Dr. Todd Harris

From the AAP: Updated Safe Sleep Guidance

Written by Dr. Todd Harris

January 12, 2017 – Recently, the American Academy of Pediatrics (AAP) came out with some updated and expanded safe sleep recommendations.

They list 19 recommendations for a safe infant sleeping environment and it is definitely worth taking a look at the details.

The 19 recommendations for a safer infant sleep environment:

  • Small detail: The 19 recommendations are listed with their strength of recommendation at the bottom of this post
  • Some detail:  A listing that includes brief explanations is found here.
  • More detail: The official AAP policy statement is found here.
  • Lots of detail: The AAP technical report is found here.

What your pediatricians at RCAM think about these new safe sleep recommendations:

1. New recommendations reflect the best information available now

First of all, we don’t shy away from new recommendations. Not at all. That is one of the strengths of medicine.

We know that we don’t know everything, and there is a vast and constant pursuit of better information. When more complete, up-to-date knowledge about how to keep our children healthy comes available, we want to incorporate it into what we do.

That is why it is okay that we sometimes hear grandmothers say, “That’s not what I was told when you were a baby.

Medicine strives to recommend based on the best information available now.

2. Old habits are sometimes hard to kick

It has taken us a few months to comment as a practice because these 19 recommendations include some real game changers.

For example, consider #4 below: “Room-sharing with the infant on a separate sleep surface is recommended” (for the first 6-12 months).

As a practice, we have generally agreed that establishing a healthy, through-the-night sleep pattern is greatly aided by the move of your infant into a separate room. But, some studies have shown a 50% reduction in the incidence of Sudden Infant Death Syndrome (SIDS) in infants who room-shared (not bed-shared) for the first 6-12 months. That is what I mean by a game changer.

There are 19 recommendations. No one will be perfect and follow all of them 100% of the time for the first 12 months of life (if your child has ever fallen asleep in their car seat and you didn’t as quickly as possible move them to a firm, flat surface, then you haven’t followed all the recommendations all the time).

However, it is important that we assess what we do and change our habits to be as safe as we can with out most valued members of society – our children.

3. Some old habits do not need to change

Back to sleep for every sleep is still very important for a safe infant sleep environment.

Summary of Recommendations With Strength of Recommendation

The list below comes from the AAP (link). The linked article provides more information along with references with each recommendation. The recommendations are grouped based on the Strength-of-Recommendation Taxonomy (SORT) for the assignment of letter grades to each of its recommendations (A, B, or C).

A-level recommendations (Level A: There is good-quality patient-oriented evidence.)

  1. Back to sleep for every sleep
  2. Use a firm sleep surface
  3. Breastfeeding is recommended
  4. Room-sharing with the infant on a separate sleep surface is recommended
  5. Keep soft objects and loose bedding away from the infant’s sleep area
  6. Consider offering a pacifier at naptime and bedtime
  7. Avoid smoke exposure during pregnancy and after birth
  8. Avoid alcohol and illicit drug use during pregnancy and after birth
  9. Avoid overheating
  10. Pregnant women should seek and obtain regular prenatal care
  11. Infants should be immunized in accordance with AAP and CDC recommendations
  12. Do not use home cardiorespiratory monitors as a strategy to reduce the risk of SIDS
  13. Health care providers, staff in newborn nurseries and NICUs, and child care providers should endorse and model the SIDS risk-reduction recommendations from birth
  14. Media and manufacturers should follow safe sleep guidelines in their messaging and advertising
  15. Continue the “Safe to Sleep” campaign, focusing on ways to reduce the risk of all sleep-related infant deaths, including SIDS, suffocation, and other unintentional deaths. Pediatricians and other primary care providers should actively participate in this campaign

B-level recommendations (Level B: There is inconsistent or limited-quality patient-oriented evidence.)

  1. Avoid the use of commercial devices that are inconsistent with safe sleep recommendations
  2. Supervised, awake tummy time is recommended to facilitate development and to minimize development of positional plagiocephaly

C-level recommendations (Level C: The recommendation is based on consensus, disease-oriented evidence, usual practice, expert opinion, or case series for studies of diagnosis, treatment, prevention, or screening.)

  1. Continue research and surveillance on the risk factors, causes, and pathophysiologic mechanisms of SIDS and other sleep-related infant deaths, with the ultimate goal of eliminating these deaths entirely
  2. There is no evidence to recommend swaddling as a strategy to reduce the risk of SIDS

Note: “patient-oriented evidence” measures outcomes that matter to patients: morbidity, mortality, symptom improvement, cost reduction, and quality of life; “disease-oriented evidence” measures immediate, physiologic, or surrogate end points that may or may not reflect improvements in patient outcomes (eg, blood pressure, blood chemistry, physiologic function, pathologic findings). CDC, Centers for Disease Control and Prevention.


Dr. Lily Harris

 May 23, 2016 – EDITOR’S NOTE: Raleigh Children continues a regular feature that attempts to answer the question,

“What are the best resources available to our families for pediatric medical information and guidance?”

We define “best resource” as being:

  • Based on the best science
  • Presented in a practical and easy-to-understand format
  • Regularly updated as we find new things
  • Not a replacement for your pediatrician’s advice – intended to supplement and keep everyone well informed!

Today’s topic:

Breastfeeding and Lactation

RCAM Approved Resource

Our Lactation Consultants

  • We offer lactation support practically every weekday at both Duraleigh and Brier Creek office locations from certified lactation consultants
  • They also provide support by phone when you can’t be seen in person
  • Come in early and often – our lactation consultants are quick to acknowledge that “breastfeeding Is natural and best for baby but often doesn’t always come easy; come in early and often
  • Participating in a breastfeeding class before your baby is born is a helpful first step (many listed below)

Nursing Mothers of Raleigh

nursingmothersofraleigh.org

  • Volunteer mothers
  • Provide support and encouragement for breastfeeding mothers
  • They offer in home support, phone support, online resources, and free local meetings

Rex Lactation Services

rexhealth.com/rh/care-treatment/womens-health/maternity/breastfeeding-support

Phone: 919-784-3224

  • Prenatal and postnatal classes
  • In-Hospital Lactation Store where they offer breastfeeding supplies, hospital-grade pump rental, and bra-fitting services for nursing bras

WakeMed Lactation Services

wakemed.org/landing.cfm?id=1886

Phone: 919-350-5742

  • Free breastfeeding support groups meeting in three different locations
  • Breastfeeding classes and online education about breastfeeding
  • Hospital-grade breast pump rental

Mothers’ Milk Bank-WakeMed

wakemed.org/landing.cfm?id=135

Phone: 919-350-8599

Email: mothersmilkbank@wakemed.org

  • Non-profit milk bank
  • Provides safe donor milk to premature babies in hospitals all along the eastern coast
  • Their website offers information about donating breast milk
  • Outpatient dispensing of donor milk is available when supply permits.

ZipMilk

zipmilk.org

  • Simply plug in your zip code to find breastfeeding support that is close to you

WIC

wakegov.com/humanservices/family/wic/Pages/default.aspx

Phone: 919-250-4720, Option 6

  • Supplemental nutrition program for women, infants, and children
  • Intended for breastfeeding mothers that qualify for the WIC program
  • Breastfeeding classes in English and Spanish
  • Breastfeeding peer counselors
  • Breast pumps for rent
  • In-home support, phone support, and other resources

Triangle Breastfeeding Alliance

nctba.org

  • Organization of healthcare professional working together to care for breastfeeding families in the triangle
  • Although the website is geared more towards medical professionals, it does offer breastfeeding education including prenatal breastfeeding information, tips for new breastfeeding mothers, working mothers breastfeeding, and breastfeeding humor

Dr. Todd Harris

Safe Sleep for Babies

Written by Dr. Todd Harris

February 24, 2016 – For new and expectant parents, here is everything you need to know about what makes for a safe sleep environment for your baby in only 12 minutes.

This video is presented by the American Academy of Pediatrics (AAP) through HealthyChildren.org.

Unlike many pediatric instructional videos, this one contains only straight answers: at NO time are AAP recommendations put to verse and presented as a musical or rap performance:


Dr. Todd Harris

FAQ 9: Health Insurance Plans & RCAM

Written by Dr. Todd Harris

View of the Smoky Mountains from Mount Mitchell State Park

“What health plans list RCAM Pediatricians as providers?”

  • Aetna / Coventry

  • Blue Cross Blue Shield (BCBS)

  • Cigna / Great West

  • Humana / Choice Care

  • Medcost

  • Medicaid (new patients must be 2 months old or younger at time of first visit)

  • NC Healthchoice

  • PHCS / Multiplan

  • United Healthcare

  • UMR

  • Wellpath / First Health