6/12/2014 REDUCING THE RISK OF SIDS Presented by: REDUCING THE RISK OF SUDDEN INFANT DEATH IN CHILD CARE Prevention through the Promotion of a Healthy Sleep Environment in Child Care Settings Adapted from Copyright © 2004 American Academy of Pediatrics

6/12/2014 What Is Sudden Unexpected Infant Death (SUID)? SIDS is the unexpected death of seemingly healthy babies 12 months or younger No cause of death is determined by –Death scene investigation or autopsy –Review of babys medical history –SUID means a likely cause of death was determined by death scene investigation: bedsharing, unsafe sleep, accidental suffocation much more common Experts cannot predict which infants will die from SIDS or SUID, although some babies are at greater risk 140 SUIDs in Virginia in 2009

6/12/2014 Healthy Child Care America Back to Sleep Campaign Launched in 2003 Activities –Increase awareness –Decrease incidence –Educate policy makers to include back-to- sleep positioning in child care regulations

6/12/2014 SIDS and Child Care Two thirds of US infants younger than year are in non-parental child care Infants of employed mothers spend an average of 22 hours per week in child care 32% of infants are in child care full time. Less than 9% of SIDS deaths should occur in child care –Ehrle et al, 2001

6/12/2014 SIDS in Child Care 20.4% of sudden infant deaths occurred in regulated child care (1995–1997) –60% in family child care –20% in child care centers Infants tended to be white with older, more educated parents –Moon et al, 2000 Now, 18% of sudden infant deaths deaths occur in child care thanks to improved education and training and licensing requirements begun in 2003

6/12/2014 SIDS in Child Care Approximately 1 / 3 of SIDS-related deaths in child care occur in the first week, 1 / 2 of these on the first day Something intrinsic to child care? No Unaccustomed tummy sleeping? Yes Stress!

6/12/2014 Unaccustomed Tummy Sleeping Increased risk of SIDS (19.3 times) Non-parental caregivers may use tummy sleeping without parental knowledge Less ability to lift head in tummy position Later development of upper body strength –Mitchell et al, 1999

6/12/2014 Goal To improve sleep environment which may reduce the number of infants dying of SUID in child care settings

6/12/2014 SUID Facts Over 4500 babies died of sudden unexpected infant death each year for the past 10 years It is the leading cause of death for babies from 1 to 12 months of age Highest number is at 2 to 4 months; 91% occur between 1 to 6 months of age Seasonal trend: there are more SUID deaths in winter months More male babies die of SUID Unaccustomed tummy sleeping increases risk of dying by 18 to 20 times

6/12/2014 SIDS Facts The exact causes of SIDS are unknown, but SIDS is NOT: -Caused by immunizations -The same thing as suffocation, but the distinction on autopsy is impossible to make -Caused by vomiting or choking

6/12/2014 Modifying SUID Risks Risks that can be modified Risks that cannot be modified Easy and free placing babies to sleep on their backs on a firm surface that is intended for infant sleep

6/12/2014 SIDS Rate and Sleep Position SIDS rates have decreased and percent of back sleeping has increased since the campaign began. Over 30,000 babies lives have been saved by Back to Sleep since 1993!

6/12/2014 Babies at Risk for SUID African Americans (3x greater risk) American Indians (more than 3x greater risk) Mothers who smoke during pregnancy (3-4x greater risk) Babies who breathe secondhand smoke (2.5x greater risk) Babies who sleep on their tummies (5x greater risk) Babies put on their tummies to sleep who usually sleep on their backs (18–20x greater risk)

6/12/2014 Why Dont People Put Babies to Sleep on Their Backs? Lack of awareness –25% of licensed child care providers say they never heard of the relationship between SIDS and sleep position Misconceptions about risk of sleep position –Supine and aspiration, choking –Belief that tummy sleeping improves infant comfort Parental preference –Lack of information –Lack of education

6/12/2014 Standards for Licensed Child Day Centers (22 VAC ) When an infant is placed in his crib, he shall be placed on his back (supine). When an infant is able to easily turn over from the back to the belly position… he shall still be put on his back but allowed to adopt whatever position he prefers. Resting or sleeping infants shall be individually checked every minutes

6/12/2014 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 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

6/12/2014 Implementing SIDS Risk Reduction Remember, tummy to play and back to sleep Use safe sleep practices Provide a safe sleep environment Provide a smoke free environment

6/12/2014 Tummy to Play and Back to Sleep Supervised tummy time when babies are awake –Promotes healthy physical and brain development –Strengthens neck, arm, and shoulder muscles Back to sleep –Reduces the risk of SIDS –Comfortable and safe

6/12/2014 Safe Sleep Practices Always put healthy babies to sleep on their backs Avoid overheating –Never cover babys head with a blanket. –Keep room temperature at 68°F to 72°F –Do not overdress baby Never have more than one baby per crib

6/12/2014 Bed Sharing or Co-sleeping Adults, children, or siblings should avoid bed sharing with an infant Adults who choose to bed share with an infant should not smoke or use substances that impair arousal The weight of the dads arm can prevent the baby from breathing Better to have baby sleep in own crib, bassinet or pack n play next to parent, not in same bed

6/12/2014 Safe Sleep Environment Safe crib, firm mattress Avoid chairs, sofas, and water beds No excess bedding, comforters, or pillows No toys or stuffed animals in crib Bumper pads and wedges ARE NOT needed and may cause suffocation.

6/12/2014 Benefits of a Safe Sleep Policy May save lives of babies Shows parents babys health and safety is your #1 priority Educates staff –Consistent care –Educate parents –Professional development If followed, may help to reduce your risk of liability Part of both licensing regulations and national standards

6/12/2014 Elements of a Safe Sleep Policy Healthy babies always sleep on their backs Obtain physicians note for non–back sleepers Use safety-approved cribs and firm mattresses Sleep only one baby per crib

6/12/2014 Elements of a Safe Sleep Policy Crib will be free of toys, stuffed animals, and excess bedding Blankets and bumper pads should not be used Provide a smoke free sleeping environment Follows Virginia Standard for Licensed Child Day Center 22 VAC

6/12/2014 Elements of a Safe Sleep Policy Room temperature is 68°F to 72°F Monitor sleeping babiesUse your eyes, not just an electronic monitor Have supervised tummy time for awake babies Teach staff about safe sleep policy and practices Provide parents with safe sleep policy

6/12/2014 Alternate Sleep Position Require written and signed physicians note –Identifies medical reason why baby sleeps in position other than on back. Note must be from babys physician Inform all child care providers and substitutes Keep physicians note in babys medical file and post notice on crib Refer to 22 VAC for regulation requirements in Virginia

6/12/2014 Legal Considerations Litigation –Wrongful death –Loss to society –Neglect –Breach of contract between parents and provider Back to sleep = STANDARD OF CARE 22 VAC – licensing requirement for licensed child day centers

6/12/2014 Handling Parents Concerns Discuss SIDS and safe sleep with parents You are the professional they see most often Discuss sleep position policies Discuss medical waiver and implications

6/12/2014 What We Need to Do Implement and follow state licensing regulations and the National Health and Safety Performance Standards (Caring for Our Children) Develop relationship with local rescue squad and post phone number in classrooms Develop relationship with a child care health consultant – for info on finding a CCHC, contact Healthy Child Care Virginia at or (804) Be aware of bereavement resources SIDS Mid Atlantic - or Betty at www.sidsma.org

6/12/2014 Handling a Medical Emergency Have an Emergency Preparedness plan in place ( for link to free VDH publication, It Pays to Prepare) Review the plan monthly Be sure you have CPR and first aid trained staff

6/12/2014 Handling a Medical Emergency of an Unresponsive Infant Check for responsiveness of infant Initiate emergency plan –Call 911 –Initiate CPR/rescue breathing **There must be at least one staff present with children who is certified in age appropriate first aid, CPR and rescue breathing. Course must be AHA, Red Cross or National Safety Council approved, or receive approval by Dept. of Social Services** (22 VAC )

6/12/2014 Handling a Medical Emergency of an Unresponsive Infant (cont) 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 Notify licensing agency and insurance agency

6/12/2014 Family and Provider Support after a SIDS event 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 for families and children National Health and Safety Performance Standards: Caring for our Children, 2 nd Ed.)

6/12/2014 What to expect when a child dies in child care 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

6/12/2014 What to expect when a child dies in child care (cont) Licensing agency –Questions about licensing regulations –SIDS death is not a cause for revoking a license Coroner/medical examiner –Conducts autopsy –Determines circumstances of death

6/12/2014 In the news – recent findings Researchers continue to study the correlation between the SIDS and: Smoking Altering Sleep Environment Serotonin Levels found in SIDS children

6/12/2014 Resources National Resource Center for Health and Safety in Child Care – nrc.uchsc.edu – 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) – Healthy Kids, Healthy Care – SIDS Risk Reduction

6/12/2014 Resources Virginia Department of Health, Healthy Child Care Virginia Program (804) Virginia Department of Social Services, Division of Licensing Programs Local Community Service Boards (CSB) and Rescue Squads - may offer mental health services for families and centers for local CSB directory for local rescue squad directory

6/12/2014 Partners and Resources National Institute of Child Health and Human Development Back to Sleep campaign –800/505-CRIB (2742), CJ Foundation for SIDS –888/8CJ-SIDS ( ),

6/12/2014 Providing Emotional Support to surviving children, families and providers Support SIDS Mid-Atlantic or or First Candle/SIDS Alliance: 24 hour hotline 1314 Bedford Ave, Suite 210 Baltimore, MD Phone: 800/ or 410/ Fax: 410/ Web site:

6/12/2014 Healthy Child Care America Back to Sleep Campaign American Academy of Pediatrics 141 Northwest Point Blvd Elk Grove Village, IL –Phone: 888/ or 847/ –Fax: 847/ – –Web site:

6/12/2014 A Child Care Provider's Guide to Safe Sleep (Healthy Child Care America Back to Sleep Campaign) A Parent's Guide to Safe Sleep (Healthy Child Care America Back to Sleep Campaign) Back to Sleep, Tummy to Play (Healthy Child Care America Back to Sleep Campaign) Additional Resources

6/12/2014 Additional Resources Consumer Product Safety Commission Resources on Safe Sleep and Crib Safety e.HTML SIDS Network (materials in multiple languages) e.HTML

6/12/2014 Summary What SIDS is and is NOT SIDS risk factors Reducing the risk State Licensing Requirements and National Health and Safety Performance Standards Handling a medical emergency Current research and resources for more information

6/12/2014 Faces of SIDS - Thank you to those families who have shared photos of their children

6/12/2014 Acknowledgments Betty Connal, Executive Director SIDS Mid-Atlantic Bethany Geldmaker, PhD Claire Wood, RN, Child Care Health Consultant Healthy Child Care Virginia Virginia Department of Health