY 2021, the CQI State Priority Focus was to improve on this rate through Plan-Do Study Act (PDSA) projects each contracting agency has been completing. Due to the necessity for visits to be virtual much of this timeframe, the same priority focus is being continued for 2022 through 2023 to allow “in-person” support by home visitors. The Home Visiting Program included articles, webinars, and other resources on breastfeeding in four Weekly Updates on 10/2/20, 11/13/20, 4/2/21, and 8/20/21. Breastfeeding Awareness Month was promoted in the fourth quarter Quality Outlook newsletter. The Home Visiting Program addressed home visitors’ breastfeeding technical assistance needs through monthly subrecipient monitoring and provided resources and training opportunities through ongoing communication. Collaboration with the State Breastfeeding Coordinator and the Home Visiting Program continued to assure up to date information, training opportunities, and support for all contracted home visitors.

 

Other Title V Program Activities Related to the Perinatal-Infant Health Domain

 

Count the Kicks

In FY18, the Newborn Health Program partnered with Healthy Birth Day, Inc. to implement and operate a Count the Kicks Public Awareness Campaign program to support pregnant women and reduce stillbirth rates in Missouri. According to the CDC, Missouri has the 18th highest stillbirth rate in the country. Missouri vital statistics show there are approximately 353 stillborn births each year. The continued use of Count the Kicks has the potential to save 91 babies every year if Missouri’s stillbirth rate decreases by 26 percent, as has happened in neighboring Iowa where the campaign began. Count the Kicks teaches the method and importance of counting baby’s kicks in the third trimester of pregnancy. Free educational materials can be ordered from Count the Kicks at https://www.countthekicks.org/order-materials/. The Newborn Health Program continued to partner with a wide range of community health partners to promote Count the Kicks. The program hosted webinars to equip home visitors with tools to teach their clients how to count kicks. The program was also promoted at OB/GYN clinics and birthing hospitals.

 

Newborn Screening

The Newborn Screening Program continued to work to increase awareness of newborn screening with the goal of ensuring all newborns have access to newborn screening shortly after birth, thereby reducing the risk of mortality/morbidity related to undiagnosed and untreated metabolic, genetic, and endocrine disorders. Missouri law requires all babies born in the state to be screened for over 70 different disorders including hearing loss and critical congenital heart disease. The Program continued to work with the Missouri Midwives Association and the Amish and Mennonite communities to provide education and technical assistance when needed.

 

Neonatal Abstinence Syndrome (NAS)

Missouri participated in the Association of State and Territorial Health Officials (ASTHO) and the Association of Maternal and Child Health Programs (AMCHP) Promoting Innovation in State & Territorial MCH Policymaking (PRISM) Learning Community to advance policy implementation to equitably address substance misuse and addiction and mental health disorders in women, children, and families within the context of the COVID-19 pandemic. Missouri’s participation in the PRISM Learning Community provided the conceptual frame for the development of a state action plan to address the impact of maternal substance use and mental health issues on the mother-infant dyad. The state action plan included strategies to leverage Missouri’s existing maternal-fetal-infant/neonatal abstinence syndrome (MFI/NAS) workgroups, including the NAS Stakeholder Workgroup previously facilitated by the DHSS, to organize a statewide Maternal Multisector Action Network to coordinate and collaborate on maternal mental health and substance use prevention and treatment efforts and advance policy proposals to promote maternal mental health and substance use prevention and treatment.

 

Oral Health

The ODH continued to educate mothers about the importance of oral health for their overall health and well-being. This was accomplished via continued collaboration with the Missouri Primary Care Association (MPCA) to provide education to women about the importance of dental visits during pregnancy. As quantity allowed, ODH supplied infant toothbrushes and Healthy Smiles from the Start booklets to the St. Louis Safe Kids Coordinator for use during baby safety classes. The baby safety classes covered safe sleep habits, car seat safety, breast and bottle-feeding and oral care. The training reached pregnant moms, new parents and grandparents and was presented in both English and Spanish.

 

Injury Prevention

From January 1, 2021 thru September 30, 2021, SSM Health Cardinal Glennon Children’s Hospital (Safe Kids St. Louis) provided approximately 338 injury prevention consultations to patients and families. Healthcare providers entered an injury prevention consult order into the electronic medical record (EMR) based on results of safety assessments. During the safety assessment, the physician was required to ask parents about sleeping concerns for any child under the age of one. After the assessment, one-on-one safe sleep education was provided by a member of the safety program. A safe sleep environment was provided at no cost, including a portable play yard, fitted crib sheet, sleep sack, bulb suction syringe, pacifier, and the “Sleep Baby Safe and Sound” book by Charlie’s Kids Foundation. Documentation in the patient’s medical record was completed by the injury prevention team member who provided the education and resources. The injury prevention consult was not exclusive to infant safe sleep. The consult also included safety education and resources for all unintentional injury risk areas, including car seat safety, gun locks, medication lock pouches, home & water safety resources, such as and bike safety.

 

The Safe Kids St. Louis coordinator, who is also the Injury Prevention Nurse Coordinator at SSM Health Cardinal Glennon Children's Hospital, is the instructor of the Infant Safe Sleep training. A firefighter/paramedic reported the Infant Safe Sleep training may have saved an infant’s life. The firefighter/paramedic’s crew responded to a local extended stay hotel to care for a female with abdominal pain. Upon arrival, the crew noted a mom, dad, and infant were staying in the room, and the first responders asked where the child was sleeping. The parents reported the child was sharing the bed with them. After transporting the mother to the hospital, the first responders returned to their engine house to get a pack-n-play crib and delivered it to the family. The family was very grateful and said they would use it moving forward. The Safe Kids St. Louis coordinator reported there have been at least two previous pediatric cardiac arrests at the same hotel, including a child that was sleeping in the same bed as the parents.

 

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