Lake Fong, Post-Gazette Barbara Clemons, Cribs for Kids distribution manager, instructs Wylein Moore, of McKeesport, how to operate the Graco Pack 'n Play. Ms. Moore's 22-day-old baby KaNya Pitts sleeps on her back with the crib in the bassinet position. Click photo for larger image. Related article Parents can take steps to reduce SIDS risk

One baby, one crib.

That simple formula is the basis of a program that started in Pittsburgh to save babies' lives in 1998 and has spread to 79 cities and counties in 29 states.

It bloomed out of concerns about the loss of babies to sudden infant death syndrome and efforts to spread the word that babies are safest when sleeping on their backs. Judith Bannon, executive director of the Sudden Infant Death Services of Pennsylvania, remembers when the American Academy of Pediatrics began its "Back to Sleep" campaign in 1994 -- directing parents to put their healthy infants on their backs to sleep.

"We started seeing the [SIDS] rates going down, but then in 1997, we saw a little bit of a bump up; we saw more babies dying, and that low-income African-American families were not adhering to the recommendation," Ms. Bannon said. Research found that many families continued to put their babies on their stomachs, and that many deaths occurred when they were sharing a bed with others.

It was apparent to Ms. Bannon and community leaders concerned about SIDS in Allegheny County that the next step after Back to Sleep was a safe environment for sleeping babies. Providing cribs to low-income families became a mission in 1998.

The risk of death is higher in bed with a parent than sleeping on the stomach, said Eileen Carlins, SIDS of PA director of support and education. She helps grieving families who have lost a baby and conducts educational seminars. She and Ms. Bannon are on the county's child death review team, which monthly reviews all deaths of people from birth to 19 years old.

The team, made up of physicians, public health experts, children and youth services officials, law enforcement personnel and educators, found that of the 39 SIDS deaths in the county between 2000 and 2003, most appeared to be due to accidental suffocation. Thirty-six percent involved infants sleeping on their stomachs, and 54 percent were babies who died while sleeping with someone else.

"We look for ways to keep these deaths from happening," Ms. Carlins said.

Reducing the risk may be paying off. Ms. Bannon reported that as of August 2006, all 5,000 infants in the county who received a crib from Cribs for Kids were alive at 1 year old. SIDS/accidental suffocation deaths in the county declined from 17 in 1998 to five in 2004.

"When I talk to a parent, and we don't know the cause of death, I explain the need for an autopsy and an investigation," Ms. Carlins said. "What is hard is when the autopsy report says a parent was sleeping with the baby and there is evidence the baby died of compression."

New offices

First headquartered in a space in South Side Hospital, SIDS of PA has recently moved to Riverfront Place on the North Shore, with offices for its staff of three: Ms. Bannon, Ms. Carlins and Barbara Clemons, crib distribution manager.

"Many families are not buying a crib. We can give them a Pack 'n Play. And then we have an opportunity to give parents an education," Ms. Carlins said. "We're like the sleep-position and crib police."

Cribs for Kids gets referrals from community agencies such as Healthy Start, Alliance for Infants and Toddlers, Magee-Womens and Children's hospitals and the county Office of Children, Youth and Families. Allegheny General Hospital and Transitional Infant Care pay for cribs for their qualified families.

Lake Fong, Post-Gazette From left, Eileen Carlins, director of support and education; Judith Bannon, executive director; and Barbara Clemons, crib distribution manager, at the SIDS of PA office. Click photo for larger image.

Ms. Clemons instructs parents on the use of the Graco Pack 'n Play. Though designed for nap and play time, it was identified by SIDS of PA as an alternative to a full-size crib because of its portability, Ms. Bannon said. It's for babies less than 35 inches tall and less than 30 pounds in weight.

Ms. Clemons told a mom recently, "No bumpers, pillows, animals. When the baby is put down, everything comes out." Sleep sacks are safer than blankets, she said, and a good-fitting sheet is key. One sheet is provided, with "Back to Sleep" printed on it as a reminder. Halo sleep sacks and additional sheets are sold separately. "Does anyone smoke in the house? No? Good," Ms. Clemons said to the mother.

Word has spread about the program. Beyond Allegheny County, in the rest of the state, there are Geisinger Medical Systems clinics in 31 counties that offer Cribs for Kids. The Milton S. Hershey Medical Center has clinics in 10 counties offering the cribs. The health departments in Chester, Delaware and Montgomery counties have Cribs for Kids; in Philadelphia there's the Maternity Care Coalition; and eight counties in northwestern Pennsylvania get Cribs for Kids through the state Health Department.

Through a deal with Graco, the Pack 'n Play costs $39.78 plus shipping; in stores it's $59.99. Pitt Ohio Express provides shipping for free in states where it operates. Ms. Clemons handles the distribution and records the number of cribs ordered with a "Cribs for Kids Partners List."

The nonprofit program is supported through sales, fund-raisers such as Kayla's Run for SIDS, and donations. Initial funds came from Rotary's local and national groups, the Ronald McDonald House and county District Attorney Stephen Zappala, who was co-chairman with the late Pittsburgh Mayor Bob O'Connor of the task force that formed Cribs for Kids.

Ms. Bannon announced this week new funding from the Highmark Foundation: A grant of $213,000 over three years to fund a community services coordinator for southwestern Pennsylvania, starting in February. The job will be to establish Cribs for Kids in underserved counties.

"It's the hand of God that keeps us going," Ms. Bannon said.

A new grandmother herself, she regularly attends national conferences talking about Cribs for Kids. When government and health agencies ask about Cribs for Kids, she offers help and hands out the curriculum, along with a license agreement.

"That way, we know who's out there, that they're doing it according to our guidelines," Ms. Carlins said.

Personal loss

Ms. Carlins and Ms. Bannon agree that their work is not a job, it's a vocation. Their family members all volunteer for SIDS of PA.

Among the 20 or so volunteers are parents who have lost a child to SIDS. That includes Ms. Carlins and her husband, Daniel, who lost their second child, Rachel, 25 years ago, when she was 2 months old.

"I laid her down for a nap, 10 minutes later she was dead. ... Your life can take a different direction," she said. She was a stay-at-home mom at the time and she and her husband joined a SIDS support group.

"It gives you hope that you can survive it," she said, and so she became a peer contact, then a coordinator, then went back to get her master's degree in social work and was hired by SIDS of PA in 2002. She's had four children: Matthew, Rachel, Sarah and Emily. A family portrait drawn by one child in the family includes Baby Rachel, floating on a cloud above the others.

"The baby is seemingly healthy," Ms. Carlins explained. "It's such a shock. It's a different kind of grief, parents grieve forever."

She gave this advice for concerned friends who want to help grieving parents: "The best thing you can do is acknowledge their grief, be there with your presence and listen, listen, listen."

When she talks to groups, she shows them a quilt, stitched with squares from grieving families to commemorate lost children. Mayor O'Connor was chairman of the SIDS board when he died. He had a niece who died of SIDS and she has a square in the quilt.

Ms. Carlins credits Ms. Bannon with the hard work it took to iron out details of the Cribs for Kids program over the years, finding the right product, the right distribution system. Ms. Bannon credits Ms. Clemons for her attention to detail.

"We're inventing it as we go along," Ms. Carlins said. "We learn from our mistakes and pitfalls. We now have a program in place. We went to New York and felt if we can do it there, we can do it everywhere." The New York City Department of Health expects to distribute 5,000 cribs in its first year.

Ms. Carlins said her job of educating people about SIDS and accidental suffocation continues:

"SIDS will happen. But there are things you can do to reduce the risk."

More information is available at these Web sites:

Cribs for Kids in Pennsylvania: http://www.sids-pa.org/SIDS-CRIBS.htm

Cribs for Kids in other states: http://www.cribsforkids.org/cribs-contact.htm

For links to other SIDS-related Web sites: http://www.sids-pa.org/SIDS-LINKS.htm