Sudden infant death syndrome.

Sudden infant death syndrome (SIDS) is the sudden unexpected death of a child younger than one year during sleep that cannot be explained after a postmortem evaluation including autopsy, a thorough history, and scene evaluation. The incidence of SIDS has decreased more than 50% in the past 20 years, largely as a result of the Back to Sleep campaign. The most important risk factors relate to the sleep environment. Prone and side sleeping positions are significantly more dangerous than the supine position. Bed sharing with a parent is strongly correlated with an increased risk of SIDS, especially in infants younger than 12 weeks. Apparent life-threatening events are not a risk factor for SIDS. Parents should place infants on their backs to sleep, should not share a bed, and should avoid exposing the infant to tobacco smoke. Other risk-reducing measures include using a firm crib mattress, breastfeeding, keeping vaccinations up to date, avoiding overheating due to overbundling, avoiding soft bedding, and considering the use of a pacifier during sleep once breastfeeding is established. One consequence of the Back to Sleep campaign is a significant increase in the incidence of occipital flattening. Infants who develop a flat spot should be placed with the head facing alternating directions each time he or she is put to bed. Supervised prone positioning while the infant is awake, avoiding excessive use of carriers, and upright positioning while awake are also recommended.

Pediatric Residents' Knowledge and Comfort With Oral Health Bright Futures Concepts: A CORNET Study.

OBJECTIVE: Training residents in oral health helps eliminate disparities and improves access. The American Academy of Pediatrics Bright Futures Guidelines curriculum is used as a training guide. We assessed knowledge, confidence, and perceived barriers to incorporating Bright Futures oral health concepts into well-child care for children below 3 years in a national sample of pediatric residents. METHODS: A sample of postgraduate year 1 and 2 residents from CORNET sites completed demographic, Bright Futures oral health concepts confidence and knowledge cross-sectional surveys before any intervention. Measures were tested for reliability using Cronbach's alpha coefficient. RESULTS: One hundred sixty-three residents from 28 CORNET sites completed the surveys. One third reported no prior training in oral health. Time (42%) and knowledge (33%) led the perceived barriers to addressing these concepts in well visits. Although 63% rated their confidence as excellent in identifying tooth decay risk factors, a significant percentage rated their oral health risk assessment skills as poor or neutral (64%) and identifying caries at examination (53%). Only 49% conveyed oral health messages during encounters and 80% correctly scored 75% or higher on knowledge questions. CONCLUSIONS: This cross-sectional study shows that residents from a wide geographic range have high self-reported oral health knowledge but low perceived skills and competency in clinical implementation. Lack of time and knowledge in identifying caries led the perceived barriers. Barriers are addressed by implementing oral health curricula that promote competence and skill-development. This study helps programs effectively implement Bright Futures concepts to train graduates to incorporate oral health in well visits.