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Elizabeth Hendrickson, MD
Michelle Pintea, MD, MPH
Lindsay Clukies, MD

In the United States, approximately 3,400 children die annually from unsafe sleep environments. These deaths include sudden unexpected infant deaths (SUID), suffocation, and strangulation. Numerous national educational campaigns have decreased the national SUID death rate. However, Missouri continues to experience high rates of preventable sleep-related deaths, with 103 in 2022 alone. Data reviewed from our institution showed providers rarely documented conversations about safe sleep. Our QI initiative sought to improve safe sleep screening at our level 1 pediatric trauma center and provide appropriate resources and education to families.

Our QI initiative took place at a single-center level 1 pediatric trauma center with approximately 50,000 ED visits per year. A safe sleep screening initiative was implemented with the SMART aim to increase the rate of safe sleep screening of all children under 12 months of age by providers by 75% from July 5, 2023 to March 1, 2024. We created a “Best Practice Advisory” (BPA) that flagged in the charts of all patients under 12 months of age and asked providers to answer a predeveloped, three-question screening set via an Epic “dot phrase.” At time of discharge, all patients under 12 months of age were provided with the American Academy of Pediatrics safe sleep guidelines, regardless of screening answers. If unsafe sleep practices were identified, providers were prompted to place a Social Work (SW) consult for necessary education or resources, including portable cribs at no cost. Our outcome measure was the total number of consults placed/cribettes given out.

In the 12 months prior to our initiative, 7,998 infants were seen in the ED. Of those, only 15 received SW consults for unsafe sleep practices and were provided cribettes. Following the implementation of our initiative, from July 2023 to March 2024, 5,808 infants were seen. Forty-eight were screened as practicing unsafe sleep and provided education and a cribette for home, a 340% increase in only nine months. This outcome was significant enough to justify continued implementation of this screening measure. Limitations found by analysis of process and balancing measures included increased patient volumes, the subtle location of the BPA in the chart, and noncompliance. These barriers were overcome by moving the BPA to a more visible location, sending reminders, and posting signage at provider workspaces reminding them of the initiative.

Injuries or deaths from unsafe sleep practices are preventable. Our initiative demonstrated that implementation of formalized screening in the ED setting leads to increased identification of infants at risk. While barriers to screening exist, it does increase rates of safe sleep counseling and improves access to resources to facilitate safe sleep practices.

1) Attendees will learn that there continues to be a high rate of preventable, sleep-rated death in Missouri and other individual states despite decreases in overall national SUID rates.

2) Attendees will learn the importance of documentation around safe sleep.

3) Attendees will learn the importance of a formalized screening processes aimed at decreasing preventable sleep-related deaths.

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Joanna O'Donnell, BA, GC-C
Karen Nash, MBA

Prematurity is the leading cause of sudden unexpected infant death (SUID) in the U.S.; however, sleep-related deaths are in the top three. Safe sleep messaging has been ongoing since the mid 1990’s, yet sleep-related infant deaths continue to occur.

Our organization implemented three projects designed to capture and elevate the family voice around infant safe sleep practices, increase understanding of family needs and adjust prevention efforts.

1. Sleep Baby Safe Project - 10 local health departments were invited to participate in this project. Participants attended local community events, conversed with families about their current and/or planned infant sleep habits, visually demonstrated what a safe sleep environment looks like and utilized this project to enhance their current prevention efforts. This project made it possible for health department staff to provide education around safe sleep and converse directly with families. Families also were asked to complete a survey as a method to capture first-hand information.

2. Reducing SUID Using a Collaborative Approach – The Alliance partnered with the Child Abuse and Neglect Prevention Board to survey public health departments, Women, Infants and Children (WIC) clinics and hospitals, in order to understand how infant safe sleep and abusive head trauma (AHT) information was being shared with families. In 2023-24, the survey was piloted to agencies in Milwaukee County, Wisconsin’s most populous county. The survey results revealed inconsistencies about how the agencies interpreted information delivery methods. This survey highlighted the need to offer more training to agencies about infant safe sleep and AHT that should include how to have trusting, nonjudgmental conversations to raise awareness and share information.

3. Reducing Sleep-Related Infant Mortality Impacting African American Communities in Southeast Wisconsin. African American families in Wisconsin experience SUID at a rate nearly four times greater than other families. This project focused on including family voices from impacted communities to help address the issue and to learn what barriers exist for families. The survey was offered to African American caregivers between the ages of 18-30 who were pregnant or caring for an infant under 1 year of age. Families who choose not to follow safe sleep recommendations often include one or more social determinants of health, like unstable or crowded housing, transportation and lack of support; the Alliance’s goal was to learn from families what community and professional support would look like to help address these issues.

Survey results informed state and local prevention efforts for SUID and injury in infant sleep environments.

Taking part in these projects improved collaboration and engagement between local health departments and the community. More than 500 families received education and information on the utilization of the AAP guidelines for infant safe sleep and shared their thoughts first-hand.

1. Learn how SUID impacts communities.
2. Understand how direct conversations with families can help reduce SUIDs.
3. Hear three examples of low cost projects designed to influence the health and safety of infants in local communities.

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Christie Lawrence, DNP, RNC-NIC, APN/CNS
R. Ahadi, MPH
Gina S. Lowell, MD, MPH
Kyran P. Quinlan, MD, MPH

Sudden Unexpected Infant Death (SUID) claims ~ 3,400 infants each year in the United States. In Cook County, IL, a SUID occurs nearly every week and are concentrated in areas that experience increased socio-economic hardship. Birth hospitals rarely hear about the SUID which occur among infants they discharge, contributing to low awareness of the frequency and distribution of SUID in their communities. In 2019, Cook County joined the Center for Disease Control and Prevention’s national SUID surveillance system and through these efforts SUID data by hospital of birth were obtained. In 2023, the Illinois Perinatal Quality Collaborative (ILPQC) named Equity and Safe Sleep for Infants (ESSI) as the statewide QI project for 2024. We describe our process for sharing hospital-specific SUID data and cases with Cook County, IL birth hospitals coinciding with the launch of ESSI.

We identified our Birth Hospital Outreach Coordinator, who leads our hospital’s Safe Sleep Task Force, to drive the outreach approach. Stakeholders were identified at each hospital, and two meetings were scheduled. The first meeting was used to establish relationships, review SUID and the Cook County SUID Case Registry and Prevention (SUID-CR) data, provide hospital-specific SUID rate and ranking among other institutions, and discuss each hospital’s current safe sleep education, modeling, policies and practices. The second meeting reviewed the SUID-CR data process and shared hospital-specific SUID cases, including narratives with doll scene reenactment photos. Stakeholder reflections and opportunities for growth were noted. Follow-up meetings were provided for those stakeholders who desired case-level presentations for staff review. The opportunity for building a learning community was explored. This effort was funded by the Michigan Public Health Institute.

Meetings as described above were completed with 9 hospitals. During this time, 4 other Cook County birth hospitals contacted us for their data and meetings with these hospitals were also completed. Hospital leadership were receptive to and visibly moved by their data, resulting in an openness to sharing their current safe sleep practices and policies. Three hospitals requested presentations to their perinatal and postpartum staff, and these were completed. Common reflections included the importance of raising and sustaining SUID awareness and considerations regarding improved approaches to supporting safe sleep in their perinatal and postpartum settings. The majority of hospitals discussed how ESSI has prioritized improving safe sleep modeling and education, and felt case-sharing influenced how safe sleep education could be optimized to be more conversationally oriented and inclusive.

Providing birth hospitals the details of SUID among their newborn discharges may stimulate a re-examination of how SUID prevention is handled prior to discharge including staff education, safe sleep modeling and crib/bassinet availability for families who need them. Sharing hospital-specific data with birth hospitals as they embarked on ESSI synergistically promoted SUID prevention goals. Reviewing individual SUID cases puts humanity into the statistics allowing hospital personnel to reflect on how they role model and conduct conversations for families they serve.

1. Birth hospitals rarely hear of SUID that occur among the infants they discharged.
2. Sharing hospital-specific SUID data can inform and influence birth hospital safe sleep QI initiatives.
3. Raising awareness through sharing hospital-specific SUID data is a useful approach to improving accurate risk perception of SUID.

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L'Mara Thomas, BA
Blossom Pouchie

Infant sleep related deaths are preventable if safe sleep education is provided to caregivers and the resource to obtain a safe sleep environment is made available. This program aims to reduce sleep-related infant deaths in high priority areas or areas that have high rates of sleep related infant deaths, through virtual and in person Safe Sleep trainings for community professionals and caregivers. The Program Manager is responsible for collecting data on local infant sleep related deaths which is used to make data driven decisions in the community. The program also provides Model Behavior Safe Sleep trainings for the six (6) local birthing hospitals by our 2 Safe Sleep Model Behavior Registered Nurses. Outreach to OBGYN offices, Pediatric offices, and childcare centers allows the program to share safe sleep educational resources at a professional level that can be shared with their clients. Through the program eligible families can apply for a Pack’ N Play to ensure their infant has a safe sleep environment.

Our Safe Sleep program which started in 2019 offers a 2-hour Safe Sleep training class for Professionals once a month or more as requested and Facilitated by the Program Manager. The curriculum is evidence based and modeled from the 19 Safe Sleep recommendation from the American Academy of Pediatrics. The program is made sustainable through funding from non-profit organizations that assists in purchasing monthly; 100 Pack N Plays, 100 fitted sheets, 100 sleep sacs (wearable blankets) and educational materials that are provided to families in need of a safe sleep environment. To be eligible the family must have an infant up to 12 months of age or pregnant (35 weeks gestation to birth) and household income is below the poverty line for Broward County. Funding also allows the program to acquire 2 Safe Sleep Model Behavior Nurses to provide education to local hospitals and provide outreach to OBGYN offices and Pediatric offices in Broward County.

In the fiscal year 2023 the program provided 783 Pack’n Plays, safe sleep education and resources to Broward families. The funding also allowed The Safe Sleep program to reach its yearly goal of providing Model Behavior Safe Sleep education to100 hospital staff members at the six (6) birthing hospitals in the County. The Safe Sleep train the trainer program has been successful in training 281 Community Professionals including case managers, care coordinators, nurses, child investigators and counselors.

Infant sleep related deaths are preventable. By bringing the community together using education, available resources and normalizing safe sleep practices we can ensure that every infant has a safe sleep environment.

1. Understand how the Safe Sleep Program operates in a high priority area.
2. The benefits of targeted outreach and training to professionals who provide care for infants and their families.
3. Recognize the importance of assisting families in acquiring a safe sleep environment for their infant and to practice safe sleep AAP recommendations.

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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.

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Sadiqa A.I. Kendi, MD, MPH, CPST
Joseph L. Wright, MD, MPH
Torine Creppy

Since the murder of George Floyd, there has been unprecedented recognition by many disciplines on the importance of identifying and addressing the structural causes of inequities, including racism, classism, and other forms of bigotry. The injury prevention community is no exception; injury inequities and outcome disparities persist and in some cases are widening. The CDC Vital Signs described a 28% increase in drowning deaths for children between 1 and 4, and Black people between 2019 and 2021. American Indian/Alaska Native people continue to have the highest drowning rates. In addition, Black and American Indian/Alaska Native children have the highest rates of traffic fatalities, both as pedestrians and as occupants. The leadership of Safe Kids Worldwide recognized the need for an equity science-based approach to programs, policies, and research to address these inequities. This led to the formation of the Safe Kids Worldwide Equity Advisory Committee (EAC).

The EAC was chaired by a physician scientist with expertise in injury prevention and equity science. The chair along with Safe Kids Worldwide leadership identified subject matter experts in water safety, child passenger safety, safe sleep, child fatality review, and emergency preparedness to be involved in the committee. Further, Safe Kids Worldwide governance was directly aligned with the EAC.

The EAC includes 10 members, including the chair, 6 academically-oriented, subject matter expert pediatricians, a Safe Kids Worldwide board member (also a subject matter expert pediatric subspecialist), and 2 Safe Kids Worldwide staff members. Each member agreed to a 3 year term. The EAC meets monthly for one hour and is also represented on the agenda of all Safe Kids Worldwide Board meetings. The committee discusses various research ideas, and provides input on programming and advocacy. The group has presented on approaches to centering equity in injury outcomes at various scholarly meetings, including the Pediatric Academic Societies, the Society for the Advancement of Violence & Injury Research, Lifesavers, and Safe States. The EAC has successfully supported Safe Kids Worldwide in implementing an equity science-based approach. This is in line with comprehensive work being done by other pediatric focused organizations such as the American Academy of Pediatrics, which has seated equity science experts to support the incorporation of race-conscious approaches to the development of clinical practice guidelines.

It is feasible and mutually beneficial for a scholarly-based, academic committee to support the work of a community facing injury prevention organization in prioritizing an equity focus.

1. To understand how an academic committee with expertise in injury and equity science can support the work of community facing organizations.
2. To understand the breadth and depth of work that can be accomplished by an injury prevention organization with the support of an academic focused committee.
3. The field of injury prevention can benefit from partnerships across community facing organizations and equity science pediatrician experts.