Back to Sleep in the NICU

[Guest acmorriscns]

One of the elements of transitioning the baby in preparation for discharge is going "back to sleep" I would like to hear from members who were successful in the process. What did you find to be supportive of the change for staff. I am curious about successful stratagies that have been used in the implimentation process.

Thank you

[Stefan Johansson]

Hi!

I am not sure if I understand what you mean by "back to sleep" - do you mean how infants are prepared for discharge home, or the transition from level-3 to level-2 care?

[JACK]

I think acmorriscns is referring to the promotion of supine sleeping position in infants to prevent SIDS.

We do promote this......but a little time of supervised "tummy time" (prone position) is important for the infant to practise his head control and prevent positional plagiocephaly!

(Remember this prone positioning is for a short duration only and always supervised)

[Guest acmorriscns]

Thank you for the replies. We are trying to identify some of the "markers" to initiate "Back to sleep". So the infant is 34 weeks adjusted age, working on PO feedings, minimal O2 needs, etc. There are several articles that point out how poorly NICUs pattern the behavior for the families on the supine sleeping position. We have the babies prone and really need to get them used to supine sleeping before they go home. They will be fussy and sleep poorly if not transitioned to supine before going home and then the parent is more likely to place them prone to get them to quiet. also transitioning them a day or 2 before going home doesn't really get them acustomed to supine.

With the NICU infant having an increased risk for SIDS we would really like to get the behavior modeled for the families.

regards, Andrea

[skaushik]

WE emphasis on "Back to Sleep" as part of discharge planning. We do this when the infant is weaned to a crib and is getting ready to go home. Parents are told babies should always be on the back and if prone for tummy time, babies should be "supervised".

[NCDeb]

Hello,

We also implement this as a part of our discharge process. Currently we have a policy that all infants are positioned on their back once they are weaned to a crib. The only exceptions to this is if the infant is a bad refluxer or is being discharged home on an apnea monitor. In thoses cases an order is required to position the infant prone. This is only done in rare circumstances though.

Using the policy of once the child is weaned to a crib seems to work well for us as the marker for when "back to sleep" is begun. Hope this helps.

[Guest JoannieO]

Hi,

We also sleep babies supine once they have transitioned to a crib. We explain to the parents that when the baby was sick or tiny it was in an incubator so we could watch it closely, but now that baby is well and getting ready to go home, we put them down to sleep on their backs. This is reinforced with the literature about SIDS.

[Guest enaid1]

Hi,

As per our "Back to Sleep" policy, we begin this transition once the infant is taking all feedings by mouth! For some of our infants have already been cooled and in open cribs before being able to take all feedings po! If there is history of severe reflux an order is written to position infant prone after feedings.