Making sleep safe with babies to reduce SIDS incidence in First Nations infants

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Indigenous babies die from sudden unexplained death in infancy (SUDI) and sudden infant death syndrome (SIDS) three to four times more often than non-Aboriginal babies. Co-sleeping is a culturally valued practice by many Indigenous families, however is associated with an increased risk of infant death in hazardous circumstances. The Pepi-Pod sleep space program is one approach being applied in many regions of Australia and New Zealand to enable more vulnerable babies to have a safe space for sleeping every time and place they sleep.

Credit: Change for our Children Ltd

Following a successful trial in 2014 led by Professor Jeanine Young from the University of the Sunshine Coast, the program has been established in Queensland since 2017 with hundreds of Pepi-Pods distributed to at-risk mothers through participating health services.

“The Pepi-Pod Program comprises three essential elements: a portable infant sleep space that provides a zone of physical protection for baby’s airway, safe sleeping parent education and safety briefing, and a family commitment to use the sleep space as intended and to share safe sleeping messages within the family’s social networks,” Professor Young said.

Designed for newborns up to five months old, the Pedi-Pod is a plastic tub ‘safe sleep enabler’, with its own mattress and linen. It is intended to sit on an adult mattress and creating a zone of physical protection around the baby and others in the bed, particularly where there was an increased risk of suffocation.

The Pepi-Pod Program has been used successfully in high risk Indigenous populations, with an observed 29% reduction in infant mortality in NZ. “The program specifically reduces the interaction between shared sleeping environments and maternal and household member smoking, which is reported to increase SUDI risk ten-fold,” Professor Young said.

When launched Professor Young said Australia's infant mortality rates were three times that of other OECD developed countries, and for Australian Indigenous families that increased again three-fold.

"Around 97 per cent of these deaths are associated with preventable risk factors. That's just not OK,” she said.

"This never has been and never will be OK," say Professor Julian Grant and Dr. Nina Sivertsen, who are leading a South Australian program led by Flinders University. They have just published the findings of their study in Primary Health Care Research & Development.

The program, in collaboration with the Aboriginal Health Council of SA, the Women and Children's Health Network and SA Health, sought 'culturally safe' solutions to do more for Aboriginal babies to sleep safely.

"We wanted to see if the Pepi-Pod program was experienced as culturally safe and if First Nations families would even use it," said Dr. Sivertsen of the first small initial pilot trial in SA.

"Families told us that one of the best parts of the Pepi-Pod program is that 'you don't have to worry' babies were in their 'own little comfort zone'."

Credit: Flinders University

"Babies were 'peaceful and safe' and you could 'see him,' 'feel him' 'touch him' and 'hear him,' while baby slept safely in the pod."

Flinders adjunct Professor Grant, now at Charles Sturt University, said that many families including First Nations peoples sleep with their babies in the family bed. "While bed sharing has many benefits, it is also associated with infant death.”

Sharon Watts, an Aboriginal researcher on the project, said that it is "really important for First Nations families to feel close to their babies all the time, especially when sleeping."

While some participants thought the Pepi-Pod itself looked a bit too much like a 'breadbox," they found the sense of safety comforting and the education program a great way to share safe sleep knowledge with family, friends and community.

The South Australian research team is now completing a larger Medical Research Future Fund project to deliver a safe sleep education module to about 235 health care professionals, as well as the safe sleep information and Pepi-Pod deliveries to up to 70 families to sleep their baby. 

"We are now finding out together if the Pepi-Pod program is culturally safe and if it can be used in mainstream health services," the researchers said.