EXECUTIVE SUMMARY

Suffocation and falls while being held by a family member is a little-known risk to newborn babies. Nurses and other staff should be alerted to the risk so they can take precautions.

  • Parent-related newborn falls are not common, but still happen more than one would expect.
  • Serious injury and death have occurred.
  • Prevention begins with explaining the risk to parents.

The scenario is dreadful, but it actually happens with some regularity: A mother holding her newborn child, perhaps nursing, falls asleep from exhaustion. She either accidentally smothers or drops the child, resulting in serious injury or death.

The risk first came to the attention of former hospital risk manager Susan C. Wallace, MPH, CPHRM, patient safety analyst with the Pennsylvania Patient Safety Authority (PPSA) in Harrisburg, when she came across an adverse event report of a mother who had been breast-feeding her newborn in the hospital when she fell asleep because she was exhausted from childbirth.

“When she woke up, unfortunately she had suffocated the baby,” Wallace says. “I started looking into this and found a lot of reports over the years, not all involving suffocation but involving injury or even death because the mom, dad, or even a family member was so exhausted from being up all night and all the stress from labor and childbirth. They fall asleep, their arm relaxes, and the baby falls.”

In addition to sheer exhaustion, mothers may have received pain medication that makes them sleepy or impairs judgment, Wallace notes. It is up to nurses and family members to watch these mothers carefully when breast-feeding or holding their babies.

The potential for this type of newborn injury is largely unrecognized by physicians and birthing unit staff, Wallace says, because when it happens it seems like a freak occurrence and not something preventable. After all, hospitals now encourage parents to hold their newborns soon after birth and as often as possible in the time before discharge, to foster bonding, breast-feeding, and overall wellness for the baby and parents. In many hospitals, newborns stay with the mother as much as possible rather than sleeping in the nursery.

But this tragedy happens often enough that it deserves attention from risk managers and clinicians, Wallace says. In Pennsylvania alone, Wallace’s research found about 30 incidents per year in the several years she studied. Her analysis of reports submitted to the PPSA from July 2004 to 2013 revealed almost 300 incidents of family members dropping their newborns after falling asleep, newborns slipping out of family members’ arms to the floor, and newborns receiving bumps to their heads while with their families. More than 9% of the incidents resulted in serious patient harm. (Wallace’s full report on this safety risk is available online at: http://bit.ly/2kOPw8K.)

The majority of the incidents — 85.3% — occurred when the newborn was younger than four days old. Of those falls, 42.7% occurred on day one and 32.8% occurred on day two.

“In some cases, these babies fall to the floor and they will get a brain injury,” she says. “In a few instances, the baby was held in the mother’s arms in such that it didn’t fall, but as the mother relaxed her body as she fell asleep and the baby was caught up in the bedding or the mother’s body and clothing, and suffocated.”

In addition to parents falling asleep, babies can suffer other types of fall injuries while in the parents’ care. PPSA records include these examples of both types from incident reports:

  • “Upon entering the mom’s room, the nurse found a man crying and holding a crying infant. Mom stated she was sitting in the chair feeding the newborn when she fell asleep. The infant slid to the floor off of [the mom’s] lap. Mom stated the newborn’s head was hit on the right side.”
  • “Infant was sleeping on father’s chest in chair at side of bed; father fell asleep, and infant rolled to the floor face down. Infant found crying in father’s arms. [Infant] returned to nursery for assessment by pediatrician.”
  • “Mother of [newborn] reported that her baby had fallen out of her arms and onto the floor during the night, stating that she was holding her baby and fell asleep. X-ray revealed a skull fracture.”
  • “Infant fell from mother’s arms, landing on right side of head and body. Infant taken to NICU. Infant sustained bone skull fracture and small subdural hematoma.”
  • “Infant fell from mother’s arms when mother bent over to pick something up from the floor.”
  • “Mom brought baby to the nursery [in the morning]. Mom stated that she dropped the baby onto the floor while changing breastfeeding position. Mom was sitting in her bed. Baby fell and hit back of head.”

Hospitals are taking notice of the risk and implementing frequent checks when a mother is breast-feeding, and some are requiring parents to sign a document acknowledging that they have been warned about the risks and understand how to protect the child, Wallace says.

The best way to prevent these accidents is to educate parents, family, and clinicians about the risk and encourage vigilance, Wallace says. Nervous first-time dads may worry about dropping the baby, but those concerns are dismissed by others who assure him he will do fine. And he almost always does. But the idea of falling asleep and harming the baby does not occur to many, Wallace says.

Also, parents and family members may falsely believe that it is OK to fall asleep with the baby as long as the baby is held in such a way that there is no chance of falling. That is not safe because suffocation is always a risk, she says.

“Just making parents aware of this is the first step,” Wallace says. “They need to be encouraged to let someone know if they’re getting sleepy and need to hand the child to someone else or put the baby in a bassinette. Tell them directly that while it might seem warm and wonderful to fall asleep with your baby, it’s actually quite dangerous and should be avoided.”