This article first appeared in the St. Louis Beacon, Oct. 4, 2011 - The message is catchy enough for most parents to remember. "Back to Sleep," it says, as a reminder to put infants to bed on their backs. Other messages urge parents to allow infants to sleep alone in their own cribs without blankets or other bedding that might cause them to suffocate.
In spite of advice from a national safe sleep campaign dating back nearly two decades, sudden unexpected infant death statistics in St. Louis suggest that the message isn't reaching many parents of African-American infants. The rate of sudden death for them is at least twice as high as for other infants.
One study published in 2008 in the journal Pediatrics focused on the deaths of 119 infants in St. Louis and St. Louis County. The study was done by the area's two medical schools and the city and county health departments. It found a SIDS rate of 2.08 per 1,000 live births for black babies, versus 0.65 per 1,000 live births for other babies. Groups who work on the issue say the numbers haven't changed much over the years, with African-American infants two to three times more likely to succumb to sudden infant death.
The problem is so serious that BJC HealthCare, St. Louis University, Washington University and the Regional Health Commission are supporting a study to figure out why these safe sleep ideas seem alien to some groups and find alternative prevention messages for those unable or unwilling to follow best practices.
A cautionary tale that reinforced the urgency of action was the double tragedy in August when 3-month-old twin boys in north county suffocated from bedding after their 8-year-old sister apparently decided to place them in bed with her to keep them warm.
"What happened with the twins was absolutely tragic all the way around," says Melinda M. Ohlemiller, CEO of Nurses for Newborns Foundation. "Our entire organization is in grief when we see something like this happen. It's a time for us, though, to remind everyone of the importance of safe sleeping and the tragic results that could happen."
She added that young parents in particular should always get safe sleep advice for infants from visiting nurses, pediatricians and others who can offer them the most current information available.
Children's Hospital takes a different approach to the back-to-sleep issue. The hospital says it promotes safe sleeping by swadding babies in sleep sacks, which allows them to sleep comfortably on their backs. The hospital says that sleep sacks also eliminate the need for loose bedding that can cause suffocation.
In 2008, the journal Pediatrics published a study showed that bed-sharing deaths of infants were nearly twice as common in African-American families in St. Louis than in other families here. The study suggested that a public health campaign could call attention to the risks of bed-sharing with infants.
Following that study and similar ones in other cities, groups seeking to stop infant deaths began to focus on community outreach to educate parents about safe sleeping practices.
"Our group and many others around the country have dedicated staff to doing more of that," says Lori Behrens, head of SIDS Resources in St. Louis.
But the focus now, she says, is on whether parents understand safe practices and, if so, why they aren't following them. That's among the objectives of the new study sponsored by the Regional Health Commission and other partners. It's a unique venture for St. Louis. Normally such studies are controlled solely by a principal investigator from a university. This study, though, has co-investigators, one from a university and one from the community. The reason? The Regional Health Commission says it wants to build community-university partnerships to seek answers to important health questions.
The academic investigator for the project is Dr. James Kemp, professor of pediatrics at Washington University. His co-investigator is Behrens of SIDS Resources.
"We know there is disparity," says Behrens. "We know that back-sleeping protects against sudden infant death. We know that in the African-American population some caregivers are more likely to put babies on their tummies to sleep. What we are trying to figure out is if they have heard about 'Back to Sleep' and other kinds of safe sleep recommendations."
The investigators also want to know whether the African-American mothers may be picking up conflicting recommendations from others, including grandparents, about how to put an infant to bed. Behrens says it might be a case of a grandmother telling a granddaughter who is a new mother that the grandmother followed certain practices in raising her own children and that they all turned out fine.
Beyond the grandma factor, however, is the influence of physicians who serve African-American mothers. Behrens says researchers will try to find out "what health-care providers are telling new parents and if they are delivering the message consistently. We know some of them are, but we don't know if everybody is."
The hope, she says, is that new approaches growing out of the study will help doctors and mothers reduce sudden infant death rates among African-American infants.
The study is one of seven funded and administered by the Regional Health Commission and the other university-health system partners. The other six focus on increasing the use of mammography, promoting healthy pregnancies, improving access to healthy foods, reducing early childhood injuries, supporting substance abuse recovery, and encouraging better diabetes care.
Funding for the Beacon's health reporting is provided in part by the Missouri Foundation for Health, a philanthropic organization that aims to improve the health of the people in the communities it serves.
