| SIDS Research - Back to Sleep: Can We Influence Child Care Providers? |
| WHAT IS SIDS? Sudden Infant Death Syndrome (SIDS) is the sudden and unexplained death of a child under one year of age. Twenty percent of SIDS deaths occur in child care settings. In California, 10.1% of babies who die of SIDS do so while under the care of a child care provider. Despite a nearly 50% decrease in SIDS deaths nationally since 1992, the rate of SIDS in child care has not changed. Many of these child care deaths are associated with sleeping on the stomach, especially when the infant is unaccustomed to being placed in that position. This is particularly concerning, as we know that unaccustomed stomach sleeping increases the risk of SIDS 18-fold. However, many child care providers continue to place infants on the stomach. Studies of child care centers have shown that 20-25% of centers continue to place infants prone for sleep. Child care providers place infants on the stomach because they are unaware of the danger of sleeping on the stomach and/or are misinformed as to the risks and benefits of the various sleep positions. For instance, providers may be worried that a back sleeper is more likely to choke or aspirate if s/he spits up. Providers are more likely to report using the supine position when centers have written sleep policies. However, most states, including California, have no regulations or laws requiring back sleeping for babies in child care. We (Washington, DC) therefore designed a 60 minute educational intervention for child care providers. Our goal was to determine whether such an intervention is effective in 1) providing information and understanding about SIDS risk reduction practices, 2) changing child care provider behavior, and 3) promoting development of written sleep position policies. The in-services were led by a trained health educator and were offered to child care providers through a collaboration with the Office of Early Childhood Development, which is the licensing agency for child care providers in Washington, DC. All providers who attended the in-service were asked to complete surveys before and after the in-service. We then called the child care centers where the participating providers worked and interviewed the directors of the centers. A total of 96 child care providers attended the educational in-service. The percentage of providers who were using the back position exclusively doubled from 44.8% (before in-service) to 85% (six months after the in-service). The percentage of providers who knew that the American Academy of Pediatrics recommends the back as the preferred position for healthy infants increased from 18.8% to 44.4%. This last result is especially important, as child care providers are much more likely to place infants supine and practice other safe sleep behaviors when a written policy is in effect in the center. We know that many people are working hard to educate child care providers about the importance of a safe sleeping environment for babies. Our study indicates that these efforts are effective in changing a child care provider’s knowledge and behavior. We hope that these efforts will be reflected in our follow up analysis of SIDS in child care. We are currently collecting data on SIDS deaths from 2001 to see if there has been a decrease in SIDS in child care. California is participating in this study and we hope that it will demonstrate that education about SIDS risk reduction efforts has made a difference in this population.
California SIDS Program Rachel Y. Moon, MD, Division of General and Community Pediatrics, Children’s National Medical Center Associate Professor of Pediatrics, George Washington University School of Medicine and Health Sciences. References cited in this article are available upon request from the California SIDS Program. |
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