{"id":1249,"date":"2018-12-18T16:55:36","date_gmt":"2018-12-18T16:55:36","guid":{"rendered":"https:\/\/courses.lumenlearning.com\/wm-lifespandevelopment\/?post_type=chapter&#038;p=1249"},"modified":"2024-04-30T19:11:04","modified_gmt":"2024-04-30T19:11:04","slug":"sleep-and-health","status":"publish","type":"chapter","link":"https:\/\/courses.lumenlearning.com\/wm-lifespandevelopment\/chapter\/sleep-and-health\/","title":{"raw":"Sleep and Health","rendered":"Sleep and Health"},"content":{"raw":"<div class=\"textbox learning-objectives\">\r\n<h3>Learning Outcomes<\/h3>\r\n<ul>\r\n \t<li>Describe sleep concerns for infants<\/li>\r\n \t<li>Explain the vaccination debate and its consequences<\/li>\r\n<\/ul>\r\n<\/div>\r\n<h2>Infant Sleep<\/h2>\r\n[caption id=\"attachment_6418\" align=\"alignleft\" width=\"392\"]<img class=\"wp-image-6418\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/3707\/2018\/12\/23131503\/baby-2582305_1280.jpg\" alt=\"A sleeping child.\" width=\"392\" height=\"261\" \/> <strong>Figure 1<\/strong>. Sleep is critical for healthy infant development.[\/caption]\r\n\r\nInfants 0 to 2 years of age sleep an average of 12.8 hours a day, a<span style=\"color: #333333;\">lthough this changes and develops gradually throughout an infant's life. For the first three months, newborns sleep between 14 and 17 hours a day, then they become increasingly alert for longer periods of time.\u00a0About one-half of an infant\u2019s sleep is rapid eye movement (<\/span>REM) sleep,\u00a0<span style=\"color: #333333;\"><span style=\"color: #333333;\">and infants often begin their sleep cycle with REM rather than non-REM sleep. They also move through the sleep cycle more quickly than adults. <\/span><\/span>\r\n\r\n<span style=\"color: #333333;\"><span style=\"color: #333333;\">Parents spend a significant amount of time worrying about and losing even more sleep over their infant's sleep schedule, but there remains a great deal<\/span><\/span> of variation in sleep patterns and habits for individual children. A 2018 study showed that at 6 months of age, 62% of infants slept at least six hours during the night, 43% of infants slept at least 8 hours through the night, and 38% of infants were <em>not<\/em> sleeping at least six continual hours through the night. At 12 months, 28% of children were still not sleeping at least 6 uninterrupted hours through the night, while 78% were sleeping at least 6 hours, and 56% were sleeping at least 8 hours.[footnote]Marie-H\u00e9l\u00e8ne Pennestri, Christine Lagani\u00e8re, Andr\u00e9e-Anne Bouvette-Turcot, Irina Pokhvisneva, Meir Steiner, Michael J. Meaney, H\u00e9l\u00e8ne Gaudreau, on behalf of the Mavan Research Team (December 2018).\u00a0<em>Uninterrupted Infant Sleep, Development, and Maternal Mood.\u00a0<\/em>Pediatrics, Volume 142. [\/footnote]\r\n\r\n<span style=\"color: #333333;\">The most common infant sleep-related problem reported by parents is nighttime waking.\u00a0Studies of new parents and sleep patterns show that parents lose the most sleep during the first three months with a new baby, with mothers losing about an hour of sleep each night, and fathers losing a disproportionate 13 minutes. This decline in sl<\/span>eep quality and quantity for adults persists until the child is about six years old. [footnote]David Richter, Michael D Kr\u00e4mer, Nicole K Y Tang, Hawley E Montgomery-Downs, Sakari Lemola, Long-term effects of pregnancy and childbirth on sleep satisfaction and duration of first-time and experienced mothers and fathers, Sleep, Volume 42, Issue 4, April 2019, zsz015, <a href=\"https:\/\/doi.org\/10.1093\/sleep\/zsz015\" target=\"_blank\" rel=\"noopener\">https:\/\/doi.org\/10.1093\/sleep\/zsz015<\/a>[\/footnote]\r\n\r\n[caption id=\"attachment_6417\" align=\"alignright\" width=\"465\"]<img class=\"wp-image-6417\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/3707\/2018\/12\/23131317\/13941972617449.jpg\" alt=\"Dad holding newborn baby.\" width=\"465\" height=\"309\" \/> <strong>Figure 2<\/strong>. This newborn takes a nap with his dad. Co-sleeping is the norm in many regions of the world, and controversial in others.[\/caption]\r\n\r\nWhile this shows there is no precise science as to when and how an infant will sleep, there are general trends in sleep patterns. Around six months, babies typically sleep between 14-15 hours a day, with 3-4 of those hours happening during daytime naps. As they get older, these naps decrease from several to typically two naps a day between ages 9-18 months. Often, periods of rapid weight gain or changes in developmental abilities such as crawling or walking will cause changes to sleep habits as well. Infants generally move towards one 2-4 hour nap a day by around 18 months, and many children will continue to nap until around four or five years old.[footnote]Macall Gordon (October 2018).\u00a0From Safe Sleep to Healthy Sleep: A Systemic Perspective on Sleep In the First Year. Northwest Bulletin: Family and Child Health. University of Washington. retrieved from\u00a0https:\/\/depts.washington.edu\/nwbfch\/infant-safe-sleep-development. [\/footnote]\r\n<h2><strong>Sudden Unexpected Infant Deaths (SUID)<\/strong><\/h2>\r\nEach year in the United States, there are about 3,500 Sudden Unexpected Infant Deaths (SUID). These deaths occur among infants less than one-year-old and have no immediately obvious cause (CDC, 2015). The three commonly reported types of SUID are:\r\n<ul>\r\n \t<li><strong>Sudden Infant Death Syndrome (SIDS):<\/strong>\u00a0SIDS is identified when the death of a healthy infant occurs suddenly and unexpectedly, and medical and forensic investigation findings (including an autopsy) are inconclusive. SIDS is the leading cause of death in infants up to 12 months old, and approximately 1,500 infants died of SIDS in 2013 (CDC, 2015). The risk of SIDS is highest at 4 to 6 weeks of age.\u00a0Because SIDS is diagnosed when no other cause of death can be determined, possible causes of SIDS are regularly researched. One leading hypothesis suggests that infants who die from SIDS have abnormalities in the area of the brainstem responsible for regulating breathing (Weekes-Shackelford &amp; Shackelford, 2005). Although the exact cause is unknown, doctors have identified the following risk factors for SIDS:\r\n<ul>\r\n \t<li>low birth weight<\/li>\r\n \t<li>siblings who have had SIDS<\/li>\r\n \t<li>sleep apnea<\/li>\r\n \t<li>of African-American or Inuit descent<\/li>\r\n \t<li>low socioeconomic status (SES)<\/li>\r\n \t<li>smoking in the home<\/li>\r\n<\/ul>\r\n<\/li>\r\n \t<li><strong>Unknown cause:\u00a0<\/strong>The sudden death of an infant less than one year of age that cannot be explained because a thorough investigation was not conducted and the cause of death could not be determined.<\/li>\r\n \t<li><strong>Accidental suffocation and strangulation in bed:\u00a0<\/strong>Reasons for accidental suffocation include the following: suffocation by soft bedding, another person rolling on top of or against the infant while sleeping, an infant being wedged between two objects such as a mattress and wall, and strangulation such as when an infant\u2019s head and neck become caught between crib railings.<\/li>\r\n<\/ul>\r\nThe combined SUID rate declined considerably following the release of the American Academy of Pediatrics safe sleep recommendations in 1992, which advocated that infants be placed on their backs for sleep (non-prone position). These recommendations were followed by a major Back to Sleep Campaign in 1994. According to the CDC, the SIDS death rate is now less than one-fourth of what is was (130 per 100,000 live birth in 1990 versus 40 in 2015).\u00a0However, accidental suffocation and strangulation in bed mortality rates remained unchanged until the late 1990s. Some parents were still putting newborns to sleep on their stomachs partly because of past tradition. Most SIDS victims experience several risks, an interaction of biological and social circumstances. But thanks to research, the major risk, stomach sleeping, has been highly publicized.\u00a0Other causes of death during infancy include congenital birth defects and homicide.\r\n<h3>Co-Sleeping<\/h3>\r\nThe location of sleep depends primarily on the baby's age and culture.\u00a0<strong>Bed-sharing<\/strong> (in the parents' bed) or <strong>co-sleeping<\/strong> (in the parents' room) is the norm is some cultures, but not in others (Esposito et al. 2015)\u00a0[footnote]Esposito, G., Setoh, P., &amp; Bornstein, M.H. (2015). Beyond practices and values: Toward a physio-bioecological analysis of sleep arrangements in early infancy. Frontiers in Psychology, 6, 264.[\/footnote].\u00a0Colvin, Collie-Akers, Schunn and Moon (2014)[footnote]Colvin, J.D., Collie-Akers, V., Schunn, C., &amp; Moon, RY (2014). Sleep environment risks for younger and older infants. Pediatrics. 134(2):e406-12. doi: 10.1542\/peds.2014-0401.[\/footnote] analyzed a total of 8,207 deaths from 24 states during 2004\u20132012. The deaths were documented in the National Center for the Review and Prevention of Child Deaths Case Reporting System, a database of death reports from state child death review teams. The results indicated that younger victims (0-3 months) were more likely to die by bed-sharing and sleeping in an adult's bed or on a person. A higher percentage of older victims (4 months to 364 days) rolled into objects in the sleep environment and changed position from side\/back to prone. Carpenter et al. (2013)[footnote]<a href=\"https:\/\/bmjopen.bmj.com\/content\/3\/5\/e002299.long\" target=\"_blank\" rel=\"noopener\">https:\/\/bmjopen.bmj.com\/content\/3\/5\/e002299.long<\/a>[\/footnote] compared infants who died of SIDS with a matched control and found that infants younger than three months old who slept in bed with a parent were five times more likely to die of SIDS compared to babies who slept separately from the parents, but were still in the same room. They concluded that bed-sharing, even when the parents do not smoke or take alcohol or drugs, increases the risk of SIDS. However, when combined with parental smoking and maternal alcohol consumption and\/or drug use, the risks associated with bed-sharing greatly increased.\r\n\r\nDespite the risks noted above, the controversy about where babies should sleep has been ongoing. Co-sleeping has been recommended for those who advocate attachment parenting (Sears &amp; Sears, 2001) [footnote]Sears, W. &amp; Sears, M. (2001). The attachment parenting book: A commonsense guide to understanding and nurturing your baby. Boston: MA: Little Brown.[\/footnote] and other research suggests that bed-sharing and co-sleeping is becoming more popular in the United States (Colson et al., 2013) [footnote]Colson, E.R., Willinger, M., Rybin, D., Heeren, T., Smith, L.A., Lister, G. &amp; Corwin, M.J. (2013). Trends and factors associated with infant bed sharing, 1993-2010: The National Sleep Position study. JAMA Pediatrics, 167(11), 1032-1037.[\/footnote]. So, what are the latest recommendations?\r\n\r\nThe American Academy of Pediatrics (AAP) actually updated their recommendations for a Safe Infant Sleeping Environment in 2016. The most recent\u00a0AAP recommendations on creating a safe sleep environment include:\r\n<ul>\r\n \t<li>Back to sleep for every sleep. Always place the baby on their back on a firm sleep surface such as a crib or bassinet with a tight-fitting sheet.<\/li>\r\n \t<li>Avoid the use of soft bedding, including crib bumpers, blankets, pillows, and soft toys. The crib should be bare.<\/li>\r\n \t<li>Breastfeeding is recommended.<\/li>\r\n \t<li>Share a bedroom with parents, but not the same sleeping surface, preferably until the baby turns 1 but at least for the first six months. Room-sharing decreases the risk of SIDS by as much as 50 percent.<\/li>\r\n \t<li>Avoid baby's exposure to smoke, alcohol, and illicit drugs.<\/li>\r\n<\/ul>\r\nAs you can see, there is a recommendation to now \"share a bedroom with parents,\" but not the same sleeping surface.\u00a0Breastfeeding is also recommended as adding protection against SIDS, but after feeding, the AAP encourages parents to move the baby to their separate sleeping space, preferably a crib or bassinet in the parents' bedroom. Finally, the report\u00a0included new evidence that supports skin-to-skin care for newborn infants.[footnote]SIDS and Other Sleep-Related Infant Deaths: Updated 2016 Recommendations for a Safe Infant Sleeping Environment. Task Force on Sudden Infant Death Syndrome. Pediatrics. Retrieved from <a href=\"https:\/\/pediatrics.aappublications.org\/content\/138\/5\/e20162938\" target=\"_blank\" rel=\"noopener\">https:\/\/pediatrics.aappublications.org\/content\/138\/5\/e20162938<\/a>.[\/footnote]\r\n<div class=\"textbox exercises\">\r\n<h3>Link to Learning<\/h3>\r\n<span style=\"color: #333333;\">The website\u00a0<a class=\"external\" style=\"color: #333333;\" title=\"Zero to Three\" href=\"https:\/\/www.zerotothree.org\/early-development\/sleep\" target=\"_blank\" rel=\"noopener noreferrer\"><strong>Zero to Three\u00a0<\/strong><\/a>has more information on infant sleep patterns and habits. Feel free to explore their multiple topics on the subject.<\/span>\r\n\r\n<\/div>\r\n<div class=\"textbox tryit\">\r\n<h3>Try It<\/h3>\r\nhttps:\/\/assess.lumenlearning.com\/practice\/8083d827-8f7c-4dc7-aab6-22722bddb742\r\n\r\n<\/div>\r\n<h2>Immunizations<\/h2>\r\nPreventing communicable diseases from early infancy is one of the major tasks of the Public Health System in the USA. Infants mouth every single object they find as one of their typical developmental tasks. They learn through their senses and tasting objects stimulates their brain and provides a sensory experience as well as learning.\r\n\r\nInfants have much contact with dirty surfaces. They lay on a carpet that most likely has been contaminated by adults walking on it; they mouth keys, rattles, toys, and books; they crawl on the floor; they hold on to furniture to walk, and much more. How do we prevent infants from getting sick? One possible answer is\u00a0<strong>immunizations<\/strong>.\r\n<div class=\"textbox examples\">\r\n<h3>Watch It<\/h3>\r\nWatch the first ten minutes of <a href=\"https:\/\/www.youtube.com\/watch?v=VPOrnU3ImxI&amp;t=285s\" target=\"_blank\" rel=\"noopener\">this video clip from the Alexander Street Database<\/a>\u00a0that illustrates what has become known as the vaccine war.\r\n\r\nThis debate continues on today, only amplified by the Covid-19 Pandemic. The rush to develop a vaccine to protect against coronavirus resulted in many people celebrating the vaccine and its success in preventing the spread and the severity of Covid-19, while others remained distrustful of potential side effects. Questions and opinions circulating about vaccination led to increased social and political divisions throughout the United States.\r\n\r\n<\/div>\r\nMany decades ago, our society struggled to find vaccines and cures for illnesses such as Polio, whooping cough, and many other medical conditions. A few decades ago parents started changing their minds on the need to vaccinate children. Some children are not vaccinated for valid medical reasons, but some states allow a child to be unvaccinated because of a parent's personal or religious beliefs. At least 1 in 14 children is not vaccinated. What is the outcome of not vaccinating children? Some of the preventable illnesses are returning. Fortunately, each vaccinated child stops the transmission of the disease, a phenomenon called <em>herd immunity<\/em>. Usually, if 90% of the people in a community (a herd) are immunized, no one dies of that disease.\r\n\r\nIn 2017, Community Care Licensing in California, the agency that regulates childcare centers, changed regulations. Before it was possible for parents to opt-out of vaccinations due to personal beliefs, but this changed after Governor Brown signed a Bill in 2016 to only exclude children from being vaccinated if there were medical reasons. Furthermore, all personnel working with children must be immunized.\r\n<div class=\"textbox exercises\">\r\n<h3>Link to Learning<\/h3>\r\nRead more information about vaccinations at the website\u00a0<strong><a class=\"external\" href=\"http:\/\/www.shotsforschool.org\/\" target=\"_blank\" rel=\"noopener noreferrer\">Shots for School.<\/a>\u00a0<\/strong>\r\n\r\n<\/div>\r\n<div class=\"textbox tryit\">\r\n<h3>Try It<\/h3>\r\nhttps:\/\/assess.lumenlearning.com\/practice\/3d297ab8-9585-472f-9b32-80eff54fbb94\r\n\r\n<\/div>\r\n<div class=\"textbox key-takeaways\">\r\n<h3>Glossary<\/h3>\r\n[glossary-page]\r\n[glossary-term]bed-sharing:[\/glossary-term]\r\n[glossary-definition] when two or more people sleep in the same bed[\/glossary-definition]\r\n\r\n[glossary-term]co-sleeping:[\/glossary-term]\r\n[glossary-definition]a custom in which parents and their children (usually infants) sleep together in the same room[\/glossary-definition]\r\n\r\n[glossary-term]immunization:[\/glossary-term]\r\n[glossary-definition]a process that stimulates the body's immune system by causing the production of antibodies to defend against attack by a specific contagious disease[\/glossary-definition]\r\n\r\n[glossary-term]sudden infant death syndrome (SIDS):[\/glossary-term]\r\n[glossary-definition]a situation in which a seemingly healthy infant, usually between 2 and 6 months old, suddenly stops breathing and dies unexpectedly while asleep[\/glossary-definition]\r\n[\/glossary-page]\r\n\r\n<\/div>","rendered":"<div class=\"textbox learning-objectives\">\n<h3>Learning Outcomes<\/h3>\n<ul>\n<li>Describe sleep concerns for infants<\/li>\n<li>Explain the vaccination debate and its consequences<\/li>\n<\/ul>\n<\/div>\n<h2>Infant Sleep<\/h2>\n<div id=\"attachment_6418\" style=\"width: 402px\" class=\"wp-caption alignleft\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-6418\" class=\"wp-image-6418\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/3707\/2018\/12\/23131503\/baby-2582305_1280.jpg\" alt=\"A sleeping child.\" width=\"392\" height=\"261\" \/><\/p>\n<p id=\"caption-attachment-6418\" class=\"wp-caption-text\"><strong>Figure 1<\/strong>. Sleep is critical for healthy infant development.<\/p>\n<\/div>\n<p>Infants 0 to 2 years of age sleep an average of 12.8 hours a day, a<span style=\"color: #333333;\">lthough this changes and develops gradually throughout an infant&#8217;s life. For the first three months, newborns sleep between 14 and 17 hours a day, then they become increasingly alert for longer periods of time.\u00a0About one-half of an infant\u2019s sleep is rapid eye movement (<\/span>REM) sleep,\u00a0<span style=\"color: #333333;\"><span style=\"color: #333333;\">and infants often begin their sleep cycle with REM rather than non-REM sleep. They also move through the sleep cycle more quickly than adults. <\/span><\/span><\/p>\n<p><span style=\"color: #333333;\"><span style=\"color: #333333;\">Parents spend a significant amount of time worrying about and losing even more sleep over their infant&#8217;s sleep schedule, but there remains a great deal<\/span><\/span> of variation in sleep patterns and habits for individual children. A 2018 study showed that at 6 months of age, 62% of infants slept at least six hours during the night, 43% of infants slept at least 8 hours through the night, and 38% of infants were <em>not<\/em> sleeping at least six continual hours through the night. At 12 months, 28% of children were still not sleeping at least 6 uninterrupted hours through the night, while 78% were sleeping at least 6 hours, and 56% were sleeping at least 8 hours.<a class=\"footnote\" title=\"Marie-H\u00e9l\u00e8ne Pennestri, Christine Lagani\u00e8re, Andr\u00e9e-Anne Bouvette-Turcot, Irina Pokhvisneva, Meir Steiner, Michael J. Meaney, H\u00e9l\u00e8ne Gaudreau, on behalf of the Mavan Research Team (December 2018).\u00a0Uninterrupted Infant Sleep, Development, and Maternal Mood.\u00a0Pediatrics, Volume 142.\" id=\"return-footnote-1249-1\" href=\"#footnote-1249-1\" aria-label=\"Footnote 1\"><sup class=\"footnote\">[1]<\/sup><\/a><\/p>\n<p><span style=\"color: #333333;\">The most common infant sleep-related problem reported by parents is nighttime waking.\u00a0Studies of new parents and sleep patterns show that parents lose the most sleep during the first three months with a new baby, with mothers losing about an hour of sleep each night, and fathers losing a disproportionate 13 minutes. This decline in sl<\/span>eep quality and quantity for adults persists until the child is about six years old. <a class=\"footnote\" title=\"David Richter, Michael D Kr\u00e4mer, Nicole K Y Tang, Hawley E Montgomery-Downs, Sakari Lemola, Long-term effects of pregnancy and childbirth on sleep satisfaction and duration of first-time and experienced mothers and fathers, Sleep, Volume 42, Issue 4, April 2019, zsz015, https:\/\/doi.org\/10.1093\/sleep\/zsz015\" id=\"return-footnote-1249-2\" href=\"#footnote-1249-2\" aria-label=\"Footnote 2\"><sup class=\"footnote\">[2]<\/sup><\/a><\/p>\n<div id=\"attachment_6417\" style=\"width: 475px\" class=\"wp-caption alignright\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-6417\" class=\"wp-image-6417\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/3707\/2018\/12\/23131317\/13941972617449.jpg\" alt=\"Dad holding newborn baby.\" width=\"465\" height=\"309\" \/><\/p>\n<p id=\"caption-attachment-6417\" class=\"wp-caption-text\"><strong>Figure 2<\/strong>. This newborn takes a nap with his dad. Co-sleeping is the norm in many regions of the world, and controversial in others.<\/p>\n<\/div>\n<p>While this shows there is no precise science as to when and how an infant will sleep, there are general trends in sleep patterns. Around six months, babies typically sleep between 14-15 hours a day, with 3-4 of those hours happening during daytime naps. As they get older, these naps decrease from several to typically two naps a day between ages 9-18 months. Often, periods of rapid weight gain or changes in developmental abilities such as crawling or walking will cause changes to sleep habits as well. Infants generally move towards one 2-4 hour nap a day by around 18 months, and many children will continue to nap until around four or five years old.<a class=\"footnote\" title=\"Macall Gordon (October 2018).\u00a0From Safe Sleep to Healthy Sleep: A Systemic Perspective on Sleep In the First Year. Northwest Bulletin: Family and Child Health. University of Washington. retrieved from\u00a0https:\/\/depts.washington.edu\/nwbfch\/infant-safe-sleep-development.\" id=\"return-footnote-1249-3\" href=\"#footnote-1249-3\" aria-label=\"Footnote 3\"><sup class=\"footnote\">[3]<\/sup><\/a><\/p>\n<h2><strong>Sudden Unexpected Infant Deaths (SUID)<\/strong><\/h2>\n<p>Each year in the United States, there are about 3,500 Sudden Unexpected Infant Deaths (SUID). These deaths occur among infants less than one-year-old and have no immediately obvious cause (CDC, 2015). The three commonly reported types of SUID are:<\/p>\n<ul>\n<li><strong>Sudden Infant Death Syndrome (SIDS):<\/strong>\u00a0SIDS is identified when the death of a healthy infant occurs suddenly and unexpectedly, and medical and forensic investigation findings (including an autopsy) are inconclusive. SIDS is the leading cause of death in infants up to 12 months old, and approximately 1,500 infants died of SIDS in 2013 (CDC, 2015). The risk of SIDS is highest at 4 to 6 weeks of age.\u00a0Because SIDS is diagnosed when no other cause of death can be determined, possible causes of SIDS are regularly researched. One leading hypothesis suggests that infants who die from SIDS have abnormalities in the area of the brainstem responsible for regulating breathing (Weekes-Shackelford &amp; Shackelford, 2005). Although the exact cause is unknown, doctors have identified the following risk factors for SIDS:\n<ul>\n<li>low birth weight<\/li>\n<li>siblings who have had SIDS<\/li>\n<li>sleep apnea<\/li>\n<li>of African-American or Inuit descent<\/li>\n<li>low socioeconomic status (SES)<\/li>\n<li>smoking in the home<\/li>\n<\/ul>\n<\/li>\n<li><strong>Unknown cause:\u00a0<\/strong>The sudden death of an infant less than one year of age that cannot be explained because a thorough investigation was not conducted and the cause of death could not be determined.<\/li>\n<li><strong>Accidental suffocation and strangulation in bed:\u00a0<\/strong>Reasons for accidental suffocation include the following: suffocation by soft bedding, another person rolling on top of or against the infant while sleeping, an infant being wedged between two objects such as a mattress and wall, and strangulation such as when an infant\u2019s head and neck become caught between crib railings.<\/li>\n<\/ul>\n<p>The combined SUID rate declined considerably following the release of the American Academy of Pediatrics safe sleep recommendations in 1992, which advocated that infants be placed on their backs for sleep (non-prone position). These recommendations were followed by a major Back to Sleep Campaign in 1994. According to the CDC, the SIDS death rate is now less than one-fourth of what is was (130 per 100,000 live birth in 1990 versus 40 in 2015).\u00a0However, accidental suffocation and strangulation in bed mortality rates remained unchanged until the late 1990s. Some parents were still putting newborns to sleep on their stomachs partly because of past tradition. Most SIDS victims experience several risks, an interaction of biological and social circumstances. But thanks to research, the major risk, stomach sleeping, has been highly publicized.\u00a0Other causes of death during infancy include congenital birth defects and homicide.<\/p>\n<h3>Co-Sleeping<\/h3>\n<p>The location of sleep depends primarily on the baby&#8217;s age and culture.\u00a0<strong>Bed-sharing<\/strong> (in the parents&#8217; bed) or <strong>co-sleeping<\/strong> (in the parents&#8217; room) is the norm is some cultures, but not in others (Esposito et al. 2015)\u00a0<a class=\"footnote\" title=\"Esposito, G., Setoh, P., &amp; Bornstein, M.H. (2015). Beyond practices and values: Toward a physio-bioecological analysis of sleep arrangements in early infancy. Frontiers in Psychology, 6, 264.\" id=\"return-footnote-1249-4\" href=\"#footnote-1249-4\" aria-label=\"Footnote 4\"><sup class=\"footnote\">[4]<\/sup><\/a>.\u00a0Colvin, Collie-Akers, Schunn and Moon (2014)<a class=\"footnote\" title=\"Colvin, J.D., Collie-Akers, V., Schunn, C., &amp; Moon, RY (2014). Sleep environment risks for younger and older infants. Pediatrics. 134(2):e406-12. doi: 10.1542\/peds.2014-0401.\" id=\"return-footnote-1249-5\" href=\"#footnote-1249-5\" aria-label=\"Footnote 5\"><sup class=\"footnote\">[5]<\/sup><\/a> analyzed a total of 8,207 deaths from 24 states during 2004\u20132012. The deaths were documented in the National Center for the Review and Prevention of Child Deaths Case Reporting System, a database of death reports from state child death review teams. The results indicated that younger victims (0-3 months) were more likely to die by bed-sharing and sleeping in an adult&#8217;s bed or on a person. A higher percentage of older victims (4 months to 364 days) rolled into objects in the sleep environment and changed position from side\/back to prone. Carpenter et al. (2013)<a class=\"footnote\" title=\"https:\/\/bmjopen.bmj.com\/content\/3\/5\/e002299.long\" id=\"return-footnote-1249-6\" href=\"#footnote-1249-6\" aria-label=\"Footnote 6\"><sup class=\"footnote\">[6]<\/sup><\/a> compared infants who died of SIDS with a matched control and found that infants younger than three months old who slept in bed with a parent were five times more likely to die of SIDS compared to babies who slept separately from the parents, but were still in the same room. They concluded that bed-sharing, even when the parents do not smoke or take alcohol or drugs, increases the risk of SIDS. However, when combined with parental smoking and maternal alcohol consumption and\/or drug use, the risks associated with bed-sharing greatly increased.<\/p>\n<p>Despite the risks noted above, the controversy about where babies should sleep has been ongoing. Co-sleeping has been recommended for those who advocate attachment parenting (Sears &amp; Sears, 2001) <a class=\"footnote\" title=\"Sears, W. &amp; Sears, M. (2001). The attachment parenting book: A commonsense guide to understanding and nurturing your baby. Boston: MA: Little Brown.\" id=\"return-footnote-1249-7\" href=\"#footnote-1249-7\" aria-label=\"Footnote 7\"><sup class=\"footnote\">[7]<\/sup><\/a> and other research suggests that bed-sharing and co-sleeping is becoming more popular in the United States (Colson et al., 2013) <a class=\"footnote\" title=\"Colson, E.R., Willinger, M., Rybin, D., Heeren, T., Smith, L.A., Lister, G. &amp; Corwin, M.J. (2013). Trends and factors associated with infant bed sharing, 1993-2010: The National Sleep Position study. JAMA Pediatrics, 167(11), 1032-1037.\" id=\"return-footnote-1249-8\" href=\"#footnote-1249-8\" aria-label=\"Footnote 8\"><sup class=\"footnote\">[8]<\/sup><\/a>. So, what are the latest recommendations?<\/p>\n<p>The American Academy of Pediatrics (AAP) actually updated their recommendations for a Safe Infant Sleeping Environment in 2016. The most recent\u00a0AAP recommendations on creating a safe sleep environment include:<\/p>\n<ul>\n<li>Back to sleep for every sleep. Always place the baby on their back on a firm sleep surface such as a crib or bassinet with a tight-fitting sheet.<\/li>\n<li>Avoid the use of soft bedding, including crib bumpers, blankets, pillows, and soft toys. The crib should be bare.<\/li>\n<li>Breastfeeding is recommended.<\/li>\n<li>Share a bedroom with parents, but not the same sleeping surface, preferably until the baby turns 1 but at least for the first six months. Room-sharing decreases the risk of SIDS by as much as 50 percent.<\/li>\n<li>Avoid baby&#8217;s exposure to smoke, alcohol, and illicit drugs.<\/li>\n<\/ul>\n<p>As you can see, there is a recommendation to now &#8220;share a bedroom with parents,&#8221; but not the same sleeping surface.\u00a0Breastfeeding is also recommended as adding protection against SIDS, but after feeding, the AAP encourages parents to move the baby to their separate sleeping space, preferably a crib or bassinet in the parents&#8217; bedroom. Finally, the report\u00a0included new evidence that supports skin-to-skin care for newborn infants.<a class=\"footnote\" title=\"SIDS and Other Sleep-Related Infant Deaths: Updated 2016 Recommendations for a Safe Infant Sleeping Environment. Task Force on Sudden Infant Death Syndrome. Pediatrics. Retrieved from https:\/\/pediatrics.aappublications.org\/content\/138\/5\/e20162938.\" id=\"return-footnote-1249-9\" href=\"#footnote-1249-9\" aria-label=\"Footnote 9\"><sup class=\"footnote\">[9]<\/sup><\/a><\/p>\n<div class=\"textbox exercises\">\n<h3>Link to Learning<\/h3>\n<p><span style=\"color: #333333;\">The website\u00a0<a class=\"external\" style=\"color: #333333;\" title=\"Zero to Three\" href=\"https:\/\/www.zerotothree.org\/early-development\/sleep\" target=\"_blank\" rel=\"noopener noreferrer\"><strong>Zero to Three\u00a0<\/strong><\/a>has more information on infant sleep patterns and habits. Feel free to explore their multiple topics on the subject.<\/span><\/p>\n<\/div>\n<div class=\"textbox tryit\">\n<h3>Try It<\/h3>\n<p>\t<iframe id=\"assessment_practice_8083d827-8f7c-4dc7-aab6-22722bddb742\" class=\"resizable\" src=\"https:\/\/assess.lumenlearning.com\/practice\/8083d827-8f7c-4dc7-aab6-22722bddb742?iframe_resize_id=assessment_practice_id_8083d827-8f7c-4dc7-aab6-22722bddb742\" frameborder=\"0\" style=\"border:none;width:100%;height:100%;min-height:300px;\"><br \/>\n\t<\/iframe><\/p>\n<\/div>\n<h2>Immunizations<\/h2>\n<p>Preventing communicable diseases from early infancy is one of the major tasks of the Public Health System in the USA. Infants mouth every single object they find as one of their typical developmental tasks. They learn through their senses and tasting objects stimulates their brain and provides a sensory experience as well as learning.<\/p>\n<p>Infants have much contact with dirty surfaces. They lay on a carpet that most likely has been contaminated by adults walking on it; they mouth keys, rattles, toys, and books; they crawl on the floor; they hold on to furniture to walk, and much more. How do we prevent infants from getting sick? One possible answer is\u00a0<strong>immunizations<\/strong>.<\/p>\n<div class=\"textbox examples\">\n<h3>Watch It<\/h3>\n<p>Watch the first ten minutes of <a href=\"https:\/\/www.youtube.com\/watch?v=VPOrnU3ImxI&amp;t=285s\" target=\"_blank\" rel=\"noopener\">this video clip from the Alexander Street Database<\/a>\u00a0that illustrates what has become known as the vaccine war.<\/p>\n<p>This debate continues on today, only amplified by the Covid-19 Pandemic. The rush to develop a vaccine to protect against coronavirus resulted in many people celebrating the vaccine and its success in preventing the spread and the severity of Covid-19, while others remained distrustful of potential side effects. Questions and opinions circulating about vaccination led to increased social and political divisions throughout the United States.<\/p>\n<\/div>\n<p>Many decades ago, our society struggled to find vaccines and cures for illnesses such as Polio, whooping cough, and many other medical conditions. A few decades ago parents started changing their minds on the need to vaccinate children. Some children are not vaccinated for valid medical reasons, but some states allow a child to be unvaccinated because of a parent&#8217;s personal or religious beliefs. At least 1 in 14 children is not vaccinated. What is the outcome of not vaccinating children? Some of the preventable illnesses are returning. Fortunately, each vaccinated child stops the transmission of the disease, a phenomenon called <em>herd immunity<\/em>. Usually, if 90% of the people in a community (a herd) are immunized, no one dies of that disease.<\/p>\n<p>In 2017, Community Care Licensing in California, the agency that regulates childcare centers, changed regulations. Before it was possible for parents to opt-out of vaccinations due to personal beliefs, but this changed after Governor Brown signed a Bill in 2016 to only exclude children from being vaccinated if there were medical reasons. Furthermore, all personnel working with children must be immunized.<\/p>\n<div class=\"textbox exercises\">\n<h3>Link to Learning<\/h3>\n<p>Read more information about vaccinations at the website\u00a0<strong><a class=\"external\" href=\"http:\/\/www.shotsforschool.org\/\" target=\"_blank\" rel=\"noopener noreferrer\">Shots for School.<\/a>\u00a0<\/strong><\/p>\n<\/div>\n<div class=\"textbox tryit\">\n<h3>Try It<\/h3>\n<p>\t<iframe id=\"assessment_practice_3d297ab8-9585-472f-9b32-80eff54fbb94\" class=\"resizable\" src=\"https:\/\/assess.lumenlearning.com\/practice\/3d297ab8-9585-472f-9b32-80eff54fbb94?iframe_resize_id=assessment_practice_id_3d297ab8-9585-472f-9b32-80eff54fbb94\" frameborder=\"0\" style=\"border:none;width:100%;height:100%;min-height:300px;\"><br \/>\n\t<\/iframe><\/p>\n<\/div>\n<div class=\"textbox key-takeaways\">\n<h3>Glossary<\/h3>\n<div class=\"titlepage\">\n<dl>\n<dt>bed-sharing:<\/dt>\n<dd> when two or more people sleep in the same bed<\/dd>\n<dt>co-sleeping:<\/dt>\n<dd>a custom in which parents and their children (usually infants) sleep together in the same room<\/dd>\n<dt>immunization:<\/dt>\n<dd>a process that stimulates the body&#8217;s immune system by causing the production of antibodies to defend against attack by a specific contagious disease<\/dd>\n<dt>sudden infant death syndrome (SIDS):<\/dt>\n<dd>a situation in which a seemingly healthy infant, usually between 2 and 6 months old, suddenly stops breathing and dies unexpectedly while asleep<\/dd>\n<\/dl>\n<\/div>\n<\/div>\n\n\t\t\t <section class=\"citations-section\" role=\"contentinfo\">\n\t\t\t <h3>Candela Citations<\/h3>\n\t\t\t\t\t <div>\n\t\t\t\t\t\t <div id=\"citation-list-1249\">\n\t\t\t\t\t\t\t <div class=\"licensing\"><div class=\"license-attribution-dropdown-subheading\">CC licensed content, Original<\/div><ul class=\"citation-list\"><li>Modification, adaptation, and original content. <strong>Authored by<\/strong>: Tera Jones for Lumen Learning. <strong>Provided by<\/strong>: Lumen Learning. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY: Attribution<\/a><\/em><\/li><\/ul><div class=\"license-attribution-dropdown-subheading\">CC licensed content, Shared previously<\/div><ul class=\"citation-list\"><li>Psyc 200 Lifespan Psychology. <strong>Authored by<\/strong>: Laura Overstreet. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"http:\/\/opencourselibrary.org\/econ-201\/\">http:\/\/opencourselibrary.org\/econ-201\/<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY: Attribution<\/a><\/em><\/li><li>Sleeping baby. <strong>Authored by<\/strong>: ULOVInteractive. <strong>Provided by<\/strong>: Needpix. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/www.needpix.com\/photo\/download\/1048947\/baby-sleeping-rest-sleeping-baby-infant-cute-little-face-child\">https:\/\/www.needpix.com\/photo\/download\/1048947\/baby-sleeping-rest-sleeping-baby-infant-cute-little-face-child<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/about\/cc0\">CC0: No Rights Reserved<\/a><\/em><\/li><\/ul><div class=\"license-attribution-dropdown-subheading\">All rights reserved content<\/div><ul class=\"citation-list\"><li>FRONTLINE | The Vaccine War | PBS. <strong>Provided by<\/strong>: PBS. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/www.youtube.com\/watch?v=VPOrnU3ImxI\">https:\/\/www.youtube.com\/watch?v=VPOrnU3ImxI<\/a>. <strong>License<\/strong>: <em>Other<\/em>. <strong>License Terms<\/strong>: Standard YouTube License<\/li><\/ul><div class=\"license-attribution-dropdown-subheading\">Public domain content<\/div><ul class=\"citation-list\"><li>Baby and Dad. <strong>Authored by<\/strong>: Vera Kratochvil. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"http:\/\/www.publicdomainfiles.com\/show_file.php?id=13941972617449\">http:\/\/www.publicdomainfiles.com\/show_file.php?id=13941972617449<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/about\/pdm\">Public Domain: No Known Copyright<\/a><\/em><\/li><\/ul><\/div>\n\t\t\t\t\t\t <\/div>\n\t\t\t\t\t <\/div>\n\t\t\t <\/section><hr class=\"before-footnotes clear\" \/><div class=\"footnotes\"><ol><li id=\"footnote-1249-1\">Marie-H\u00e9l\u00e8ne Pennestri, Christine Lagani\u00e8re, Andr\u00e9e-Anne Bouvette-Turcot, Irina Pokhvisneva, Meir Steiner, Michael J. Meaney, H\u00e9l\u00e8ne Gaudreau, on behalf of the Mavan Research Team (December 2018).\u00a0<em>Uninterrupted Infant Sleep, Development, and Maternal Mood.\u00a0<\/em>Pediatrics, Volume 142.  <a href=\"#return-footnote-1249-1\" class=\"return-footnote\" aria-label=\"Return to footnote 1\">&crarr;<\/a><\/li><li id=\"footnote-1249-2\">David Richter, Michael D Kr\u00e4mer, Nicole K Y Tang, Hawley E Montgomery-Downs, Sakari Lemola, Long-term effects of pregnancy and childbirth on sleep satisfaction and duration of first-time and experienced mothers and fathers, Sleep, Volume 42, Issue 4, April 2019, zsz015, <a href=\"https:\/\/doi.org\/10.1093\/sleep\/zsz015\" target=\"_blank\" rel=\"noopener\">https:\/\/doi.org\/10.1093\/sleep\/zsz015<\/a> <a href=\"#return-footnote-1249-2\" class=\"return-footnote\" aria-label=\"Return to footnote 2\">&crarr;<\/a><\/li><li id=\"footnote-1249-3\">Macall Gordon (October 2018).\u00a0From Safe Sleep to Healthy Sleep: A Systemic Perspective on Sleep In the First Year. Northwest Bulletin: Family and Child Health. University of Washington. retrieved from\u00a0https:\/\/depts.washington.edu\/nwbfch\/infant-safe-sleep-development.  <a href=\"#return-footnote-1249-3\" class=\"return-footnote\" aria-label=\"Return to footnote 3\">&crarr;<\/a><\/li><li id=\"footnote-1249-4\">Esposito, G., Setoh, P., &amp; Bornstein, M.H. (2015). Beyond practices and values: Toward a physio-bioecological analysis of sleep arrangements in early infancy. Frontiers in Psychology, 6, 264. <a href=\"#return-footnote-1249-4\" class=\"return-footnote\" aria-label=\"Return to footnote 4\">&crarr;<\/a><\/li><li id=\"footnote-1249-5\">Colvin, J.D., Collie-Akers, V., Schunn, C., &amp; Moon, RY (2014). Sleep environment risks for younger and older infants. Pediatrics. 134(2):e406-12. doi: 10.1542\/peds.2014-0401. <a href=\"#return-footnote-1249-5\" class=\"return-footnote\" aria-label=\"Return to footnote 5\">&crarr;<\/a><\/li><li id=\"footnote-1249-6\"><a href=\"https:\/\/bmjopen.bmj.com\/content\/3\/5\/e002299.long\" target=\"_blank\" rel=\"noopener\">https:\/\/bmjopen.bmj.com\/content\/3\/5\/e002299.long<\/a> <a href=\"#return-footnote-1249-6\" class=\"return-footnote\" aria-label=\"Return to footnote 6\">&crarr;<\/a><\/li><li id=\"footnote-1249-7\">Sears, W. &amp; Sears, M. (2001). The attachment parenting book: A commonsense guide to understanding and nurturing your baby. Boston: MA: Little Brown. <a href=\"#return-footnote-1249-7\" class=\"return-footnote\" aria-label=\"Return to footnote 7\">&crarr;<\/a><\/li><li id=\"footnote-1249-8\">Colson, E.R., Willinger, M., Rybin, D., Heeren, T., Smith, L.A., Lister, G. &amp; Corwin, M.J. (2013). Trends and factors associated with infant bed sharing, 1993-2010: The National Sleep Position study. JAMA Pediatrics, 167(11), 1032-1037. <a href=\"#return-footnote-1249-8\" class=\"return-footnote\" aria-label=\"Return to footnote 8\">&crarr;<\/a><\/li><li id=\"footnote-1249-9\">SIDS and Other Sleep-Related Infant Deaths: Updated 2016 Recommendations for a Safe Infant Sleeping Environment. Task Force on Sudden Infant Death Syndrome. Pediatrics. Retrieved from <a href=\"https:\/\/pediatrics.aappublications.org\/content\/138\/5\/e20162938\" target=\"_blank\" rel=\"noopener\">https:\/\/pediatrics.aappublications.org\/content\/138\/5\/e20162938<\/a>. <a href=\"#return-footnote-1249-9\" class=\"return-footnote\" aria-label=\"Return to footnote 9\">&crarr;<\/a><\/li><\/ol><\/div>","protected":false},"author":29,"menu_order":6,"template":"","meta":{"_candela_citation":"[{\"type\":\"cc\",\"description\":\"Psyc 200 Lifespan Psychology\",\"author\":\"Laura Overstreet\",\"organization\":\"\",\"url\":\"http:\/\/opencourselibrary.org\/econ-201\/\",\"project\":\"\",\"license\":\"cc-by\",\"license_terms\":\"\"},{\"type\":\"copyrighted_video\",\"description\":\"FRONTLINE | The Vaccine War | PBS\",\"author\":\"\",\"organization\":\"PBS\",\"url\":\"https:\/\/www.youtube.com\/watch?v=VPOrnU3ImxI\",\"project\":\"\",\"license\":\"other\",\"license_terms\":\"Standard YouTube License\"},{\"type\":\"original\",\"description\":\"Modification, adaptation, and original content\",\"author\":\"Tera Jones for Lumen Learning\",\"organization\":\"Lumen Learning\",\"url\":\"\",\"project\":\"\",\"license\":\"cc-by\",\"license_terms\":\"\"},{\"type\":\"pd\",\"description\":\"Baby and Dad\",\"author\":\"Vera Kratochvil\",\"organization\":\"\",\"url\":\"http:\/\/www.publicdomainfiles.com\/show_file.php?id=13941972617449\",\"project\":\"\",\"license\":\"pd\",\"license_terms\":\"\"},{\"type\":\"cc\",\"description\":\"Sleeping baby\",\"author\":\"ULOVInteractive\",\"organization\":\"Needpix\",\"url\":\"https:\/\/www.needpix.com\/photo\/download\/1048947\/baby-sleeping-rest-sleeping-baby-infant-cute-little-face-child\",\"project\":\"\",\"license\":\"cc0\",\"license_terms\":\"\"}]","CANDELA_OUTCOMES_GUID":"2697bd6e-bea1-4f64-81ea-c79ffad7bcf2, 54cb4cb9-0021-4a23-bd8b-cbef6ce76acc, 4d76cf07-4fd6-4457-8b65-7c0d28d717de","pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":""},"chapter-type":[],"contributor":[],"license":[],"class_list":["post-1249","chapter","type-chapter","status-publish","hentry"],"part":212,"_links":{"self":[{"href":"https:\/\/courses.lumenlearning.com\/wm-lifespandevelopment\/wp-json\/pressbooks\/v2\/chapters\/1249","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/courses.lumenlearning.com\/wm-lifespandevelopment\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/courses.lumenlearning.com\/wm-lifespandevelopment\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/courses.lumenlearning.com\/wm-lifespandevelopment\/wp-json\/wp\/v2\/users\/29"}],"version-history":[{"count":42,"href":"https:\/\/courses.lumenlearning.com\/wm-lifespandevelopment\/wp-json\/pressbooks\/v2\/chapters\/1249\/revisions"}],"predecessor-version":[{"id":7762,"href":"https:\/\/courses.lumenlearning.com\/wm-lifespandevelopment\/wp-json\/pressbooks\/v2\/chapters\/1249\/revisions\/7762"}],"part":[{"href":"https:\/\/courses.lumenlearning.com\/wm-lifespandevelopment\/wp-json\/pressbooks\/v2\/parts\/212"}],"metadata":[{"href":"https:\/\/courses.lumenlearning.com\/wm-lifespandevelopment\/wp-json\/pressbooks\/v2\/chapters\/1249\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/courses.lumenlearning.com\/wm-lifespandevelopment\/wp-json\/wp\/v2\/media?parent=1249"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/courses.lumenlearning.com\/wm-lifespandevelopment\/wp-json\/pressbooks\/v2\/chapter-type?post=1249"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/courses.lumenlearning.com\/wm-lifespandevelopment\/wp-json\/wp\/v2\/contributor?post=1249"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/courses.lumenlearning.com\/wm-lifespandevelopment\/wp-json\/wp\/v2\/license?post=1249"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}