Maternal and Child Health
Campaign Raises Money for Louisiana Public Health Association
At the recently concluded APHA Annual Meeting in Philadelphia, many of us had the opportunity to meet colleagues from Gulf Coast states that were ravaged last fall by Hurricanes Katrina and Rita. The stories they shared gave us a deeper appreciation for the tragedy most of us just experienced through television. Many were inspired by their fortitude, and think of them now as news of the controversial rebuilding effort unfolds. However, more must be done than just holding these colleagues in our thoughts and prayers. The APHA State affiliates in Massachusetts, Minnesota, and Washington State invite you to join them in raising $10,000 to help the Louisiana Public Health Association hold its 2006 annual meeting this spring.
The seed for this fundraising effort was planted in an evening “late breaker” session in Philadelphia, where leaders from Louisiana and Mississippi showed slides and discussed their personal hurricane experiences. In discussions after, it was learned that the Mississippi affiliate needed help recruiting a keynote speaker for its 2006 annual meeting, while Louisiana needed at least $10,000 to organize and provide scholarships for members to attend their annual meeting in Baton Rouge on April 19-21.
Affiliate leaders present that night helped secure a keynote speaker for Mississippi—2005 APHA Roemer Award winner, Harold Cox—and agreed to raise funds for the Louisiana affiliate, which must organize its annual meeting this year without support it normally receives from the state health department.
Help the Louisiana Public Health Association reach out to as many public health professionals as possible with their meeting by making the most generous contribution possible now to ensure that members of the Louisiana affiliate can have a successful annual meeting in April, despite the devastation suffered by their families and communities.
This is a special, one-time request for voluntary contributions. This appeal was approved by a unanimous vote of the Committee on Affiliates, which considered the proposal in Philadelphia. The project has been discussed with and approved by leaders from both Mississippi and Louisiana. APHA is establishing a special fund to collect donations. One hundred percent of funds received will be used for the 2006 Louisiana Public Health Association annual meeting. Affiliates including Illinois, Minnesota, Massachusetts, Ohio, Washington, and Wisconsin have already made financial commitments. Checks should be made to the American Public Health Association and mailed to:
American Public Health Association
800 I Street, NW
Washington, DC 20001
ATTN: Lakitia Mayo
Memo Section of Check: Louisiana Public Health Association Fundraiser
This is a critical juncture for the Louisiana Public Health Association and our public health colleagues in Louisiana. Let’s help our sister affiliate make a difference in providing its public health colleagues with the debriefing they need after such a difficult time.
Thank you very much for your consideration. If you have any questions regarding this effort, please contact Lakitia Mayo at (202) 777-2515 or firstname.lastname@example.org.
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ACNM, Other Health Care Organizations, Ask Congress to Apply Lessons Learned from Recent Hurricanes
The American College of Nurse-Midwives (ACNM) was one of more than 25 health care organizations who sponsored a Capitol Hill briefing, Public Health 101: The Public Health Response to Hurricanes Katrina and Rita – Applying Lessons Learned, on Jan. 19, 2006. The event was organized by the Coalition for Health Funding. The briefing focused on public health responses before, during and after hurricanes Katrina and Rita.
A discussion of maternal and child health needs in emergency and disaster situations was led by Dr. Gina Lagarde, medical director of the Maternal and Child Health Program in Louisiana. Dr. Lagarde described the catastrophic impact of the disasters on Louisiana’s health care system and population. Misinformation, lack of appropriate service and funding, and poor coordination of resources before, during and after the hurricane delayed health care services. Dr. Lagarde proposed many potential policy solutions, including the creation of a comprehensive Pediatric and Maternal Health Master Plan, disaster-specific training of health care providers, and synchronization of tracking mechanisms for health care volunteers and professionals.
ACNM provided written information related to maternal well-being in emergency situations; their materials included disaster preparedness strategies for women, the ACNM publication “Giving Birth in Place,” and stories from midwives who responded to calls for help after the hurricanes. “Giving Birth in Place” is a guide to emergency preparedness for childbirth, written by certified nurse-midwives. The guide helps women and their families know what to do if they go into labor during an emergency. To view the guide, visit http://www.mymidwife.org/index.cfm?id=107.
“We were proud to call attention to the special needs of women during disasters and to represent midwives at this event,” said Deanne Williams, CNM, ACNM executive director. “It was important to acknowledge the contribution of nurses, nurse-midwives and nurse practitioners. Policies in Louisiana that make practice difficult for midwives were acknowledged as a barrier to getting services to women and this disastrous result could be the motivation that is needed to change these policies.”
Dr. Donald E. Williamson of the Alabama Department of Public Health outlined challenges to the public health system in the Gulf Coast region. Dr. Williamson asserted that shortcomings in shelter operations, lack of surge capacity, and misinformation impeded an effective public health response. In addition, lack of coordinated professional licensure verification and volunteer management were also major obstacles to the effective delivery of medical care during these emergencies.
Russell T. Jones, PhD, a professor of psychology at Virginia Tech, called for increased attention to the mental health needs of afflicted persons. He cited the alarmingly high rates of mental distress among hurricane victims, and the potential public health costs associated with treatment. Dr. Jones advocated bolstering the region’s mental health infrastructure, including enhanced research of the short and long-term effects of disaster-related trauma.
Additional information about this event can be found on the Coalition for Health Funding Web site at http://www.aamc.org/advocacy/healthfunding.
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Improving Pregnancy Outcomes: Committee Report
Greetings from the Improving Pregnancy Outcomes (IPO) Committee! We are pleased to report that the IPO Committee had a very successful set of events at the APHA Annual Meeting in Philadelphia. Here are the highlights:
1. Committee Meeting: IPO Committee Meeting, Sunday, Dec. 7:
2. Podium and Poster Sessions, (Philadelphia, 2005)
- We organized and moderated two podium sessions as well as a poster session, all of which were very well attended. Both podium sessions were filled to capacity. More importantly, the presentations were excellent with a lot of questions and comments from the audience. Many people expressed an interest in the IPO Committee, so we now have a lot of new names added to our listerv.
3. IPO Sessions for the 2006 meeting: Please submit an abstract for presentation at the next APHA Annual Meeting in Boston. The theme is Public Health and Human Rights. The following IPO sessions are planned:
· A Global Perspective: The role of reproductive choice and human rights in determining pregnancy outcomes.
National policies and practices help to determine women’s access to reproductive as well as other services. We invite abstract submissions which document disparities in pregnancy outcomes which may, in part, be attributed to these issues. Submissions of abstracts for research conducted outside the United States is encouraged to provide a global perspective.
· Disparities in pregnancy outcomes: A human rights issue.
We invite abstract submissions which address disparities in healthcare services (access and/or quality) as well as other disparities that determine pregnancy outcomes and which might be considered a human rights issue.
The Improving Pregnancy Outcomes Committee is active in the Maternal and Child Health Section. We welcome your participation and input. If you would like to become a member, please e-mail one of us!
With warmest regards from your co-chairs,
Tyan Parker Dominguez
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Innovations in Maternity Health Services Committee
The Innovations in Maternity Care Committee continues to explore the impending crisis in the provision of maternity services in the United States at this time. Members of the committee, a working coalition of certified nurse midwives, certified professional midwives, physicians, and other maternal and child health advocates, are focused on the problems in access to care which pregnant women are experiencing across the country. The root factors for these service limitation problems include: provider shortages, difficulties with malpractice, and facilities that are closing obstetrical units because of financial problems. The magnitude of the lack of care is yet to be calculated, and benign neglect seems to be the overwhelming policy.
At present, there is no national plan for dealing with this crisis, so the Innovations Committee is beginning a year-long effort to describe the problem of access to maternity care, both in quantitative and qualitative terms. The first step is to develop an appropriate databank on the extent of these concerns, so each state affiliate will be asked to assess access issues in that state.
In Philadelphia, at the 133rd APHA Annual Meeting, the Innovations in Maternity Health Services Committee began this process by sponsoring a session entitled “Who’s Left to Catch the Baby?” It was moderated by Dr. Charles S. Mahan, former Florida health officer and emeritus Dean of the University of South Florida, who now serves as the director of the Lawton and Rhea Chiles Center for Healthy Mothers and Babies. Researchers and the papers they presented in the session included the following:
Belinda K. Rogers -- Increasing access to health care for pregnant women through the Healthy Beginnings Campaign
Lynn Bourgeault -- Who’s left to catch the baby?
Kenneth Johnson and Betty-Anne Daviss -- Disturbing trends in the use of epidemiologic research on VBAC in North America
Jean Ewan -- Empowering women through multicultural enhanced doula support: an evaluation of the Birth SistersSM Program
There was also a very interesting poster session, Improving Access to Maternity Health Services, composed of an additional eight papers on the same subject.
In the call for papers for the 2006 Annual Meeting, the same theme for our committee has been continued as Who’s left to deliver the babies? We welcome abstracts which discuss women’s rights to access to comprehensive maternity care, issues of malpractice costs, impact on provider availability, and innovative community responses to the maternity care crisis, including issue’s such as VBAC, breech delivery, induction, electronic fetal monitoring, out-of-hospital settings, and doulas.
Please consider joining the Committee in its efforts to support women and their families in accessing appropriate maternity care, which is fundamental to public health. For more information, contact Committe Chairs Carol Nelson, email@example.com, and Barb Levin, BarbL11@aol.com.
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ATMCH: Sharing Knowledge in MCH
The Association of Teachers of Maternal and Child Health (ATMCH) provides leadership in education, research, and service in the field of maternal and child health. ATMCH offers an interdisciplinary forum through which MCH faculty from schools of public health and other institutions of higher learning can share the knowledge, ideas, and skills essential to educating students, advancing MCH research, and applying research results to MCH policies, programs, and services.
Membership in ATMCH is open to all faculty teaching MCH or related subjects in schools of public health and other institutions of higher learning in the United States and other countries; faculty who formerly taught MCH or related subjects; staff of MCH teaching programs; and students of MCH or related subjects.
Benefits of membership include: collaboration and sharing of knowledge, teaching concepts, and skills through networking with academic MCH leaders; receiving the semi-annual electronic newsletter on items of importance to members; participation in the semi-annual meetings; listing and receiving the ATMCH membership directory; eligibility to vote in elections, hold an ATMCH office, and join an ATMCH committee; qualification for the annual Lacey Academic Leadership Award; free online subscription to MCH Journal; Free subscription to Public Health Reports; Discounted subscription for Journal of Obstetric, Gynecologic, & Neonatal Nursing; and discounted AMCHP annual meeting registration.
To join ATMCH, an application is available on our Web site at http://www.atmch.org/membership/Application.pdf , or by contacting Kalpana Ramiah at firstname.lastname@example.org.
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Reducing Disparities For Latino Women and Children Through Insurance Enrollment
Health insurance coverage is the single most important factor in accessing timely health care. Increasingly, families are choosing between “filling prescriptions and filling their fridge,” according to Risa Lavizzo-Mourey, MD, president of the Robert Wood Johnson Foundation. Today, there are 46 million uninsured individuals in the United States, and the numbers continue to grow each year. Latinos are more likely than any other racial or ethnic group to lack health insurance coverage. More than 20 percent of Latino children in the United States have no public or private health insurance. An Institute of Medicine report released May 21, 2002, noted, “increased health insurance coverage would likely reduce racial and ethnic disparities in the use of appropriate health care services.”
The Maternal and Child Health Consortium (MCHC), a community-based social services organization, works to improve access to high quality health care for women and children in Chester County, Pa. MCHC’s programs include: Healthy Start, a federally funded program designed to reduce infant mortality and low birthweight; bilingual (Spanish/English) prenatal and parenting education; medical interpreter training; Cross Cultural Caring, professional development training to improve cultural competence of health and human service providers; and a health insurance enrollment initiative.
An estimated 45,000 Chester County residents are without health insurance. Families that meet eligibility guidelines may apply for subsidized health insurance including Medicaid, or the Children’s Health Insurance Program (CHIP). Low-income uninsured children typically live in two-parent, working households and have little contact with the welfare system. According to the 2004 State of the Child report by Pennsylvania Partnerships for Children, 2,029 more children are enrolled in CHIP and 1,167 in Medicaid (comparing December 2000 to December 2003) in Chester County. This is good news; however, MCHC continues to see hundreds of families each year without insurance.
MCHC’s Health Insurance Enrollment Initiative is part of a comprehensive strategy to reduce financial, language, or cultural barriers to care for women and their children. This Initiative grew out of our Healthy Start program, where each year more than 75 percent of newly enrolled Healthy Start clients have no health insurance. In 2005, 1,289 uninsured adults and children obtained Medicaid or SCHIP health insurance as a result of MCHC’s efforts.
A recent study, published in Pediatrics, reported that community-based case managers increase public insurance enrollment of uninsured Latino children by “providing information about the types of available insurance programs and eligibility requirements, working with parents to complete and submit application forms, and expediting final coverage decisions by State agencies. They also acted as family advocates when children were inappropriately deemed ineligible for insurance or had coverage inappropriately discontinued” (Pediatrics, 116 (6), December 6, 2005, pp. 1433-41.)
Our staff of a dozen bilingual and bicultural outreach workers and case managers form the core of this enrollment effort. The focus of the effort is to increase awareness of available subsidized health coverage for pregnant women, children and adults through outreach and education; enrollment of women and children into Medicaid or SCHIP and to advocate for long term systems change through working with providers to screen and enroll uninsured women and children into coverage.
MCHC also works to mobilize the community to address the issue of health insurance for working families. MCHC chairs the Chester County Children’s Health Insurance Coalition, and coordinates an annual legislative breakfast, held during Cover the Uninsured Week. The breakfast brings together legislators, community agencies, and local philanthropies to identify challenges and potential solutions to reducing the number of uninsured families in the county.
A strong public-private funding partnership supports this work including private foundations, United Way, and the federal Healthy Start program (Department of Health and Human Services). For more information go to http://www.ccmchc.org.
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Now Available: Beyond Women's Health: Incorporating Sex and Gender Differences Into Graduate Public Health Curricula
ASPH is pleased to announce the release of the report Beyond Women's Health: Incorporating Sex and Gender Differences Into Graduate Public Health Curricula. This project assessed how women’s health is addressed in required and elective courses for the Master of Public Health degree. Through this project, ASPH and its Federal partners sought to extend the available information at schools of public health regarding an increased recognition of women’s health issues across the life span.
The report can be accessed through the ASPH Web site at http://www.asph.org/document.cfm?page=908. For further information, please contact Christine Plepys at email@example.com.
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Collaborative Research with Communities: Value Added and Challenges Faced
The 8th Annual William T. Small, Jr. Keynote Lecture will be presented by Meredith Minkler, DrPH, Professor, Health and Social Behavior, University of California at Berkeley School of Public Health.
The lecture, broadcast by interactive C-band satellite and Internet broadcast, will take place 2 pm-3:30 pm EST, Feb.24, 2006. Originating from Chapel Hill, N.C., the lecture is part of the 27th Annual UNC-CH School of Public Health Minority Health Conference.
Webpage links for the satellite coordinates and presentation slides will be emailed to registered sites and webcast participants by Feb. 12. Please join us for this free broadcast.
Abstract of the Lecture: http://www.minority.unc.edu/sph/minconf/2006/keynoteabstract.cfm
Satellite and Internet broadcast information: http://www.minority.unc.edu/sph/minconf/2006/satellite/
Dr. Meredith Minkler and William T. Small, Jr.: http://www.minority.unc.edu/sph/minconf/2006/keynote.cfm
The Annual UNC-CH SPH Minority Health Conference: http://www.minority.unc.edu/sph/minconf/
Attending the Conference in person in Chapel Hill: http://www.minority.unc.edu/sph/minconf/2006/agenda.cfm
The broadcast is sponsored by the Centers for Disease Control and Prevention through a cooperative agreement with the Association of Schools of Public Health and by the School of Public Health Dean's Office.
Please write to Minority_Health@unc.edu for information about co-sponsorship opportunities.
Share this announcement with your colleagues. We hope you can join us.
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ASPH Education Committee Releases MPH Core Competencies Version 1.3
The ASPH Education Committee has released the MPH Core Competencies Version 1.3. This most recent set is limited to the discipline-specific competencies in the five basic public health science areas. In this version, the discipline-specific competencies are considered final. The Core Competencies can be viewed at http://www.asph.org/UserFiles/FINAL%20-%20Version%201.3%20for%20DISTRIBUTION1.pdf.
The discipline-specific competencies in Version 1.3 are those considered essential for all MPH students upon graduation, regardless of area of specialization or intended career trajectory.
ASPH has now commenced Phase 2 of the core MPH competency development process. In this phase, experts from schools of public health, public health programs and practitioners will refine and finalize cross-cutting and Public Health Biology competencies. The six cross-cutting domain areas are: Communication, Diversity and Cultural Proficiency, Leadership, Professionalism and Ethics, Program Planning and Assessment, and Systems Thinking.
The final set of MPH core competencies will include:
- Five core discipline areas (biostatistics, environmental health sciences, epidemiology, health policy management and social and behavioral sciences)
- An integrated interdisciplinary, cross-cutting set of overall competency domains (Communication, Diversity and Cultural Proficiency, Leadership, Professionalism and Ethics, Program Planning and Assessment and Systems thinking)
- Public Health Biology competencies
The competencies are intended to serve as a resource and guide for those interested in improving the quality and accountability of public health education and raining. They were developed with respect for the uniqueness and diversity of the SPH. They are not meant to prescribe the methods or processes for achievement, recognizing that implementation of the competencies may vary as a function of each school’s mission and goals.
In particular, it is anticipated that the competencies could be useful to colleagues at graduate public health programs, employers, practice and agency partners, CEPH, and the board that will credential graduates of schools. Through this process, ASPH aims to fill the void that exists regarding an MPH core curriculum, and thus provide leadership in graduate public health education that will help define contemporary and future education in public health.
For details on the process and background on the project, see http://www.asph.org/document.cfm?page=851. ASPH continues to welcome comments at firstname.lastname@example.org. Questions should be directed to Ms. Kalpana Ramiah at email@example.com.
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ASPH Launches New Case Studies Resource Center
ASPH has launched the Public Health Case Studies Resource Center. The resource center is designed to allow both public health academics and professionals to post and access case studies contributed by schools and programs of public health and other friends of graduate public health education. Individuals may register to add case studies at http://www.asph.org/casestudies <http://www.asph.org/casestudies> .
Currently, the site is not populated, however, once resources are added, it will become an excellent mechanism to search and access case studies and related resources.
Cases teach students about the roles of managers, policy-makers, program designers and implementers, in other words, practitioners who must deal with limited time, incomplete information, and resource constraints. Students learn to recognize and speak to conflicting perspectives and interests, fashion alternatives, and craft solutions to problems for which there are no authoritative or demonstrable right answers.
Please visit the site to add your most successful case studies and related materials. For more information, contact Ms. Kalpana Ramiah at firstname.lastname@example.org.
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Commonwealth Fund Announces Children's Conference
The Commonwealth Fund has announced that the National Initiative for Children's Health Care Quality (NICHQ) will be hosting Forging Connections, the Fifth Annual Forum for Improving Children's Health Care, March 16-18 at the Royal Pacific Resort in Orlando, Fla.
The event aims to build will for improvement by highlighting successful evidence-based models and interventions and creating a community of dedicated professionals, policy-makers, and payers who are working to transform health care for children. Topics to be covered include family-centered care, systems transformation, clinical innovations, reducing health disparities, and more.
Fund staff and grantees will take part in several forum sessions, including:
- Peter Margolis, MD, PhD, Kim Paul, and Judy Shaw: Increasing Capacity of Primary Care Practices to Provide Organized Preventive Services: Models from Across the Nation
- Edward Schor, MD, and Melinda Abrams: Working dinner on preventive and developmental services for young children
- David Bergman: Innovation and Change in Well Child Care: The Results of a National Conference to Generate Innovations for Well Child Care
For more information or to register, visit the NICHQ Web site at http://www.nichq.org/NICHQ/Programs/ConferencesAndTraining/5thannualforum.htm.
To join the e-mail list of the Commonwealth Fund and receive regular notices about its activities, register at http://www.cmwf.org/emailalert.
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Distance-Learning Master of Public Health in Maternal and Child Health
The Maternal and Child Health Program (http://www.epi.umn.edu/mch) at the University of Minnesota's School of Public Health is offering a distance learning Maters of Public Health to MCH professionals.
Who should apply: The program is designed for working professionals whose goal is to advance to leadership roles in Maternal and Child Health:
- Individuals with an advanced degree (e.g., MD, MSW, MSN, MS, PhD, DrPH) and five or more years of work experience in MCH OR
- Individuals without an advanced degree who have 8-10 years of work experience in MCH.
Program delivery: The program focuses on the principles of social justice and concern for vulnerable populations. Graduates of the 42-credit program will develop expertise in evidence-based advocacy, rigorous public heath assessment, accessible and appropriate health education, and effective and innovative programs that promote the health and well-being of infants, children, youth, families, and women. Training will be delivered through a combination of online courses and short intensive courses at the Twin Cities campus.
Tuition: Irrespective of residency, all students will be charged in-state tuition.
For more information: Go to http://www.sph.umn.edu/mchonline.html.
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Free Web-based Educational Module to Learn About Folic Acid
ASPH, with support from the March of Dimes, has designed a free, Web-based educational module, Advocating For Folic Acid: A Guide For Health Professionals, to educate current and future health professionals about the importance of folic acid and ways to counsel patients. The module provides information such as the benefits of folic acid and strategies for counseling individuals regarding folic acid intake. Special features are available for educators to view student performance. This module also contains interactive components for students to learn about folic acid. Specific sections focus on the following health professions: Allied Health, Dentistry, Dietitian, Nursing, Optometry, Medicine, Pharmacy, and Public Health. A number of health professional schools are currently using this education tool. If you are interested in including http://www.folicacid.net in your next course offering, please contact Ms. Kalpana Ramiah at email@example.com.
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UIC Maternal and Child Health Leadership Conference
Register today for the 19th Annual National MCH Leadership Conference, Translating Research into MCH Public Health Practice. The conference is sponsored by the University of Illinois at Chicago MCH Program. Join us at the Hyatt Lodge in Oakbrook, Ill. (close to both O'Hare and Midway airports) on May 16-17, 2006. In this year's conference, interdisciplinary experts and participants will come together to share findings about emerging MCH issues, cutting-edge research, and innovative programs designed to improve the health and well-being of women, children, and families.
The conference includes a dynamic keynote address by Paul Wise, MD, MPH, Stanford University, Center for Health Policy/Center for Primary Care and Outcomes Research, who will speak on The Translation and Dissemination of Health Care Interventions for Poor Children: Can Research Speak to Power?
Plenary sessions include:
- Washington State Uses Data in an Innovative Way to Improve Their System of Care for Children with Special Health Care Needs.
- Interdisciplinary Research on Disparities in Pregnancy Outcomes: From Bench to Community.
- A National Survey of U.S. Maternity Care Practice From the Mothers Perspective.
For more information about the conference, including the detailed agenda and a listing of all sessions (keynote, plenary, and workshop) and speakers, please visit our Web site at http://www.uic.edu/sph/mch/mch_leadership_conference.htm.
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Recent Headlines of Interest
- Obesity and Kids: 2005 could be called the Year of the Obese Child, as study after study voiced growing concern over the expanding girth of our nation’s children, which could wipe out the strides made by decreasing rates of smoking, drinking, and substance abuse. In response, the National Heart, Lung, and Blood Institute released its We Can! initiative, designed to say “whoa,” “go,” and “slow” to junk foods, nutritious foods, and packaged foods, also pushing for less time in front of the TV and more time playing outside. Also, the Department of Agriculture developed a kid-friendly online food pyramid, designed to teach kids the importance of healthy foods and more exercise. Other important research issues in 2005 included immunization, SIDS, breastfeeding, and heavy backpacks. For the full story, see http://www.medpagetoday.com/Pediatrics/GeneralPediatrics/tb2/2410.
- Orphan drug effective for infant botulism: An orphan drug known as BabyBIG, approved to treat infant botulism, has been shown in a five-year randomized trial to shorten hospital stays, reduce time spent in intensive care, and decrease need for mechanical ventilation and intravenous feeding. The drug is another success story for the 1982 Orphan Drug Act, which eases the financial burden of developing orphan drugs. Arnon SS et al. Human Botulism Immune Globulin for the Treatment of Infant Botulism. N Engl J Med 2006;354:462-71; Marlene E. Haffner. Adopting Orphan Drugs – Two Dozen Years of Treating Rare Diseases. N Engl J Med 2006;354:445-47.
- Genetic, environmental factors in SIDS: African Americans carrying a common genetic predisposition to cardiac arrhythmia are at increased risk of bearing children who are susceptible to sudden infant death syndrome. SIDS is likely caused by a complicated combination of genetic and environmental factors; this genetic variation puts children at increased risk of respiratory acidosis, which can be exacerbated by sleep apnea caused by sleeping on the stomach. Respiratory acidosis is a known risk factor for SIDS. Other environmental and genetic factors probably contribute to SIDS, but the results of this study suggest that genetic screening is warranted in specific situations where other risk factors are present. Plant LD et al. A Common Cardiac Sodium Channel Variant Associated with Sudden Infant Death in African Americans SCN5A S1103Y. J. Clin. Invest. 2006;116:430-435. Jonathan C. Makielski. SIDS: genetic and environmental influences may cause arrhythmia in this silent killer. J. Clin. Invest. 2006;116:297-299.
- Changing epidemiology of SIDS: In other news about SIDS, although mortality has declined dramatically in England in the last 20 years, the number of deaths involving a parent and an infant sleeping together on a sofa are on the rise. Although the Back to Sleep campaign has been very effective in reducing deaths from SIDS, researchers feel that the risk of infants sleeping with a parent on a couch have not been sufficiently publicized. Also, the Back to Sleep Campaign significantly changed the epidemiology of this syndrome, as the decrease in one risk factor caused others, such as low income, smoking, and preterm birth, to become more important. Blair PS et al. Major epidemiological changes in sudden infant death syndrome: a 20-year population-based study in the UK. The Lancet. Advanced online publication January 18, 2006.
Selected from MedPage Today Daily Headlines. To subscribe, register at http://www.medpagetoday.com/register.cfm.
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ILCA Responds to Policy Statement by AAP Task Force on SIDS
The following statement was submitted by the president-elect of the International Lactation Consultants Association (ILCA). Footnotes have been removed. For a full copy, contact http://www.ilca.org.
The sudden unexpected death of an otherwise healthy infant is a tragedy no family should have to experience. In an effort to continue to reduce rates of sudden infant death syndrome in the United States, the American Academy of Pediatrics Task Force on SIDS has issued a revised set of recommendations that have provoked controversy because of their potential impact on breastfeeding families.1 Specifically, concerns about the new recommendations to increase the use of pacifiers and to discourage bed sharing have been raised by the Academy of Breastfeeding Medicine, as well as other breastfeeding advocacy groups.2-4 Because these recommendations will be used to determine standards of practice among physicians, it is important that lactation consultants understand their basis and significance for breastfeeding families.
The International Lactation Consultant Association recognizes that much of the controversy surrounding the recommendations results from inconsistency in research findings related to breastfeeding and pacifier use, bed-sharing/co-sleeping and SIDS. Inconsistent results in breastfeeding-related research often occur due to lack of a clear definition of breastfeeding. Comparing children who were “never” breastfed to those who were “ever” breastfed combines highly varied practices into the same groups, potentially mixing children who breastfed once in the hospital with those who exclusively breastfed for several months. Well-designed research trials should define both exclusivity and duration of breastfeeding. Very few of the studies cited in the AAP policy statement defined either exclusivity or duration. The baby who is exclusively breastfed for six months is the appropriate reference model.
There have been many studies examining the association between pacifier use and breastfeeding duration among both term and preterm infants. Many of the observational studies indicate that pacifier use, at any stage of lactation, is associated with reduced breastfeeding exclusivity or duration. However, randomized controlled trials indicate that pacifier use, after the first month postpartum, is not significantly associated with shorter breastfeeding duration. It is possible that pacifier use is an indicator for breastfeeding difficulties rather than a cause of problems or that other factors contribute to both pacifier use and early weaning. On the basis of the evidence from the randomized trials examining the association between pacifier use and reduced risk for SIDS, the AAP committee recommended that pacifiers be avoided by breastfeeding families in the first month postpartum to ensure that breastfeeding is well established. Lactation consultants will play an important role in ensuring that pacifier use after the first month does not interfere with successful lactation.
ILCA applauds the AAP for recommending sleeping in close proximity to one’s infant to reduce risk of SIDS. Advising against any bed-sharing for the breastfed infant is highly controversial. The breastfed infant is more likely to sleep supine and suckle frequently through the night, naturally achieving the potentially SIDS reducing goals of less deep sleep and frequent brief arousals. Given the need for night feeds in the early months postpartum, bed-sharing is used as a means by parents to reduce the time they spend awake during the night. In a study of over 10,000 families, breastfeeding parents were three times more likely than bottle-feeding parents to bed-share. The potential effects of the guidelines on breastfeeding duration and exclusivity have yet to be explored. It is important that lactation consultants educate themselves about all the options for sleeping arrangements for families and to follow-up on any breastfeeding-related concerns.
ILCA continues to recommend exclusive breastfeeding for six months followed by the addition of complementary, age-appropriate solids and continued breastfeeding for two years and beyond. In keeping with the new AAP guidelines:
• Pacifiers should be avoided until breastfeeding is well established.
• Mothers who are having difficulty with breastfeeding should be closely monitored, particularly if they choose to use pacifiers.
• Infants should sleep in close proximity to their mothers though not necessarily in the same bed.
• Further research is needed on the sleeping practices of healthy infants and the association between co-sleeping and infant feeding patterns.
• Infants should never sleep with other children, with parents who smoke or abuse drugs or alcohol, on couches or other locations where entrapment might occur.
• Infants should always be placed on their backs to sleep, on a firm mattress without any pillows or other soft, loose bedding.
Community education efforts should focus strongly on increasing exclusive breastfeeding for the first six months of life, decreasing parental smoking and smoking during pregnancy and educating parents, non-parental caregivers and hospital staff about the dangers of non-supine sleep positions for infants. While the new guidelines remain controversial, the recommendations to avoid pacifiers in the first month and encourage parents to sleep in the same room with their infants are positive steps toward the promotion of breastfeeding. Lactation consultants must continue to call for research in these important areas of SIDS prevention. As the evidence-base grows, it will be the responsibility of the AAP to refine their guidelines in line with research outcomes.
The International Lactation Consultant Association is a worldwide network of lactation professionals. For more information on increasing exclusive breastfeeding, see ILCA’s Clinical Guidelines for the Establishment of Exclusive Breastfeeding published in 2005, available at http://www.ilca.org.
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