Health Explanations for Motivated Patients: Your Checkup
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Health Explanations for Motivated Patients: Your Checkup
Safe Sleep: Every Parent Needs to Know These Life-Saving Guidelines
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Safe infant sleep guidelines have reduced SIDS deaths by 50-80% over the last three decades, yet funding for this critical public health campaign is now at risk of being cut.
• Explained difference between SIDS (sudden infant death syndrome) and SUID (sudden unexpected infant death)
• Described the "triple risk model" that leads to SIDS: vulnerable infant + critical developmental period + external stressor
• Detailed the history of the Back to Sleep campaign which began in 1994
• Outlined key safe sleep recommendations: babies on backs, firm flat surface, no loose bedding or soft objects
• Discussed why co-sleeping increases SIDS risk despite cultural preferences
• Clarified that products like Dockatot are not designed for safe sleep
• Highlighted that Black and Indigenous communities experience higher SIDS rates
• Examined how funding cuts could impact access to life-saving health information
• Connected these changes to a broader pattern of removing evidence-based health information from government resources
Check out our website, email us at yourcheckuppod@gmail.com with questions or feedback, and most importantly, stay healthy until next time.
Production and Content: Edward Delesky, MD & Nicole Aruffo, RN
Artwork: Olivia Pawlowski
Hi, welcome to your checkup. We are the patient education podcast, where we bring conversations from the doctor's office to your ears. On this podcast, we try to bring medicine closer to its patients. I'm Ed Delesky, a family medicine doctor in the Philadelphia area.
Nicole Aruffo, RN:And I'm Nicole Aruffo. I'm a nurse.
Ed Delesky, MD:And we are so excited you were able to join us here again today. It's been a great weekend so far, very exciting. I got to have some oysters last night. You didn't get to join me in that venture.
Nicole Aruffo, RN:Sounds like I wasn't missing a lot.
Ed Delesky, MD:No, I would say that if I'm going to like a lukewarm, like reference I don't know it's a, I don't know. Should I say the name of the place or should I spare them?
Ed Delesky, MD:I don't know I don't think we need to slander anyone great, but they were, um, they were okay and they were very expensive for being just okay. I think about the oyster trip to Doc's that we took, where we like those were great and I couldn't get enough. And they were huge. These like large oysters that they labeled large. Our intern, if you couldn't hear him, is very interested in this conversation too. You know they were OK. I not too much to say about them. Ordered a crab dip, got a crab toast instead. Yeah, the dinner was a little lukewarm. You didn't come with us. I went with Karthik and Mike.
Nicole Aruffo, RN:The boys chat came over.
Ed Delesky, MD:Yes, yes, they did, and they love their dirty martini, I'll tell you my God. And for the first time, hand-stuffed blue cheesed olives um, with your help and you know, ziploc bags can become well. It worked out really well, I think. Uh, I don't know, what did you think of those?
Nicole Aruffo, RN:I thought they were delicious thank you I think everyone else did too. So did ollie so did ollie.
Ed Delesky, MD:But um, just so that're clear, we don't let him drink.
Nicole Aruffo, RN:Oh, no, no, Not for little boys.
Ed Delesky, MD:Definitely not. Do you have any highlights from this week?
Nicole Aruffo, RN:From the week? Honestly no.
Ed Delesky, MD:Well, it's a much more calm week because I didn't have like a whole ice cream meltdown like I did last week. But there is a new ice cream place that opened up down the street that I'm interested in trying at some point yeah, maybe we can go, like this week, because you're on vacation for two weeks. I am, so you know going to you I know, lucky me.
Ed Delesky, MD:Getting ice cream would be fun. And then we started running together, which I love. I think it's so fun, I feel so great about it and we do our little. Peloton runs outside.
Nicole Aruffo, RN:Yeah, they have been fun until I can't walk the next day, but it's okay.
Ed Delesky, MD:Yeah, it turns out you probably have something wrong with your feet.
Nicole Aruffo, RN:Well, my feet keep going numb every time I run, and they like have for the last couple years, and I really just like thought that I just hadn't found the right running shoe for me. So I went through a lot of different brands and now I'm coming to realize it's probably like I'm the problem. Yeah, I think it's my feet, not my shoes.
Ed Delesky, MD:Totally. Yeah, I think something else is going on there. Especially when we came to the end you were like oh, like you know, it was a hard run that we did. It was long Like a 60 minute run is not a small thing and then at the end you're like man, I just had to be careful there for a while.
Nicole Aruffo, RN:I just didn't want to step weird, so I can't feel my feet.
Ed Delesky, MD:Yeah, I was gonna like step weird or like do something like I definitely get that in the cold, but I think that's a totally different thing than what you're experiencing whenever you go and do this, and you're so nonchalantly said it too. You were just like, oh yeah, by the way, like my feet get really numb whenever we do these intervals and then it's better when I stop walk and when I start walking, like jesus christ, get in there. We had um and all the excitement of the the boys chat. We did like a test run of the, the podcast set up for them while we were. You know, we had a recorded version of american history trivia that will never see the public's eye and or ears, and mike got really excited with the um. Well, to go back to his podcasting days, right, because he had the toothpick pod and they would go and review toothpicks Wait are you for real?
Nicole Aruffo, RN:That's what it was? Yeah, no, it was called the toothpick pod Like a toothpick.
Ed Delesky, MD:A toothpick review, yeah, and they would go to different restaurants and they would look at like they would get the toothpicks and then they would talk about other stuff. They had different segments. They did it when they were in college. They had a whole setup.
Nicole Aruffo, RN:How many episodes did they do?
Ed Delesky, MD:I'm not entirely sure. I certainly hope that he's listening in his basement right now and he's going to send in some fan mail Doing basement things, doing basement things, all right. So what are we going to talk about today?
Nicole Aruffo, RN:Nick, today we're talking about safe sleep, and I don't want to hear an eye roll from anyone. Why?
Ed Delesky, MD:would we hear an eye roll from anyone? Why would we hear an eye roll from anyone about this?
Nicole Aruffo, RN:It's a little controversial, I think. Oh, for some reason.
Ed Delesky, MD:Well, that's a weird thing.
Nicole Aruffo, RN:Yeah.
Ed Delesky, MD:To be controversial about, especially given that it was so effective, yeah, at preventing what it was supposed to prevent.
Nicole Aruffo, RN:Yeah, well, you know.
Ed Delesky, MD:Yeah Well, you know. Yeah Well, I guess one thing you're going to serve as our expert here today, because this is one of the foundations of your career.
Nicole Aruffo, RN:Yeah, the foundation of my career has been educating parents on safe sleep for their infants, so they don't die.
Ed Delesky, MD:Right, and so to prevent that, they created this program. But the reason that we're talking about it here today is because we were seeing in the news. We were seeing in the news that there are reports of funding being cut for this campaign. The safe to sleep is a campaign. We're going to talk about all of that, but it seems like this current administration is looking to reduce the funding for the safe sleep, or safe to sleep campaign, outreach and materials, and that's why we're going to talk about it here today. So why don't we dive in and get at the core thing, because this is such an important topic? The campaign and intervention, I guess, is really what it is.
Nicole Aruffo, RN:Yeah, I mean, if you've been to a pediatrician in the last 30 years, you've gotten this spiel. But I mean it's not for nothing. So Totally.
Ed Delesky, MD:All of this is born out of a certain idea of preventing SIDS or, I guess, s-u-i-d. Can you tell us a little bit about what those actually are?
Nicole Aruffo, RN:Yes, so SIDS, which, if you for some reason have never heard of it before, it's sudden infant death syndrome, which is unexplained death in infants under one year old, and this typically happens during their sleep. Suid is essentially the same thing, but a little different. It stands for sudden, unexpected infant death, which includes, um, it's kind of an umbrella, so it includes SIDS, and then accidental suffocation and unknown, unknown causes.
Ed Delesky, MD:And when I was looking at this cause, this is a part of our practice. It's like this type of thing SIDS occurs when three things overlap and it takes a vulnerable infant, a critical period in development meaning that, like in their development, they can't like move their fate, move their arm to protect their airway or they can't roll over at a certain point and an external stressor for this specific talk. That external stressor is an unsleep, unsafe sleep position, and when all of those things happen together it brews an opportunity for really horrible things to happen. So can you tell us a little bit more about the history of what started off as back to sleep?
Nicole Aruffo, RN:Yeah, so it started off as back to sleep. So in 1992, the american academy of pediatrics started recommending back or side sleeping, typically really back sleeping, for infants. And then in 1994 was when the whole back to sleep campaign started. Um, it was like a national launch to encourage babies sleeping on their back only and a couple other things that we'll talk about to reduce the risk of SIDS. This has reduced the risk of your baby dying right it has and it's been effective um, it's been effective.
Nicole Aruffo, RN:So it's been um a 50 percent reduction in SIDS deaths. Um, I want to say at least a 50% reduction.
Nicole Aruffo, RN:I've seen other sources say quoted higher higher almost to like 80% in the U? S since it began, so really just in the last 30 years, it's had a huge impact and this can be controversial because one of the kind of like pillars of it, I guess, is having your baby sleep like by themselves with nothing, so essentially not co-sleeping, which a lot of people like to do. Um, I personally will never be doing that If we have kids some people do. It does increase your risk of your baby dying and that's just how it is.
Ed Delesky, MD:Um, I couldn't help but think we're at an if now.
Nicole Aruffo, RN:Well, you know, you never know, you're right. You're right If we can't.
Ed Delesky, MD:You're right, you're right, no. So it sounds like the co-sleeping is the big thing.
Nicole Aruffo, RN:Co-sleeping is a big thing.
Ed Delesky, MD:And then so there's like a generational feature.
Nicole Aruffo, RN:Yeah, you know, like it's, I guess like our parents' generation or grandparents' generation I guess you probably haven't heard it a lot because you didn't actually like work in peds a lot but like people saying like, oh well, like you know, like I put you in a crib with a million stuffed animals or wrapped you up in a blanket when you were a newborn and had no neck control, or like, oh, like I slept with a blanket and I was fine. But yeah, like I mean I don't have an actual, solid number of how many babies have died from SIDS in the last 30 years or you know before all of that happened, but a lot of babies did, and now at least 50% less babies are not dying because of this Exactly.
Ed Delesky, MD:And it's a simple intervention that we're going to dive into a little bit more on the specific detailed recommendations, but it really does sound like the co-sleeping is the big culprit. Having those loose objects near your baby is the culprit. And one thing when we're counseling people like you know, when, like new mom comes in and the inadvertent like someone who's breastfeeding, the inadvertent like sleepiness that can happen when like say that, like you're feeding your baby and then you fall asleep and then that's a really vulnerable time. It.
Ed Delesky, MD:It sounds like so, like not all of this is intentional or outright like defiance towards the American.
Nicole Aruffo, RN:Yeah, like this doesn't happen because of, of, like nefarious action of a parent. It's just kind of the day to day thing. You know, your, your baby, has no neck control. If they aren't breathing and their body needs them to take a breath, they can't move to do that.
Ed Delesky, MD:Exactly, and that's that like developmental thing. So I you know, thankfully this is pretty rare. Um, we don't have a like a readily available quote, but SIDS is pretty rare and it took a decent amount of time to evaluate this and actually cause there are. People are looking at this all the time saying like how can we reduce the risk of SIDS? Because literally no one wants that to happen.
Nicole Aruffo, RN:And like it shouldn't happen, like your normal healthy baby, shouldn't? Just you shouldn't go check on them in the morning and they're dead, because, like, that's what it is.
Ed Delesky, MD:And so when they came out with this and they were able to find something to take that risk and lower it, it was huge and it remains huge. And so they had this whole campaign to push the agenda forward and tell everyone about it and be like you should be executing these things at home, like this is how your baby should be sleeping and like we've talked about here, it's not like it's not out of malintent that anyone's having their baby like sleep in a weird way. It's just stuff that happens, unfortunately, when those three things come together that we talked about, that triple risk model, the highlights from the recommendations from the American Academy of Pediatrics, and maybe add in your own flair of, like your counseling style that you would give someone when you met them, Sure.
Nicole Aruffo, RN:So we're always placing the infant on their backs to go to sleep, especially when they're like at that really young age where they can't roll over. They're staying on their back on a firm, flat, non-inclined sleep surface okay, that's.
Ed Delesky, MD:That's a lot of words there.
Nicole Aruffo, RN:Firm yeah, firm, flat, no incline. They actually make um, I don't know what the material of it is, but they make like crib mattresses kind of specific, to like help reduce this risk. The um materials kind of like um spongy, no, I guess, and like airy um, and they actually will do tests like just because I've like seen people online and they'll like put their face like in the mattress and like you can still breathe oh, so that's kind of like in an effort to help reduce this.
Ed Delesky, MD:I don't know what the material is but if you like, look it up, you'll come across it online Room sharing without bed sharing.
Nicole Aruffo, RN:So this goes back to our co-sleeping. Also, I want to point out there that the Dockatot or anything of that like similar structure is not meant for safe sleep. It is not meant for you to sleep next to your baby while they're asleep.
Ed Delesky, MD:Explain what the Dockatot is a little bit.
Nicole Aruffo, RN:The Dockatot is. I mean, it's a great thing to have for your baby when you're supervising them or like when you're sitting next to them on the couch. It's kind of like a little oval pillow. It honestly kind of looks like a dog bed a little bit, with like four sides and then the little indent where the baby goes um.
Nicole Aruffo, RN:I guess it has three sides really, but whatever, anyhow, it's kind of yeah, that's like the best way you can describe it as like a little dog bed oh, okay for a baby so that they can, like, um, sit, like it does kind of have sides, but you really are supposed to be like supervising them and it like says that all over the box and that's again still not something that you can reliably have the baby sleep between the two of you or next to you and just like's going to be fine.
Ed Delesky, MD:That's not what it's made for right, especially, like you know, getting at the. So co-sleeping has it's a.
Nicole Aruffo, RN:It's a messy term because I think it leaves opportunity for misinterpretation people think like a docket or something similar to that is kind of like the solution for safe co-sleeping and it is not okay your baby is still at risk for sids, which means they are still at risk for dying right.
Ed Delesky, MD:Well, even like I can imagine someone like flailing their arm over unexpectedly in like the middle of the night, like if they're right next to someone, so like their baby that is um.
Nicole Aruffo, RN:The next biggest highlight I would say this is pretty high up there is to avoid, um, like loose bedding, any soft objects, any blankets, really anything in the bed should not be in the bed with them, except the baby yeah.
Ed Delesky, MD:So you said um loose bedding and like how do you incorporate any sort of blanket? Are they just kind of like out there in the the wind?
Nicole Aruffo, RN:yeah, I mean you can put like a sleep sack on them or something they're like connected to, kind of okay, I guess I'll say or like a swaddle yeah, but no, um, or sometimes people have those like crib liner things. They kind of it's like I don't know how to describe it. You know what I'm talking about. Hey, it's really for more for like a decoration sort of thing. Um, that goes around like the outside, on like the crib rails, just none of that. Crib mattress, crib sheet, baby, okay.
Ed Delesky, MD:That's all you need. That's all you need, and there are a couple other things. Um, cause I'm interested in hearing like a little bit more about, like common pain points in conversation that you've had. But a couple other things, because I'm interested in hearing a little bit more about common pain points in conversation that you've had but a couple other things from the American Academy of Pediatrics that have showed to reduce their risk of SIDS as well, including avoiding exposure to smoke, drugs and alcohol, avoiding overheating, and prenatal care is incredibly important as well, and surprisingly I say this sarcastically, like surprisingly we know that vaccines are incredibly safe and effective and should be. We completely endorse the use of routine vaccination schedule from the CDC, and that also keeps your child safe and healthy. But what are sort of pitfalls or misunderstandings that you've experienced when describing this to people? Like, have you confronted someone who feels really strongly about this at some point? Or maybe had a piece with, like educating someone when you're you were on the floors doing this?
Nicole Aruffo, RN:well. So like the hospital like took it very seriously because, like it has happened, where someone has like brought a baby over to like the couch for the parents in the middle of the night and like the baby has died, like that has happened so like I mean we did like this whole thing, um as part of the safe to sleep campaign.
Nicole Aruffo, RN:Um, I think a lot of pediatric hospitals probably do this. There's like videos that load into the parents' TV, like for them to watch education, that, like the nurses do handout like, print out handouts on discharge, like that's all kind of part of that um. But we have had a lot of parents who would like, for whatever reason or another, would insist on like sleeping in the hospital crib with the baby, or bringing the baby over to the like parents couch or bed, um, and we like had them like sign this whole thing. It was like a discussion with the doctor too, like this whole thing, because I mean, people just do this and it's like happened in the hospital and then a baby dies right.
Ed Delesky, MD:actually now I have um some of the data from the cdc. The fast facts section of their website is that they have in 2022, they measured 700 sudden unexpected infant deaths and 1,529 of them were from SIDS, and that's some of the most up-to-date data that we have. They do calculate this stuff over the course of time but, getting back to your point, it almost sounds like there were a ton of materials and none of this stuff is free, like it takes money to produce those videos and create those deliverables and in no small part, some of that money or all of it came from this program that is now being threatened or, if it's not already shut down, actively being shut down, which is a huge public health risk yeah, I'm wondering, like at what point that that education gets taken down from the Internet getting rid of this sentiment?
Ed Delesky, MD:this not even a sentiment. This like life-saving campaign and life-saving intervention. Is there a movement because of people's cultural beliefs about like how their family, like how your family, should behave at night when you're sleeping, like yeah, that's a big thing too, but I mean the numbers are there and you can't really argue with that.
Nicole Aruffo, RN:It's also one of those things like it is a lot more rare now because of this.
Ed Delesky, MD:Right.
Nicole Aruffo, RN:So then, people, I feel like it's just kind of one of those things where it's like, oh, this is so rare, like this isn't going to happen to me or my baby. And, like you, always think that it won't.
Ed Delesky, MD:Right and like we're talking about big numbers here, like we quoted like 3 000, but like it's when you really get on that individual level and it's you and your daily life, and like that is devastating. You quoted the 50 reduction in sids and this campaign altogether actually created this widespread change in behavior where now fewer parents are placing their babies on their stomachs and they're placing them on their backs.
Nicole Aruffo, RN:And this is all like very simple stuff.
Ed Delesky, MD:Yeah.
Nicole Aruffo, RN:So I feel like if you were a parent, right, this isn't like a heavy lift to do, and if it's like if I was a new parent, I nothing about this and I was being told by my baby's pediatrician. You know like, do x, y and z to keep your kid the safest at night or while they're sleeping. Reduce their risk of suddenly dying for seemingly no reason. It's a very simple thing to do and you know why not just do it why not?
Ed Delesky, MD:why not just do it? And you know why not just do it, why not? Why not just do it? Yeah, I can't help but think about um. I've definitely walked in early morning, like 5 am, to the hospital, like rounding on a new mom and like she's exhausted because she just delivered and like was in a really hard labor and like she's breastfeeding her baby and and the baby's laying in the bed and she had nodded off to sleep while she was breastfeeding. So this isn't a very scary thing, but I really do want to hone in that even people with the best intentions and this isn't to say that breastfeeding is bad, breastfeeding is good. If you want to do it, go ahead and do it, and you should probably. But even people with the best intentions, the biggest heart, that like that's such a vulnerable time and it's like it's so innocent.
Nicole Aruffo, RN:Just put them on a pulse ox so at least if they were suffocating I could watch them on the monitor. I guess that's harder on like a labor and delivery floor.
Ed Delesky, MD:Totally Like a normal nursery or like wherever the like recovery room is or whatever happens.
Ed Delesky, MD:Right, but like no one's in there with them to watch them, and like they're in a hospital which is supposed to be like an incredibly safe place. But then this is also like, yeah, like you nudge them like awake, and like there's a lot of like you have to be very gentle when you talk about that too and like course correcting about, hey, this is something that you have to be mindful of and think about, especially maybe even if it's a new parent and they've never had to think about anything like this and in a moment, your entire world has changed. Now you're responsible for this small living being. So there's a lot, there's a lot of stuff here. So there's a lot, there's a lot of stuff here, and I think this campaign was and still is, for the moment, extremely powerful and not free. This podcast is free, so hopefully it gets out there to anyone who needs to listen, to put their baby back to sleep.
Nicole Aruffo, RN:What other thoughts are you having? How do you feel about the program getting cut? No, I think that it's unfortunate that something that has been so proven to be so effective maybe won't be there anymore, or as much, and it almost sounded like earlier.
Ed Delesky, MD:You were kind of implying that like when you said, like, even like, how the CDC websites were taken down for a period of time and they're being, like, picked off at various times.
Nicole Aruffo, RN:Well, and there are certain like other things that I think are being like limited from what I've seen, which I won't go into specifics. I don't want to like misspeak on anything, but yeah.
Ed Delesky, MD:Yeah, I guess when I was reading about this, seeing this come up in the news, and I I think it's a damn shame that this is happening this way and just sitting here now talking to you, I didn't even consider like the underlying hidden agenda of like this, looking at this technique, technique as a like getting rid of it and scrubbing the idea yeah, because I feel like, once they like do that, then which you can like cut this part.
Nicole Aruffo, RN:but I feel like, um I haven't like actually verified this, but there was some I forget exactly what it was something about like birth control, like information, information, something like off the CDC website, and then I was seeing like um, um, I think it was like yeah, it was like HIV.
Ed Delesky, MD:Yes and STIs.
Nicole Aruffo, RN:And, like I've seen, this is this information about this portion has like strictly come from Tik TOK, but I've seen like Tik TOKs of gay men going to the pharmacy to like get their prep and then the pharmacist like giving them like printed out information or and like stopping and like taking time with them to be like, hey, this is going to be like removed from the like if this gets removed from the internet soon. Like dah, dah, dah, dah, dah dah.
Ed Delesky, MD:Oh, yeah, yep, and this, maybe this is like the opportunity for like a whole health misinformation, and like how our information is traveling these days, episode after this, because that has absolutely been happening. The treatment guidelines were taken down, like even at work, like people are like oh, I wonder what's being taken down today. Or like things that doctors use every day are to help make decisions about treatment for patients. Like was removed, I believe it was brought back up, but this stuff changes day to day and so, like, by the time you listen to this, who knows? Yeah, but will this be that again?
Nicole Aruffo, RN:And I like maybe, and like maybe it's, I don't know like, oh, sids rates are so low, we don't need to, you know, know, go as hard on this campaign. But maybe I'll try to give the benefit of the doubt and think that that's why but, there are also, like so many other, like the marketing isn't as heavy in certain populations exactly and SIDS rates are higher in like more like black and indigenous communities right so it's like not hasn't fully reached everywhere exactly they are, like, disproportionately affected in that way, and so it's worth it.
Ed Delesky, MD:It's worthwhile to keep pushing this and to keep telling people, and I mean with the way that, like, so much information is free, right, like you go online, like we, you consume any number of things in the course of a day online, and it's it is kind of crazy to think that there's so much money that it takes to produce something like this, but it makes sense. Like marketing isn't free, right, campaigns like this aren't free, but they're worthwhile because they this specific one is so simple, it's such a light lift and it saves lives and has saved lives, and I think maybe it'll be a generational thing or maybe it'll just take another administration where, like, this sentiment will keep going. This is like style, this campaign, like we'll live on, and like pediatricians practices, but if it goes away and then, decades from now, people forget, it makes you wonder, yeah, so thank you for coming back to another episode of your checkup. Hopefully you were able to learn something for yourself, a loved one or an infant neighbor going to sleep.
Ed Delesky, MD:Please check out our website. If you found this helpful at all, send it to a new parent, or if you have someone in your family who's a new parent, or send it just to a friend, a loved one or a neighbor and check out our other episodes. You can visit our website, email us at yourcheckuppod at gmailcom and send us some fan mail. We look at it all the time. We love when we get messages and we'll talk about them on the show If it's anything like a question or something like that. So thank you for coming back and we look forward to having you back next week and, most importantly, stay healthy, my friends, until next time. I'm at the Lesky. I'm Nicole. Thank you and goodbye Bye.
Ed Delesky, MD:This information may provide a brief overview of diagnosis, treatment and medications. It's not exhaustive and is a tool to help you understand potential options about your health. It doesn't cover all details about conditions, treatments or medications for a specific person. This is not medical advice or an attempt to substitute medical advice. You should contact a health care provider for personalized guidance based on your unique circumstances. We explicitly disclaim any liability relating to the information given or its use. This content doesn't endorse any treatments or medications for a specific patient. Always talk to your healthcare provider for complete information tailored to you. In short, I'm not your doctor, I am not your nurse, and make sure you go get your own checkup with your own personal doctor.
