Grandmothers' Beliefs and Practices in Infant Safe Sleep.

Background Sudden infant death syndrome (SIDS) and suffocation are leading causes of infant mortality. Supine sleep position and use of appropriate sleep surfaces reduce SIDS risk but are not universally practiced. Mothers' decisions about sleep position and environment may be influenced by guidance provided by infants' grandmothers and other caregivers. Methods A survey was conducted of a convenience sample of grandmothers aged 30-70 years who provide care at least weekly for an infant grandchild <6 months old. The survey was distributed through community partners of a university-based research team. Respondents received home safety items as compensation. Analyses focused on the relationship of grandmother demographic characteristics and beliefs on their reported practices related to infant sleep. Results Among the 239 grandmothers, 45 % reported placing infants to sleep supine on an appropriate sleep surface at the grandmother's house, while 58 % reported doing so when the infant was sleeping in the mother's house. After adjusting for other factors, respondents were less likely to adhere to recommended guidelines when they believed supine position increased choking risk (OR 0.34, 95 % CI 0.18-0.62) or believed infants are more comfortable or sleep longer when on their stomachs (OR 0.51, 95 % CI 0.28-0.93). Discussion Grandmothers do not universally observe evidence-based safe sleep practices, particularly if the infant is not sleeping in the home of the parent. Interventions for senior caregivers focused on perceived choking risk, infant comfort in the supine position, and other recent changes in recommended safety practices are warranted.

The physician's role in infant and child death review in Arkansas.

Arkansas has higher infant and child death rates than the United States overall. Multidisciplinary Infant and Child Death Review Teams are tasked to provide detailed information about unexpected infant and child deaths from the perspective of the affected community. The goals of the review are to develop specific intervention and prevention measures to decrease pediatric deaths, and examine the processes utilized by agencies to influence changes in policies, procedures and law.

A state survey of emergency department preparedness for the care of children in a mass casualty event.

OBJECTIVE: The Institute of Medicine has issued two reports over the past 10 years raising concerns about the care of children in the emergency medical care system of the United States. Given that children are involved in most mass casualty events and there are deficiencies in the day-to-day emergency care of children, this project was undertaken to document the preparedness of hospitals in AR for the care of children in mass casualty or disaster situations. DESIGN: Mailed survey to all emergency department medical directors in AR. Nonresponders received a second mailed survey and an attempt at survey via phone. PARTICIPANTS: Medical directors of the emergency departments of the 80 acute care hospitals in AR. RESULTS: Seventy-two of 80 directors responded (90 percent response rate). Only 13 percent of hospitals reported they have pediatric mass casualty protocols and in only 28 percent of hospitals the disaster plan includes pediatric-specific issues such as parental reunification. Most hospitals hold mass casualty training events (94 percent), at least annually, but only 64 percent report including pediatric patients in their disaster drills. Most hospitals include local fire (90 percent), police (82 percent), and emergency medical services (77 percent) in their drills, but only 23 percent report involving local schools in the disaster planning process. Eighty-three percent of hospitals responding reported their staff is trained in decontamination procedures. Thirty-five percent reported having warm water showers available for infant/children decontamination. Ninety-four percent of hospitals have a plan for calling in extra staff in a disaster situation, which most commonly involves a phone tree (43 percent). Ninety-three percent reported the availability of Ham Radios, walkie-talkie, or Arkansas Wireless Information Network (AWIN) units for communication in case of land line loss, but only 16 percent reported satellite phone or Tandberg units. Twelve percent reported reliance on cell phones in this situation. CONCLUSIONS: This survey demonstrated important deficiencies in the preparedness of hospitals in AR for the care of children in disaster. Although many hospitals are relatively well prepared for the care of adults in disaster situations, the needs of children are different and hospitals in AR are not as well prepared for pediatric disaster care.