Safe Sleep

Lois K. Lee, MD, MPH, FACEP, FAAP
Gina S. Lowell, MD, MPH

What TiKtok Taught Me About Safe Sleep: Rethinking Sudden Unexpected Infant Death Messaging to Adolescent Parents and Caregivers

Felicia Scott-Wellington, MD
Gina Lowell, MD, MPH
Eliot England, MPH

The transition through adolescence can be a challenging journey for most teens. Becoming a parent during adolescence is an additional transition. After the birth of a new baby, an adolescent shifts from being parented to becoming a parent who can plan appropriately, assert one's voice, and assess risk for their own child. This adaptation, however, is often met with substantial obstacles and challenges. Many parenting youth have experienced numerous negative health care encounters that contribute to disengagement and mistrust of the health care system, encouraging them to seek information from sources outside of healthcare providers.

A qualitative study of new mothers found that images of sleeping infants and infant sleep environments, as found in photographs, television, and social media platforms, were one of the most consistent influences on their decisions about how infants slept at home. Adolescents are particularly vulnerable to these images, especially when posted by peers who are strong influencers during this stage of brain development. Adolescents may rely on their parents or other family members for their infants’ care and find themselves waffling between accepting “Grandma knows best” , peer influences, and their own instincts. Those providing safe sleep counseling may inadvertently direct their guidance towards an adolescent’s parent, leaving adolescents excluded from effective safe sleep messaging, adolescent appropriate conversations, and situationally specific solutions.

This workshop will review adolescent brain development and the importance of appropriate adolescent discussions when reviewing safe sleep recommendations. We will review quotes from teen parents regarding barriers to safe sleep, highlighting the importance of engaging teens in discussions and solutions regarding infant safe sleep. Lastly, we will discuss the importance of recognizing cultural influences on safe sleep practices and historical challenges teen parents face when trying to reorganize these deeply embedded familial structures. To engage adolescents and young adults in health care, practitioners are encouraged to consider their own biases when serving this population. Together we must work towards fostering a positive, nonjudgmental approach, thereby providing supportive environments for our young parents to thrive.

1. Review data on SUID in infants with adolescent parents in temporary housing situations

2. Review adolescent brain development and its importance in adolescent specific messaging to parenting youth

3. Highlight challenges adolescent and young adult parents face when following safe sleep recommendations

4. Provide strategies to aid in discussions about safe sleep practices in parenting youth

Supporting Safe Sleep in Emergency Shelter Settings for Migrants in Chicago

Gina Lowell, MD, MPH
Monica Mitchell, MPH, LCPC, CCTP
Jessica Wilkerson
Jose Perez
Jennifer Vidis, JD
Hope Vaughn, LSW
Wayne Detmer, MD
Kyran Quinlan, MD, MPH

Sudden Unexpected Infant Death (SUID), the leading cause of death for ages 1-12 months, mostly occurs in infants <6-months-old. Bedsharing and soft bedding increase SUID risk. Since August 2022, ~40,000 migrants from Latin America have arrived in Chicago with a surge arriving in the summer through winter months of 2023. The City of Chicago’s emergency shelter system response includes 18 family-serving shelters. Sleep environments in these shelters contain multiple infant sleep hazards for this vulnerable population, placing infants at substantial risk for SUID.

The Chicago Department of Public Health (CDPH) launched monthly “Prenatal and Newborn Care for New Arrivals” collaborative calls, convening the Emergency Operations Center (EOC) of the Department of Family and Support Services (DFSS), the Illinois Department of Public Health (IDPH), healthcare systems providing prenatal/newborn care to new arrivals (Cook County Health and Hospital Systems (CCHHS), Lawndale Christian Health Center (LCHC)), the Chicago Homelessness and Health Response Group for Equity (CHHRGE), and the Cook County SUID Case Registry and Prevention, to exchange data and coordinate efforts supporting health and housing needs of newly arrived pregnant/postpartum families. SUID risk emerged as a key focus, prompting our development of “Guidance for Safe Sleep in Shelter Settings,” a document detailing SUID definitions, safe sleep guidance, a safe sleep checklist, recommended infant sleep products, and a recalled infant sleep product list developed in partnership with an advocacy group, Kids in Danger (KID). Using this guidance, we provided safe sleep education for shelter staff throughout the system and with monthly census data provided by DFSS, conducted “safe sleep rounds” at shelters with infants <6-months-old to promote safe infant sleep environments.

From December 2023-May 2024, 12 of 18 emergency shelters housed 84-88 infants <6-months-old at any given time. Safe sleep rounds (10) were well-received at the 7 shelters that housed >90% of these young infants. Visiting families (30) in the rooms where they slept allowed for observation of their infant’s sleep environment and enabled rich conversations about preventing suffocation. Shelter spaces included congregate rooms with cot-sleeping and individual rooms with bed/bunk sleeping. Space for portable bassinets/cribs varied. Bedsharing and soft bedding use was prevalent. Safe sleep conversations were held in Spanish or with translation support. Parents were receptive, appreciative, and shared usual infant sleep practices from their home countries. Cribs (16) and sleep sacks (30) were provided in real time. The EOC also established a process by which shelters could order bassinets and these were observed at 13 bedsides.

SUID prevention for vulnerable populations is possible even in highly dynamic and constrained environments. The density of Chicago’s immigrant emergency housing resulted in high risk infant sleep environments, but also enabled “Safe Sleep Rounds.” Convening multiple stakeholders with public health, maternal-infant health, emergency operations, social care, housing and healthcare expertise who are involved on-the-ground and at systems levels is necessary for an effective intervention.

1. Infants in congregate shelter settings face multiple sleep environment hazards.
2. Relationships and partnership with local and system-level stakeholders enables effective injury prevention approaches.
3. Developing safe sleep guidance specific to the unique needs of shelter settings effectively engages shelter staff and emergency response stakeholders.

Using the Injury Equity Matrix to Surface SUID Prevention Recommendations

Kyran Quinlan, MD, MPH
Felicia Clark, D-ABMDI
Christie Lawrence, DNP, RNC-NIC, APN/CNS
Gina Lowell, MD, MPH

Beginning in July 2023, the Cook County Sudden Unexpected Infant Death (SUID) Case Registry and Prevention team began using a modified Injury Equity Matrix (IEM) tailored to examine SUID. Modifications to the IEM such as including the family’s Social Environment and Belief System, considering factors related to the SUID investigation, and incorporating both parent and infant intersectional identities have facilitated meaningful conversations among team members that have surfaced new ways of thinking about SUID prevention, generated ideas regarding new partnerships, and led to proactive safe sleep approaches for Chicago’s newly arrived migrant population.

This workshop will provide a brief overview of the modified IEM for SUID, and lead participants through the practice of using the IEM for SUID cases. Participants will be broken into 4 groups, each led by one of the presenters, and guided through practice using the modified IEM for 2 cases. Groups will reconvene and discuss the potential prevention recommendations that emerged from this practice. Finally, participants will be challenged to modify the IEM for their own injury prevention topic (e.g. drowning, firearms) and consider who they might engage to regularly review cases using this tool.

1. Become familiar with the components of the Injury Equity Matrix.
2. Practice using the modified IEM to review individual SUID cases.
3. Reflect on how incorporating intersectionality illuminates new prevention approaches.
4. Determine how the IEM could be modified for other childhood injuries.