Transcript for VitalSigns Teleconference: Safe Sleep for Babies

OPERATOR: Welcome and thank you for standing by. All participants will be on a listen-only mode until the question and answer session of today’s conference. At that time, you may press star then 1 to ask a question from the phone lines. Also, this conference is being recorded. If you have any objections, you may disconnect at this time. I would now like to turn the call over to your host, Ms. Kathy Harben. Thank you, ma’am, you may begin.

KATHY HARBEN: Thank you, Katie, and thank you all for joining us today for the release of the new CDC Vital Signs. This one on trends and disparities in infant safe sleep practices. We’re joined today by CDC Director Dr. Brenda Fitzgerald, as well as Dr. Wanda Barfield, director of CDC’s Division of Reproductive Health and Assistant Surgeon General in the U.S. Public Health Service, and Dr. Carrie Shapiro-Mendoza. She’s a senior scientist in the Division of Reproductive Health and one of the authors of the Vital Signs article. Drs. Barfield and Shapiro-Mendoza will address your questions after opening remarks. I’d like to turn the call over now to Dr. Fitzgerald:

BRENDA FITZGERALD: Good afternoon, and thank you all for joining us today. CDC provides a common defense of the country against health threats. Today we’re going to talk about a health threat against our youngest citizens. Today’s Vital Signs report is about the importance of safe sleep environments for babies to help reduce the risk for sleep-related deaths. This information is critical, because each year we lose about 3,500 babies in the United States to sleep-related deaths, such as accidental suffocation and sudden infant death syndrome, or SIDS. There are known ways to reduce the risk of these deaths. One way is to follow the safe sleep practices recommended by the American Academy of Pediatrics and promoted in the safe to sleep campaign. One, always place babies on their back to sleep. Every nap, every night, every time. Two, babies should sleep in their own sleep space. Have the baby share your room, not your bed. The baby should not sleep in an adult bed, on a couch, or on a chair, with you or with anyone else. Three, put babies to sleep in a safety-approved crib or bassinet with a firm sleep surface or mattress, and last, keep all soft objects such as pillows, loose blankets, bumper pads, and toys out of the baby’s sleep area. Unfortunately, this new report revealed that unsafe sleep practices with babies are common. About one in five mothers reported placing their baby to sleep on their side or stomach. More than a half reported bed sharing with their baby. And two in five mothers reported using soft bedding in the baby’s sleep area. Among those who didn’t follow safe sleep recommendations we saw differences in population groups based on race, ethnicity, age, and education. It is clear that we all have more work to do, and everyone has a role to play in doing better when it comes to protecting our precious babies. There were significant reductions in sleep-related deaths in the 1990s. However, since the late 1990s, our progress has slowed. We need to reinvigorate this important work by getting safe to sleep messages to all audiences. We know many states are working with partners to get the word out on safe sleep practices for babies. For example, some states have safe sleep policies in every hospital statewide to train health care providers and teach caregivers about safe sleep. Others give information materials to every parent before they leave the hospital with their new baby. Many have conducted communication campaigns. All of these strategies can make a real difference in promoting safe sleep for babies. We must make sure that every caregiver, every health care provider, and state and local health departments across the country know that there are known safe sleep recommendations that can and do make a difference. We should continue to raise awareness, particularly within those groups where data shows babies are at higher risk of sleep-related deaths. We can’t be complacent when there are ways that we can reduce the risk of these deaths. I now turn it over to Dr. Wanda Barfield, who will share the specific findings from today’s report. Dr. Barfield?

WANDA BARFIELD: Thank you, Dr. Fitzgerald. For this report, we analyzed data from the pregnancy risk assessment monitoring system, or PRAMS. PRAMS is a state-based surveillance system that asks mothers about their behaviors and experiences before, during, and after pregnancy. Since the 1980s, PRAMS has collected this data each year for women with a recent live birth in the U.S. Specifically, we examined 2015 data on how often mothers reported placing their baby to sleep on their side instead of on their back, if they shared their beds with their babies, and whether they put soft bedding in their baby’s cribs. As Dr. Fitzgerald noted, we found that unsafe sleep practices with babies are common. About one in five mothers reported placing their baby to sleep on their side or stomach. Just under two in five reported using any soft bedding when placing babies to sleep. Most commonly, bumper pads and thick blankets, which are not recommended in the baby’s sleep area. More than half reported any bed sharing with their baby. We found that mothers who did not follow safe sleep recommendations varied by state, race, ethnicity, age, and education. For example, in 2015 among states with available data, the percentage of mothers who reported placing their baby on his or her side or stomach to sleep ranged from about 12% in Wisconsin to 34% in Louisiana. Placing babies on their side or stomach to sleep was more common among mothers who are non-hispanic black, mothers who are under 25, and mothers with 12 or less years of education. These findings highlight the need to continue improving safe sleep practices. So how can we work together to reduce safe sleep and reduce sleep-related infant deaths? Proven actions to improve safe sleep practices include developing culturally appropriate health messages and educational tools for caregivers and training, health, and childcare professionals. Some state and local health departments are training providers to improve safe sleep practices in childcare and hospital settings. Others are working to deliver culturally appropriate messages about safe sleep through programs that serve mothers and babies. Health care providers can advise parents and other caregivers on safe sleep practices and help them to find solutions if they have trouble following the recommendations. Health care providers can also model safe sleep practices for parents and other caregivers during office visits and in the hospital after delivery. Caregivers, including mothers, fathers, grandparents, babysitters, and childcare workers, have an important role to play in safe sleep for babies. They can place babies on their back for every sleep. Room share, but not bed share with babies. Remove soft bedding, such as blankets, pillows, and other soft objects from their baby’s sleep area, and talk to their health care provider about safe sleep practices for their baby. Although this report is focused on creating a safe sleep environment, it’s important to note that AAP has some additional recommendations for reducing the risk of sleep-related infant deaths. These include protective factors, such as breastfeeding, and avoiding exposure to smoke, alcohol, and illicit drugs. At CDC, we have a number of efforts under way to address safe sleep. We will continue to monitor infant sleep practices through PRAMS, and, in fact, 2016 data will be released soon and we’ll have more states with data available. We support 16 states and two jurisdictions in the monitoring of sleep-related deaths through CDC’s case registry. This tracking effort captures 30% of all sleep-related infant death cases in the U.S. and focuses on strategies to reduce these deaths. We’re working with state collaboratives to improve the quality of care for mothers and babies. Some participating states are working with health care providers to model safe sleep practices in the hospitals for parents and caregivers. Every single loss of a baby is an unimaginable tragedy that impacts families and communities beyond measure. We know what we can do to reduce the risk of sleep-related deaths in infants. We all share responsibilities to help mothers, fathers, and other caregivers keep babies safe and healthy. Thank you and I’ll now turn it back over to the moderator.

KATHY HARBEN: Thank you, Dr. Barfield. Katie, we are ready for questions now, please.

OPERATOR: Thank you. At this time, we would like to begin the question and answer section of today’s conference. If you would like to ask a question from the phone lines, please press star then 1, unmute your phone, and record your name when prompted. If you need to withdraw your question, please press star then 2. Once again, to ask a question from the phone lines, please press star then 1 and record your name when prompted. One moment, please, while questions queue up. Our first question comes from Mike Stobbe with the Associated Press. Your line is now open.

MIKE STOBBE: Hi, thank you for taking my question. Two questions, actually. Could you help me understand? It’s been kind of flat since the 1990s, around 2000, the number of infant deaths and also according to a new report, the practices for at least the late 2000s that you’re talking about. Could you talk about why that’s been flat?

WANDA BARFIELD: Yes, so, a previous study showed that following the back to sleep campaign, there was a rapid increase in the percentage of babies placed on their backs to sleep, and the increase in that sleeping slowed beginning around 2000. The back to sleep campaign is now known as the safe to sleep campaign, and this Vital Signs report confirms the persistence of unsafe sleep practice and really underscores the need for novel approaches promoting safe sleep recommendations and improving safe sleep practices. What was interesting about this report, really, is that unsafe sleep practices are still common.

MIKE STOBBE: Okay. So, I’m sorry, are you saying that the back to sleep program, it kind of waned? They stopped doing it, or they reduced it, or the initial impact of it faded? I’m sorry

WANDA BARFIELD: It appears that the initial impact we saw then faded, and so far we’ve sort of been stalled in our progress. And it may be we need to reinvigorate these messages.

MIKE STOBBE: Okay, thank you. And my second question, if I may, the sudden unexpected infant death rate and the number. There’s different components to that, I guess, there’s SIDS in there, there’s accidental suffocation of strangulation in bed. The things you’re highlighting, the behaviors, the practices you’re hoping families do, what proportion of sudden unexpected infant deaths do you think can be affected by these practices that you’re talking about?

WANDA BARFIELD: So, Dr. Shapiro Mendoza is going to address that question.

SHAPIRO MENDOZA: Excuse me. So, in about 2015 there are about 1,500 deaths that, according to the death certificates, were due to SIDS, 1,200 due to unknown cause, and 900 deaths that were due to or classified in the death certificate as accidental suffocation and strangulation in bed. These safe sleep practices that we’re talking about addresses both SIDS deaths and other deaths that occur in the sleep environment, like accidental suffocation.

OPERATOR: Our next question comes from Eben Brown with Fox News. Your line is now open.

EBEN BROWN: Thank you very much for holding this call today. There is a growing trend in the — I should say this anecdotally there’s a trend, just from me poking around, of parents, new parents preferring to co-sleep with their young children. For those that are determined to do this, what age is it okay to actually start doing that? Certainly, I haven’t encountered anyone that’s co-sleeping with an infant, but as the child gets into the toddler years, they try to do that. What is — a, is there an official CDC perhaps position on this, or, b, what could some recommendations be?

WANDA BARFIELD: So, the recommendations for AAP is that infants who are, you know, under a year of age should not co-sleep. They should be able to sleep within the same room as the caregiver, but they should not be in the same bed.

EBEN BROWN: Beyond a year of age, is there any guidance on that?

WANDA BARFIELD: There isn’t really any specific guidance about that.

EBEN BROWN: Okay, thank you.

OPERATOR: Once again, if you’d like to ask a question from the phone lines, please press star then 1 and record your name when prompted. Our next question comes from Molly Walker with MedPage Today. Your line is now open.

MOLLY WALKER: Hi, thank you for taking my question. My question is having to do with what message providers can sort of send to manufacturers who sort of, you know, market these unsafe sleep products like bumper pads and show these advertisements with blankets and all this sort of unsafe sleep products. Do you hope this report will be sort of a wake-up call for them, or is there any sort of advocacy action planned or do you think providers can sort of get involved in? Thank you very much.

WANDA BARFIELD: Thank you for your question, Ms. Walker. You’re absolutely right in that there’s an opportunity for many of us to really counter messages that run counter to safe sleep. So ads that show, you know, babies surrounded by stuffed animals or blankets. Many are trying to counter that message, particularly the American Academy of Pediatrics, and I think it’s important that all of us have a role to play in terms of identifying those contradictory messages to new parents and families, so that they understand that a safe sleep environment does not include soft bedding, pillows, stuffed animals, and other things within the crib.

OPERATOR: Our next question comes from Sean Hamill with Pittsburgh Post-Gazette. Your line is now open.

SEAN HAMILL: Hi, thanks for taking my question. Can you tell me, you mentioned the slackening of the reduction in unexpected deaths in infants since the 2000s, but how do the numbers that you’re reporting on unsafe sleep patterns, how do they compare over time nationally? Have we seen that number also stop falling as much, or at all? I’m talking nationally, not state by state, because it looks like there’s quite a wide variation state by state. Nationally, are these numbers continuing to fall, or have they maybe started to creep up over time?

SHAPIRO MENDOZA: So, this is Dr. Carrie Shapiro Mendoza. So you’re talking about the sleep-related infant deaths and whether you see the same pattern that we saw with back sleeping with an increase in back sleeping in the early ’90s after the back to sleep campaign and that sloughing off and does the same pattern hold true for the sleep-related infant deaths, the accidental suffocation and SIDS. We do see a very similar pattern when we look at all those causes of death together. That initially in the ’90s, we saw a big decline up until about 1999 to 2000, and then from 2000 up until the most recent year of data, I believe 2015, the rates have really been fairly stable.

OPERATOR: Once again, if you’d like to ask a question from the phone lines, please press star then 1 and record your name when prompted. We are currently showing no questions in queue.

KATHY HARBEN: Okay, unless there are other questions, I would like to thank Dr’s. Fitzgerald, Barfield, and Shapiro Mendoza for joining us today. Thank you also to the reporters who joined. If you have follow-up questions, please call our press office at 404-639-3286, or you can e-mail media@cdc@gov. Thank you for joining us, this concludes our call.

OPERATOR: this concludes today’s conference. Thank you for participating. You may disconnect at this time.

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES