Week 2: Children's Development & Public Health-A Multicontextual Issue

Many facets of public health are particularly interesting to me, and more importantly, vital to the population of young children. This week I chose to learn more about and discuss Sudden Infant Death Syndrome or SIDS. Berger defines SIDS as “a situation in which a seemingly healthy infant, at least 2 months of age, suddenly stops breathing and dies unexpectedly while asleep” (Berger, 2009).This topic is particularly meaningful for me because of a professional experience that I had when entering the field of working with children and families. In 2008, I began working as an emergency response team specialist, working cases in collaboration with Child Protective Services. It was my first on-call shift (EVER), and I was called out to a home where the family had recently moved to the area (2 Parents, a 5 year old, and her infant brother). That afternoon, the baby had died in the parents’ bed from “unknown reasons.” While on the phone taking the referral, I remember the investigator saying, “They are calling it SIDS for now.” The case also involved allegations of domestic violence. The parents denied co-sleeping with the infant reporting that he was healthy, but the 5 year old reported co-sleeping behavior. I was called in to link the parents with resources such as bereavement counseling, financial assistance, domestic violence services, childcare, etc. while the investigation ensued. The protective investigator, being overwhelmed and busy with the infant/evidence, told the family that in fact I was a bereavement counselor and was referred to come to the home to help notify their 5 year old about where her baby brother went and why he was not coming home. Not knowing how or why the child had died obviously made this a daunting task. On the drive home from this case, I remember thinking to myself, that SIDS is such a controversial issue! What if the parents were in a dispute and the baby got hurt in some unobvious way? What if they rolled over and suffocated him? I thought, “there has to be more to it.” Due to my temporary engagement with the families I serve, knowing the outcome and/or explanations of cases is often left unknown.

The rates of SIDS has decreased over the past 10-20 years due to more research and education regarding infants sleep behaviors, improved public health resources, etc. and how to use this information to decrease risk. However, over time, across cultures with different levels of access to resources, SIDS has had varied prevalence on mortality rates. There is a lot of research as to why Asian culture tends to have the lowest SIDS prevalence (Berger, 2009). I read a study done in Australia about Thai women who had immigrated there, but kept their cultural practices regarding pregnancy, and infant child rearing from their original countries where SIDS is not as common. According to the article, “Asian peoples and migrants from Asia have a lower incidence of SIDS than those of other nationalities” (Rice & Naksook, 1998). Some of these practices include co-sleeping, placing infants on their side or backs to sleep, rituals to ward away evil spirits like chants with monks, ceremonies promoting spiritual protection, refraining from taking the child out of the home during the first weeks, swaddling in several layers of clothes (Rice & Naksook, 1998). This information is interesting because some of these practices are exactly what is being taught not to do with infants to prevent SIDS in the first place! The study stated that while learning about these cultural beliefs and trying to understand the implications regarding SIDS, “Asian infants were cared for in a consistently rich sensory environment which helped to prevent SIDS” (Rice & Naksook, 1998). While it can be debated as to the degree that some of these rituals can scientifically be linked to prevention, in this study, and I agree that “cultural beliefs and practices in any culture function to provide protection and to reduce negative outcomes for the participants” (Rice & Naksook, 1998). “The practices used by Thai parents are a fruitful source of ideas and hypotheses which could be further investigated in our efforts to reduce infant deaths” (Rice & Naksook, 1998).

Understanding the cultural beliefs and practices of infant rearing, especially regarding SIDS is going to influence my professional career. Because co-sleeping, swaddling, immunizing, etc. varies culturally, SIDS from a child protection point of view is a very grey issue. On the one hand, these behaviors can be neglectful to a baby. On the other hand, they may also be protective. Like so many other issues associated with the field of children and families as well as public health in general, more research and cultural understanding is needed.

Berger, K. S. (2009). The developing person through childhood (5th ed.). New York, NY: Worth

            Publishers.

Rice, P.L., Naksook, C. (1998). Child rearing and cultural beliefs and practices amongst Thai mothers in

            Victoria, Australia: Implications for the sudden infant death syndrome. Journal of Paediatrics and

            Child Health, 34(4), 320-324.

http://www.sids.org/ This is a great resource about SIDS and prevention. Take a peek and share!