1. Why do we need to train childcare providers in the Back to Sleep campaign and SIDS?

2. Rachel Moon, MD Children’s National Medical Center Washington, DC

3. The challenge of child care 2/3 of US infants under the age of 1 year are in non-parental child care Infants of employed mothers spend an average of 22 hours each week in child care 32% of infants are in child care full time <9% of SIDS should occur in child care - Ehrle, Adams, Tout, 2001

4. The challenge of child care 20.4% of SIDS occurs in child care (1995- 1997) 1 –60% of these occur in family child care –20% of these occur in child care centers Infants tend to be Caucasian, with older, more educated parents who succumb to SIDS in daycare 1 Moon, Pediatrics 2000

5. Pre-AAP recommendation Post-AAP BTS Campaign Sleep Position Source: NICHD Household Survey SIDS Rate Source: National Center for Health Statistics, CDC

6. Why do infants die in child care? Approximately 1/3 will die in the first week in child care, 1/2 of these on the first day Something intrinsic to child care?? Unaccustomed prone sleeping

7. The dangers of unaccustomed prone sleeping Increased risk (19.3 times)* Secondary caregivers may change the position Less ability to lift head when prone Later development of upper body strength *Mitchell and Thach, Arch Pediatr Adol Med, 1999

8. Risk of SIDS vs. sleep position

9. Why do child care providers place babies prone? Lack of awareness –25% of licensed CCC have never heard of the relationship between SIDS and sleep position Misconceptions about risks of sleep position –Supine and aspiration, choking –Emphasis on infant comfort Parental preference –Lack of information –Lack of empowerment

10. Why is legislation or regulation important ?

11. We need to change the statistic ! Communication Education Empowerment

12. Legislation/regulation is effective Communication –Promotes discussion between provider and parent Education –Child care providers are more likely to follow safe sleep guidelines if regulations/legislation exists –Continual education required, because of staff turnover Empowerment –Provides resources for providers to use

13. Standards for safe sleep Back sleeping only in safety-approved crib No soft or loose bedding No sharing of cribs No smoking Supervised tummy time while awake Only exception: written note from child’s physician –Caring for Our Children -- National Health and Safety Performance Standards: Guidelines for Out-of- Home Child Care Programs (AAP and Am Public Health Assoc), 2nd edition

14. State regulations in 2003 9 states mandate nonprone sleeping for infants: –Alabama, Alaska, Arkansas, Colorado, Georgia, Illinois, Iowa, Mississippi, NJ, NY, Ohio,OK Utah, Virginia, Vermont 3 additional states mandate nonprone sleeping in family child care homes: –Maine, Oregon, Washington Child care centers in 41 states and family child care homes in 38 states have no regulations!

15. Other sleep environment regulations-2002 63% of states require cribs to meet at least 1 safety standard 11 prohibit soft bedding (primarily pillows; also comforters): –AL, CO, GA (FCCH), HI (CCC), ME (CCC), MA, NE (FCCH), GA, NM, OK, VA, VT All but 3 states (DC, Indiana, Idaho) have some regulations restricting smoking

16. Disadvantages of legislation or regulation Individual freedom –Some people are still skeptical about the safety and effectiveness of placing babies on their backs Difficulty of enforcing

17. Advantages of legislation or regulation No cost Places a priority on the safety of infants It will save lives!!!!!

18. Help us change the statistic!