Infant sleep safety still misunderstood by many caregivers

(Reuters Health) - Even though most caregivers agree on the importance of safe infant sleep practices, many of them may not know what to do – or not do – to prevent sleep-related deaths from sudden infant death syndrome (SIDS), a U.S. study suggests.

Researchers questioned caregivers of newborns at Staten Island University Hospital in New York City about sleep safety and found 53 percent of them disagreed with use of pacifiers – which are in fact linked to a lower risk of SIDS – and 62 percent believed in swaddling infants – which is tied to an increased SIDS risk.

It’s possible that new parents may have a hard time discarding advice from their own parents or grandparents even though recommendations about sleep safety have changed considerably from one generation to the next, lead study author Dr. Sarah Varghese said by email.

“There is a certain power surrounding 'traditional' knowledge,” said Varghese, now at Emory University and Children’s Healthcare of Atlanta. “Both parents and health care professionals need to stay up-to-date on recommendations.”

Nationwide, SIDS kills about four babies out of every 10,000 live births, down from about 130 in 10,000 in 1990, according to the Centers for Disease Control and Prevention.

Despite the dramatic decline in death from SIDS since 1992, when the American Academy of Pediatrics (AAP) announced that babies should be placed on their backs to sleep, SIDS in recent years has remained the third leading cause of infant mortality, the authors report in the Journal of Perinatology.

Almost four years ago, the AAP issued new infant sleep guidelines for prevention of SIDS and other sleep-related deaths; the guidelines encouraged breastfeeding, pacifier use, and firm crib mattresses, and cautioned against blankets and pillows and bed-sharing.

The study by Varghese and colleagues, while small, suggests that at least some parents may not have absorbed these most recent recommendations.

The researchers questioned 121 caregivers, including parents and grandparents, of newborns delivered in 2013, asking how strongly they agreed or disagreed with recommended infant sleep safety practice.

Most participants strongly agreed on the importance of using a safety approved crib, avoiding exposure to smoke and getting routine childhood vaccinations.

But most of them disagreed with guidance against swaddling and using home monitors, as well as recommended pacifier use.

Some caregivers may avoid pacifiers because they have concerns about dental issues, while others may worry that it could interfere with breastfeeding, the study authors note. The AAP recommends starting pacifier use when babies are about three or four weeks old, after they are successfully breastfeeding.

Swaddling with blankets or specially designed wraps can increase the risk of infant death, but some nurses still swaddle infants in the hospital and teach new parents how to do it themselves, the authors note. Some caregivers believe swaddling can soothe infants and make it easier for them to sleep.

Only 61 percent of participants recalled being taught about sleep safety by a health care provider.

The study was small, limited to English-speaking participants and included primarily white caregivers, which may limit how much the findings apply to a more diverse population, the researchers acknowledge.

Even so, the findings highlight the challenge of conveying safe sleep practices to parents who may be overwhelmed by too much advice, said Dr. Michael Goodstein, a neonatologist at York Hospital WellSpan Health in York, Pennsylvania and a member of the AAP task force on SIDS.

“Even if parents have been made aware of safe sleep information, there may be competing and conflicting information and advice available from multiple sources including books, magazines, family and friends, TV shows and the Internet, as well as many different health care providers,” Goodstein, who wasn’t involved in the study, said by email.

SOURCE: Journal of Perinatology, published online September 3, 2015.

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Many U.S. veterans may face sexual health problems

Many U.S. veterans returning from service in Iraq and Afghanistan may encounter sexual health problems, a new study suggests.

Almost 18 percent of veterans screened positive for sexual dysfunction in initial visits at the post-deployment clinic at a veterans affairs medical center in Houston, researchers say.

It’s possible the actual prevalence of sexual dysfunction is much higher, because veterans, like many other people, may be reluctant to discuss sex with providers they are seeing for the first time, noted study co-author Dr. Drew Helmer, director of the War Related Illness and Injury Study Center at the Department of Veterans Affairs (VA) New Jersey Health Care System in East Orange.

“Patients are more likely to share their sexual health concerns when they trust their provider or when the provider explicitly asks about sexual health concerns,” Helmer said by email.

To assess sexual health, clinicians asked nearly 250 veterans about these issues as part of routine physical and mental health assessments done at the post-deployment clinic in 2011 and 2012.

On average, the veterans in the study were 31 years old. Most were male and more than half didn’t report having a primary romantic partner.

Veterans responded to a five-item questionnaire rating their level of functioning or impairment in various aspects of sexual health including libido and arousal, orgasms and satisfaction, and erections for men and vaginal lubrication for women. Possible total scores for the responses could range from five to 30, with higher scores indicating more severe sexual dysfunction.

One in four of the veterans reported serious impairment in at least one area, or some difficulties with at least three aspects of sexual functioning, the researchers report in the journal Sexual Medicine.

More than half of the veterans in the study had post-traumatic stress disorder (PTSD) and almost one third had depression. About 11 percent had experienced a traumatic brain injury, and roughly 27 percent had a problem with alcohol use.

Veterans were more likely to report sexual dysfunction if they had depression or PTSD, or if they were female.

Stress related to deployment and returning home can also contribute to sexual health problems for veterans and their partners, Helmer said.

Limitations of the study include the potential for PTSD to be over-diagnosed, because the initial screenings are designed to catch any potential cases, and some of these cases are ruled out during follow-up visits, the authors acknowledge.

Researchers also lacked data on the timing of prescription medication use, which might impact sexual functioning to the extent that drugs have sexual side effects.

Even so, the findings add to a growing body of evidence linking post-deployment problems such as depression or PTSD to sexual dysfunction, Dr. Benjamin Breyer, a researcher at the University of California, San Francisco, said by email.

Compared to the civilian population, veterans can face more mental health challenges and have increased rates of PTSD and depression, noted Breyer, who wasn’t involved in the study.

PTSD can lead to decreased sexual satisfaction for both men and women, and medications used to treat depression can lead to erectile dysfunction, decreased libido and delayed ejaculation, he added.

“Compounding these physiologic issues are complex social and relational challenges that meet the veteran when they return home to established relationships,” Breyer said. “If you’re suffering from depression or PTSD, it’s more difficult to relate to your spouse, which can strain the relationship and diminish sexual wellness.”

SOURCE: Sexual Medicine, published online November 2, 2015.

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