Sudden Infant Death Syndrome: Every Parent's Worse Nightmare

    The Mayo Clinic defines Sudden Infant Death Syndrome (SIDS) simply as the unexplained death of a child. This definition is not specific, but that is because we do not know a lot about SIDS. Typically infants that die of SIDS are under a year old, healthy, and simply pass away in their cribs, asleep. Despite there not being a lot known about the ailment, around 2,300 babies in the United States die of SIDS each year, a rate much higher than other countries.  While SIDS is the death of a child under a year old, it is most common in an infant between one and four months. It is more common in boys than girls, and most deaths occur in the fall, winter, and early spring. 

 The specific cause of SIDS is not known. However, there are some theories as to how to explain it. According to the National Institute of Health, researchers have found problems in the brains of babies who have died from SIDS. In some cases, there was a problem in the network of nerves that control breathing, heart rate, blood pressure, temperature, and waking form sleep. Other researchers theorize that changes in the genes of an infant mat cause problem with the body functions previously mentioned. Some infants who have died from SIDS have even been found with high levels of serotonin in their blood, suggesting that this may play a role. However, despite this research, the physiological etiology of SIDS is still unknown. In addition, there is no current way to detect any of these problems the a baby is still alive. 

https://safetosleep.nichd.nih.gov/about/causes

    To help combat SIDS related deaths, researchers use the Triple Risk Model to suggest and understand how SIDS deaths may occur. This model involves infant vulnerability, the critical development period, and outside stressors.  

    Infant vulnerability could be due to low birth weight, fetal abstinence syndrome, premature birth, or other reasons not yet known. Environmental stressors that can potentially lead to SIDs include tobacco smoke, getting tangled in/suffocating in bedding, a minor illness, and breathing obstruction. 

    

    Since SIDS often occurs when infants are asleep, many SIDS prevention straggles center around safe sleeping. Avoiding co-sleeping and soft sleeping surfaces are some of the ways to prevent SIDS. Infants should sleep on their back on a firm surface. with as little loose material as possible.

    SIDS related deaths have declined in the United States since the release of the "Back to Sleep Campaign." This campaign began in 1994, named after its primary recommendation that all infants sleep on their back to reduce risk of SIDS. However, despite this and other interventions, SIDS rates in the US are still high, especially in African American and Indigenous American populations. Some of this is due to defiance against certain guidelines, particularly that regarding co-sleeping, while it can also be contributed to the systemic health decline in these communities. 

Sex Education: Does Abstinence Work?

    Sex education equips teenagers with the knowledge, skills, attitudes, and values that help to protect their health, develop respectful social and sexual relationship, make responsible choices, and protect and understand the rights of others. However, there are varying degrees of sex education, and not all of it is equal.

     "Abstinence" is defined as the practice of refraining oneself from indulging something, in this case, sexual activity. For many people, this is the only form of sex-education they received. Teen sexual health outcomes in the last decade have been mixed. Teen pregnancy and birth rates have decreased, but rates of sexually transmitted infections among teens and youth has risen. Much of these could perhaps be associated to the lack of of sex-ed. 

    24 States and DC mandate sex education for youth.

    37 States require that sex education must include abstinence, with 26 requiring that it is stressed.

    13 States require that the sex education be medically accurate.

    18 States and DC require that information on contraception be provided with sex education.

As seen above, there are two main approaches toward sex education: abstinence-only and comprehensive sex education, with each being defined as the following:

• Abstinence-Only Education - aka "Sexual Risk Avoidance," teaches that abstinence is the expected behavior of teens, typically excluding any information regarding contraception in preventing pregnancy and STIs
• Comprehensive Sex Education - provides medically accurate age-appropriate information about abstinence, as well as practices including contraception and condoms, in addition to information on healthy relationship and communication

There is also an intermediate between the two, Abstinence-"Plus"-Education, which stresses abstinence, but also includes some information on contraception and condoms. 

The American College of Pediatricians strongly endorses abstinence education, actually endorsing it over comprehensive sex education. They state that this position is based on "the public health principle of primary prevention - risk avoidance in lieu of risk reduction," and that it upholds the "human right to the highest attainable standard of health." The American College of Pediatricians supports abstinence only education due to claiming that adolescents need to be given clear directions repeatedly; they claim that emphasis on contraceptive usage undermines the authority of parents and the strength of the abstinence message. 

Guttanmacher.org

    Despite the increased funding and use, recent research shows abstinence-only programs could be harmful to young people. By the end of high school, over half of teenagers will have had sex, yet they are not learning the information about contraceptives, STIs, consent, or healthy communication. Instead, the abstinence-only programs they are learning promote judgment, fear, guild, and shame around sex. Additionally, abstinence-only programs are often heteronormative, framing LGBTQ students as deviant and not providing sexual education for them. 

    The previous argument in favor of abstinence-only education claimed that it undermined parents and confused students. However, a UNESCO quote from 2009 states the following: "Sexuality education does not hasten sexual activity but has a positive impact on safer sexual behaviors and can play sexual debut."

    The American Medical Association, the American College of Obstetricians and Gynecologists, and the Society for the Adolescent Health and Medicine oppose abstinence-only programs. In addition, the majority of parents of high school students support the instruction of broader topics outside of abstinence. 

Guttmacher.org

    

The Decline in Childhood Vaccination: A New United States Epidemic

     Over the last two decades, anti-vaccine activism has grown from a fringe subculture into a well organized, networked movement. This evolution is leading to severe public health repercussions. with the COVID-19 pandemic exacerbating this issue and magnifying the spread of vaccine misinformation. An article from the National Library of Medicine describes three noteworthy patterns in this movement.

1. Progression into right-wing identity and activism

2. Networked activism

3. Harassing and threatening health-care and public health professionals

    One of the major public health outcomes seen as a rise of this movement is the decline in childhood vaccination rates, which in turn is leading to increased occurrence in vaccine preventable diseases. The Journal of Pediatric Pharmacology and Therapeutics describes four overarching categories to describe the reasons that parents refuse, delay, or are hesitant to vaccinate their children. 

                    1. Religious reasons

                    2. Personal beliefs/Philosophical concerns

                    3. Safety concerns

                    4. A desire for more information from healthcare providers

    These concerns lead to a wide spectrum of decisions, ranging from parents delaying vaccinations so that they are more spread out, to parents completely refusing all vaccinations. Vaccinations play a vita role in preventing diseases in children. There are no federal laws regarding vaccine administration, but each state has laws dictating which vaccinations are required for children before attending school. All 50 states allow medical exceptions, such as for those who are immune compromised or those allergic to various vaccine components. There are 30 states that allow exemptions for those whose parents cite religious reasons. There are 18 states that make special accommodations for those expressing philisopical reasons. however, states with more lenient laws are shown to have increased rates of exemptions granted, leading to greater vulnerability in the population. In fact, the outcomes of these exemptions are arising. 30 states reported to the CDC that the COVID-19 pandemic resulted in a decreased rate of vaccination coverage for the 2021-22 school year. This was due to reduced access, but also due to "local or school level extensions of grade period of provisional enrollment policies." In 2021, one in five children under the age of one year did not have any vaccine doses. 

Five Reasons Childhood Immunization Is So Important

    There has also been shown to be large disparities in childhood vaccination rates by race, incomes nd geography. According to the Center for Disease Control and Prevention, from the years 2018 to 2022, children born in the United States from 2017 to 2018 who were uninsured, Black, Hispanic, and/or had family income below the federal poverty level had lower childhood vaccination coverage than those who were privately insured, white, and/or had family incomes at or above the federal poverty lines. These children were also more likely to miss routine immunizations. This was shown to be due to transportation challenges, lack of access to routine pediatric care, and greater parental vaccine hesitancy.    

CDC: Recommendations for Ages 18 and Younger, United States, 2024

    Routine childhood immunization has been shown to continuously yield considerable sustained reductions in the incidence across targeted diseases, such as influenza, measles, mumps, polio, rubella, etc. These diseases can have serious outcomes when contracted. Measles can cause brain swelling, leading to permanent brain damage or even death. Mumps can cause permanent deafness. Meningitis can also lead to permanent deafness or brain damage. Polio can cause permanent paralysis. The United States saw its first case of Polio since 1979 in July of 2022, where a man who was unvaccinated was paralyzed as a result f the infection. As of March 18, 2024, Measles cases in the Untited States have already reached last year's total of 58, with most of these cases being unvaccinated children. On average, one out of five unvaccinated people diagnosed with Measles end up needing to be hospitalized. A recent outbreak in Ohio even saw over 40% of infants and children infected with Measles in the hospital. The CDC describes Measles, stating that it "is so contagious that if one person has it, 9 out of 10 people of all ages around him or her will also become protected if they are not protected." Thus, delaying or refusing a child's vaccine proposes risk to their own health and safety, but also that of others. Those most at risk include people with weakened immune systems due to other medications or diseases, people with chronic medical conditions, newborn babies who are too young to be vaccinated against most diseases, and the elderly. 

    The decline in childhood vaccination rates can be addressed by improving access to and boosting confidence in childhood vaccinations. Some suggested interventions include:

• Bolstering resources for immunization programs through the federal Vaccines for Children (VFC) and Section 317 programs
• Expanding the vaccination workforce through policies that facilitate provider enrollment in the VFC program and support vaccinators, such as school nurses and pharmacists
• Increasing vaccine reimbursement to cover costs associated with vaccination, such as vaccine education and reducing administrative burdens
• Tightening and reenforcing school vaccine requirements that have been effective in producing high vaccination rates
• Engaging trusted community leaders, such as health care providers, school staff, and faith-based organizations, to counter vaccine disinformation with accurate and effective messaging