REDUCING THE RISK OF SIDS IN CHILD CARE

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REDUCING THE RISK OF SIDS IN CHILD CARE

• Based upon the research of and information
  provided by

Revised 06/12
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Healthy Child Care America Back to Sleep Campaign

• Launched in 2003
• Activities
• Increase awareness
• Decrease incidence of SIDS in child care
• Educate policy makers to include Back-to-Sleep
  positioning in child care regulations.

Revised 12/08
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• Numerous sources were used for developing this
  course revision.
• An important source was the 2012 Safe Sleep
  Practices and SIDS / Suffocation Risk Reduction.
  This report should be in all licensed childcare
  centers. It is a joint collaboration between
  AAP (American Academy of Pediatrics), APHA
  (American Public Health Association), National
  Resource Center for Health and Safety in Child
  Care and Early Education. Additional information
  was provided by the Maternal and Child Health
  Bureau, the Health Resources and Services
  Administration and the U.S. Department of Health
  and Human Services.

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What is Sudden Infant Death Syndrome (SIDS)?
From the U.S. Department of Health and Human
Services and the Eunice Kennedy Shriver National
Institute of Child Health and Human Development

• Definition The sudden death of an apparently
  healthy infant, usually between two weeks and one
  year of age, which usually occurs during sleep.
  It is unexpected from the medical history and
  remains unexplained after a thorough autopsy and
  study of the circumstances of death.

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SIDS Facts

• More boys (60) die of SIDS than girls.
• Death is sudden and unpredictable.
• It appears to be painless and occurs most often
  during sleep. There are some cases of infants
  dying while awake.

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SIDS Fact

• In most cases the baby appears healthy.
• Some infants will have signs of a cold just
  before death but this is not a precursor of SIDS.
  There appears to be a seasonal affect more
  babies die in winter, fall and spring.

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SIDS Facts

• The major cause of death in infants between two
  weeks and one year of age.
• The baby is not a victim of a rare disease. In
  the U.S., nearly 2,500 babies die each year from
  SIDS (NICHD 2010). This is about one death
  every 3 hours.
• SIDS deaths have decreased by nearly half from
  1990 to 2010 due to public awareness.

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SIDS Facts

• Occurs in families of all social and economic
  backgrounds.
• Is as least as old as the Old Testament and seems
  to have been as frequent in the 18th and 19th
  centuries as it is now.
• Researchers believe that SIDS probably has
  multiple causes with the final process of death
  resulting in respiratory failure

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What Does the Evidence Show

• Many SIDS infants are born with brain
  abnormalities that cause a vulnerability to SIDS.
  
• They are found in the arcuate nuclei which
  control the major bodily functions
• heart rate
• respiration
• temperature
• the ability to awaken.
• This is merely a suggestion at this time.

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What SIDS Is Not

• It is not caused by immunizations.
• It is not caused by vomiting or choking.

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SIDS in Child Care

• Approximately one third of SIDS-related deaths in
  child care occur in the first week
• Half these occur on the first day!

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Development Matters

• By 6 months
• Head and neck control aid baby when she rolls
  over autonomously during sleep.
• Body temperature controls located in the brain
  are well developed.

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Reducing the Risk of SIDS

• After 50 years of research, there is no
  definitive cause of SIDS. There is no way to
  predict it, but there are ways to help reduce the
  risk of its occurrence.

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Back-To-Sleep Campaign

• an educational campaign that recommends
  caregivers always place infants under the age of
  1 year on their backs to go to sleep.
• The infants may roll over on their own and
  self-determine how they end up sleeping.
• This sleeping position has brought about a
  significant reduction in SIDS deaths.

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More Ways to Reduce the Risk

• Caregivers are required to place babies under 1
  year of age on their backs to sleep
• If there is a health reason for not placing the
  child on its back to sleep, the childs physician
  must provide written orders to the child care
  center!

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Reducing the Risk

• Babies are to sleep ONLY in cribs!
• Babies may not be put to sleep on their side.
• Infants may not be propped with wedges or any
  other item
• This information is shared with parents.

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Safe Places to Sleep

• The safest place for a baby to sleep is in a
  separate sleep surface (bassinet, crib, cradle)
  in a supine position.
• Unsafe sleep surfaces include car seats, swings,
  bouncy seats.

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Caring for Our Children National Health and
Safety Performance Standards2002

• Standard 3.008 Scheduled Rest Periods and Sleep
  Arrangements
• Supine (back) sleep position for babies
• Physicians note if position other than back
  (that includes medical reason)
• Babies placed on back, but when able to turn
  over, allowed to adopt whatever position they
  prefer to sleep
• Positioning devices not to be used, unless
  specified by a physician

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Reducing the Risk

• Blankets are never used to cover a babys face to
  block sun, weather or noise. This can cause an
  accumulation of exhaled air which does not
  contain enough oxygen which may lead to either
  SIDS or suffocation.
• If a blanket is used in a crib, either the feet
  to foot rule is followed or sleep clothing is
  used. The face is never covered.

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Reducing the Risk

• A firm mattress is used in a crib that meets the
  safety standards of Consumer Protection Safety
  Commission.
• The crib must have been manufactured after June
  2011.
• The mattress should fit snugly in the crib and
  the sheet must be a fitted sheet.

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Reducing the Risk

• Keep cribs free of all blankets, comforters,
  pillows and stuffed animals.
• Bumper pads, heavy comforters and pillows are
  never used.
• Within the next year, Colorado licensing
  requirements will prohibit the use of blankets in
  cribs!

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When Babies Arrive at a PCA
Location

• If an infant arrives at the facility asleep in a
  car safety seat, the parent/guardian or caregiver
  will immediately remove the sleeping infant from
  this seat and place them in the supine position
  in the infants assigned crib.

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When Babies Sleep at a PCA
Facility

• Infants cannot and may not nap or sleep in a car
  safety seat, bouncy seat, swing, jumping chair,
  play pen or highchair while in our care.
• If an infant falls asleep in any place that is
  not a safe sleep environment, the staff will
  immediately move the infant and place them in the
  supine position in their crib.

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The Role of the Infant Nursery
Staff While Babies Sleep

• Will visually check sleeping infants
  every 15-20 minutes.
  Sleep
  information will be
  accurately recorded on
  Daily Note.
• Will be especially alert to monitoring a sleeping
  infant during the first weeks the infant is in
  child care.
• Will check to see if the infants skin color is
  normal, watch the rise and fall of the chest to
  observe breathing and look to see if the infant
  is sleeping soundly. The infant will be checked
  for signs of overheating including flushed skin
  color, body temperature by touch and
  restlessness.
• Will ensure the sleeping area is properly
  illuminated. Infants do not require a dark
  and quiet place for sleep. Once they become
  accustomed, infants are able to easily sleep
  without problems in environments with light and
  noise. Caring for Our Children

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Reducing the Risk

• Avoid overdressing or overheating the baby.
• Hyperthermia may be one cause of SIDS. The part
  of the brain that helps control the bodys
  temperature also controls breathing.
• Babies sleep well in a cool environment (68F)

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Reducing the Risk

• Keep the environment smoke-free!
• Infants should never be exposed to smoke.
  Second-hand smoke is dangerous too.

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Reducing the Risk

• Maintain air circulation in the sleeping
  environment

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Safe Comfortable Sleeping

• Firm mattress
• with tight-fitting sheet
• If used, a blanket is tucked in at the
• foot of the crib along its sides

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Safe Sleep Policy According to American Academy
of Pediatrics

• The temperature in the room is comfortable for a
  lightly clothed adult.
• The baby is placed in a supine position in the
  crib. Blanket use is discouraged.
• Sleeping babies are monitored. Enough light is
  available to view a babys breathing and
  coloring.!
• All staff, substitutes and volunteers are
  informed about / trained in Safe Sleep Policy and
  practices

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PCAsSafe Sleep Policy
All Parents and Staff Will Sign
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When Babies Are Awake

• Supervised Tummy Time when babies are awake is
  required because it
• Promotes healthy physical and brain development
• Strengthens neck, arm, and shoulder muscles
• Decreases risk of head flattening and balding
• Encourages bonding and play between the
  supervising adult and the baby

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Tummy Time

• Must occur 2 to 3 times a day.
• The amount of tummy time per day should be
  increased as the baby gets stronger.
• Caregivers should
  document this time on the babys Daily
  Report.

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First AidUnresponsive Infant

• Teaching resuscitation skills is beyond the scope
  of this workshop. You must first practice
  resuscitation on a mannequin.
• Call 911.
• Get help to care for the other children.
• Call the childs parents or emergency contact.
• Call the parents of the other children.
• Do not disturb the scene (e.g., dont try to tidy
  up).
• Notify licensing agency and insurance agency.

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What to Expect if a Baby Dies

• Investigation
• Several people will ask for the same information
  so they can help
• Law enforcement
• Note babys health, behavior, etc.
• Take photos.
• Limit disturbance of the area

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What to Expect if a Baby Dies

• Licensing agency
• Questions about licensing regulations.
• SIDS death not a reason for revoking a license.
• Coroner/medical examiner
• Conducts autopsy.
• Determines cause of death.

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Caring for Our Children National Standards

• Seek support and information from local, state,
  or national SIDS organizations.
• Provide SIDS information to the parents of the
  children in the facility.
• Provide age-appropriate information to the other
  children in the facility.
• Make resources for support available to families
  and children.

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Healthy Child Care America Back to Sleep Campaign

• American Academy of Pediatrics141 Northwest
  Point BlvdElk Grove Village, IL 60007-1098
• Phone [phone]
• Fax [phone]
• E-mail childcare_at_aap.org
• Web site www.healthychildcare.org

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Partners and Resources

• Back to Sleep campaign
• www.nichd.nih.gov/sids
• Phone [phone]-CRIB (2742)
• You can receive informational brochures, posters
  to provide to families and child care providers

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Partners and Resources

• First Candle/SIDS Alliance
• 1314 Bedford Ave, Suite 210, Baltimore, MD 21208
• Phone [phone] or 410/653-8226
• Fax [phone]
• E-mail info_at_firstcandle.org
• Web site www.firstcandle.org
• National SIDS and Infant Death Program Support
  Center
• 112 E Allegan, Suite 500, Lansing, MI 48933
• Phone 800/930-SIDS or 800/930-7437
• E-mail info_at_sidsprojectimpact.com
• Web site www.sidsprojectimpact.com

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Licensing Requirements

• National Resource Center for Health and
  Safety in Child Care and Early Education (NRC)
• www.nrckids.org
• 800/598-KIDS (5437)
• Caring for Our Children National Health and
  Safety Performance Standards Guidelines for
  Out-of-Home Child Care Programs, Second Edition
  (2002)
• State-specific Licensing information

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Practice Scenarios

• 4 scenarios that child care providers may
  encounter in their workplace

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Scenario 1

• A parent of a 2 month old baby requests that the
  child sleep on the side, propped by a pillow.
  This is how they do it at home. The mother says,
  I dont want to worry about my baby spitting up
  and it going down the wrong way. What do you do?

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Scenario 2

• A parent has requested that his baby be placed on
  the stomach for naps. You showed him the policy
  that babies are to be placed on the back only
  unless there is a medical reason. He takes the
  medical waiver form to the pediatrician. The
  pediatrician signs the waiver, but does not
  indicate a medical reason. In fact, the
  pediatrician has crossed through the section that
  asks for a medical reason. What do you do?

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Scenario 3

• You have just started as a new child care
  provider in the infant nursery at Gateway. On
  your first day, you notice that all of the other
  providers are placing babies on their stomachs
  for naps. You know from your training that back
  is best. What do you do?

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Scenario 4

• There is a new baby in the infant room. She is 2
  months old. The mother tried to get the director
  to agree to put the baby on the stomach for
  sleep, since that is what they do at home. The
  director refused, and the mother finally said
  that was okay. You now place the baby on the back
  for a nap. The baby cries and refuses to go to
  sleep. What do you do?

Revised 12/08