Infant/Toddler Safe Sleep & SIDS Risk Reduction in Child Care NEWSLETTER

Association of SIDS and Infant Mortality Programs (ASIP) Conference

SIDS and Infant Mortality Research

According to Marian Willinger, PhD, Special Assistant for SIDS at the National Institute of Child Health and Human Development (NICHD), the past 30 years have been marked by a paradigm shift and changes in strategies aimed at lowering infant deaths. For example, back in 1970, interventions to reduce SIDS were applied after the baby was born. Today, the time to begin reducing SIDS risks has shifted to the prenatal period in the belief that SIDS babies are more likely to be exposed to adverse conditions in utero. Dr. Willinger indicated, "vulnerability for SIDS originates during pregnancy."

Researchers suspect that many SIDS babies have structural and chemical abnormalities in the parts of their brain that control the heart, breathing and arousal from sleep. As a group, SIDS babies may have an autonomic nervous system that does not function properly. This dysfunction may be detected in the newborn period. Current research into the causes of SIDS is focusing on infant sleep behaviors and challenges (see previous ITS-SIDS newsletter Vol. 3 No.4), the causes of stillbirth, circumstances surrounding stillbirth, and child health within the community context. For example, the relationship between stillbirths and SIDS is being studied at the community level examining the impact of prenatal exposure to alcohol. Research into the causes of SIDS has expanded to encompass genetic factors such as the mother's ability to metabolize alcohol and how chemicals are transmitted between genes (neurotransmission).

North Carolina currently plays an important role in unraveling the mysteries of infant deaths and SIDS. The University of North Carolina is one of five clinical study sites for the NICHD's Stillbirth Research Collaborative Network (2003-2008). The Research Triangle Institute serves as the data site for this longitudinal study. In another study, the NICHD's Community Health Research Network is a multi-site, multi-level study about how community, family and individual influences interact with biological influences that result in health disparities in pregnancy outcomes and infant death and illness. The Healthy Start Baby Love Plus Consortium in eastern North Carolina participates in this study of inter-conception and preconception health and the role of stress in pregnancy and pregnancy outcomes.

Statistics

Our country has made progress combating SIDS during the past three decades. In 1982, SIDS was the second leading cause of infant deaths (12%) and by 2002 SIDS dropped to the third major cause (8%) preceded by birth defects (20%) and by preterm/low birthweight (17%). Since 1970 our nation has seen a 65% decrease in infant mortality with more than a 50% drop in SIDS deaths and fewer deaths due to birth defects and respiratory distress syndrome (RDS). Significant improvements have been made in the survival of preterm and low birthweight infants.

Challenges in combating infant mortality persist. National and statewide attention has turned to the large racial disparity in pregnancy and infant outcomes like pre-term and low birthweight births (risk factors for SIDS), fetal deaths and SIDS.

American Academy of Pediatrics

The ASIP Conference also included an overview of challenges facing the American Academy of Pediatrics (AAP) Task Force on SIDS and Infant Sleep Position as they revise the Academy's position statement. The AAP is expected to release their position statement following a more intensive review of the infant/parent cosleeping research. Rachel Moon, MD, a task force member, reported on the shift in diagnostic coding for SIDS over the past five years, issues surrounding the infant sleep environment including advantages and disadvantages of bedsharing among parents and infants, and the sleep positioning of infants in Neonatal Intensive Care Units and well baby nurseries. She reminded attendees that "risk does not denote causality" and that efforts to lower SIDS "should not focus on a single risk factor." Recommendations from the task force are likely to include continuing the Back To Sleep Campaign aimed at secondary caretakers (caretakers other than parents such as family members and childcare providers) and African-American and American Indian/Alaska native populations, groups who experience SIDS more often.

Editor's Note: The ITS-SIDS Project will alert trainers to the AAP statement when it is made public.

Q&A - Answers to Your Questions

Infant Sleep Place - Difference between Centers and Family Child Care Homes

Q: I am confused ... I went to the DCD web site to look at the regulations regarding SIDS and I didn't see the crib, bassinet reference, yet it is listed in the rules summary on the N.C. Healthy Start website. So which is correct?
A: Both websites are accurate, read on! There is a difference in the safe sleep policy licensing rules for both the CENTERS and for OPERATORS in Family Child Care Homes (FCCH) when it comes to sleeping environments. Centers' rules do not include the crib, bassinet, play pen provision (see10A NCAC 09.0606 SAFE SLEEP POLICY) while Operators rules do include a reference to cribs, bassinets, playpens (see #2 in section 10A NCAC 09.1724 SAFE SLEEP POLICY).

This means that the safe sleep policies for homes are more specific and require that children 12 months of age or under must sleep in a crib, bassinet or play pen. Once a child is older than 12 months the operator has a choice to keep the child in the crib or play pen, or transition the child onto a cot, mat or sleeping bag (.1718(3)). From the DCD web link, http://nrc.uchsc.edu/STATES/NC/nc_9.htm#pgfId-619027 scroll down to the corresponding rule numbers listed above to view the exact wording of the licensing rules. The rules summary at www.nchealthystart.org/ conveys the same information.

When conducting your ITS-SIDS training, if your audience includes providers from both centers and family child care homes please point out these differences.

In addition, sanitation rules (.2821) for centers include very specific requirements for beds, cribs, portable cribs, play pens, cots and mats that providers must comply with. The requirements also apply to the bedding and how often it must be laundered. These same requirements do not apply to family child care homes.

Regulatory - Visually checking sleeping infants

Q: Is the 15 minute check on infants a required part of the child care regulations and can a center be written up for not doing that?
A: The NC childcare licensing rules require that providers "visually check" sleeping infants and that this be part of their written safe sleep policy. A time frame for visually checking was not specified. The childcare provider must adhere to the time frame he/she specifies in his/her own safe sleep policy. Providers must also state how they will visually check and they must maintain a written record of the information such as a sleep chart. They must retain this sleep record for 30 days after the month of the reporting period. These requirements pertain to infants 12 months of age or younger. The licensing consultants will compare the provider's policy (what they said they were going to do) with their sleep log/chart (how they are documenting and how frequently) to assess providers' compliance with their own policy.

So, no, the 15 minute timeframe is not required - the providers must decide on their schedule to visually check sleeping infants. Visually checking every 15-20 minutes is a good rule of thumb and a reasonable best practice.

Resources for Parents and Providers:

New SIDS risk reduction educational tools available on-line. Three brochures produced by the American Academy of Pediatrics' Healthy Child Care America Back to Sleep Campaign provide SIDS risk reduction information for childcare providers and parents. Click on the links below to view and download:
" A Child Care Provider's Guide to Safe Sleep presents data and information about SIDS and safe sleep practices - http://www.healthychildcare.org/pdf/SIDSchildcaresafesleep.pdf.
" A Parent's Guide to Safe Sleep includes information about working with child care providers to ensure that safe sleep practices are used both at home and in child care settings - http://www.healthychildcare.org/pdf/SIDSparentsafesleep.pdf.
" Tummy Time contains information about the importance of allowing infants to spend supervised time lying or playing on their stomachs - http://www.healthychildcare.org/pdf/SIDStummytime.pdf.

Portable cribs product recall. On March 9, 2005, the Consumer Product Safety Commission issued a recall on portable cribs made by Delta Enterprise Corporation of New York, N.Y. Crib slats can separate from the headboard posing an entrapment hazard or children could fall through the slat opening. For more information about this recall visit: http://www.cpsc.gov/cpscpub/prerel/prhtml05/05131.html

Cover the Uninsured Week - May 1-8, 2005: You can be part of the solution to get kids covered!
Fortunately many members of the childcare community are helping to enroll the children they serve in our state's child health insurance programs - Health Check (Medicaid) and NC Health Choice. By providing a FACT SHEET and APPLICATION FORM to families whose children are uninsured, you are giving families everything they need to get started. To find out more about Health Check (Medicaid) and NC Health Choice, and learn how you can participate and access free materials, click here, www.nchealthystart.org or call 1-800-367-2229. To find out more about Cover the Uninsured Week events, visit www.covertheuninsuredweek.org.

ITS-SIDS trainers continue to surpass expectations! In just two years since the ITS-SIDS trainings began, a record number of 28,080 childcare providers statewide had received ITS-SIDS training as of March 31. A total of 1,562 trainings have been scheduled or completed during that time. Over the past three months of Phase 3B, ITS-SIDS trainers collectively trained 2,809 providers and scheduled or completed 223 trainings. Kudos!

Phase 1 - 11,162 childcare providers; 591 trainings scheduled or completed
Phase 2 - 10,906 childcare providers; 587 trainings scheduled or completed
Phase 3A - 5,030 childcare providers; 296 trainings scheduled or completed
Phase 3B - 982 childcare providers; 88 trainings scheduled or completed