Dear Ms. Witt and Ms. Forsythe,
As a neonatal nurse practitioner at St. Louis Children's Hospital, I was extremely interested in reading the article "SAFE Discharge for Infants with High-risk Home Environments" and the associated Family Teaching Toolbox on Infant Safety at Home, in the April 2007 issue of Advances in Neonatal Care. One of the challenging aspects of our everyday practice is to determine if a home environment is safe for one of our vulnerable patients.
A concern I have is related to the content of the Family Teaching Toolbox on Infant Safety at Home. In the section "Cribs," items 4, 6, and 7 are misleading. According to the 2005 recommendations from the American Academy of Pediatrics (AAP) Task Force on Sudden Infant Death Syndrome (SIDS), if bumper pads are used in cribs, "they should be thin, firm, well secured, and not pillow-like," a description lacking in item 4.
According to the AAP, "soft materials or objects such as pillows, quilts, comforters, or sheepskins should be kept out of an infant's sleeping environment" not just "away from the baby's face," as stated in item 6. The AAP recommendations also state that "infants should be placed for sleep in a supine position (wholly on back) for every sleep." This recommendation is the basis for the Back to Sleep effort and should be described in greater detail in item 7, especially differentiating between back and side sleeping and the importance of educating secondary caregivers. Other information lacking from the Family Teaching Toolbox is the avoidance of exposure to second hand smoke in the home, a risk associated with many conditions in addition to SIDS.
Even though the items noted above in the Family Teaching Toolbox address these issues globally, parents need more specific and current information to educate them on issues related to the care of their infants. The article states that the parents of high-risk infants require "family support and assistance to be successful.[horizontal ellipsis] and each family needs information and education to address those needs as an integral part of a safe discharge plan." This additional information could be included in a way to preserve the size and readability of the Family Teaching Toolbox.
I look forward to each issue of Advances in Neonatal Care. Thank you in advance for your consideration and attention to my concerns.
Jeanne M. Giebe, MSN, NNP, RN
St. Louis Children's Hospital St. Louis, Missouri