REDUCING THE RISK OF SIDS IN CHILD CARE Based upon the research of and information provided by Revised – 06/12

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

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. Revised – 12/08

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.” Revised – 12/08

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. Revised – 12/08

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. Revised – 12/08

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. Revised – 12/08

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 Revised – 12/08

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. Revised – 12/08

What SIDS Is Not It is not caused by immunizations. It is not caused by vomiting or choking. Revised – 12/08

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! Revised – 12/08

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. Revised – 12/08

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. Revised – 12/08

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. Revised – 12/08

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 child’s physician must provide written orders to the child care center! Revised – 12/08

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. Revised – 12/08

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. Revised – 12/08

Caring for Our Children: National Health and Safety Performance Standards—2002 Standard 3.008: Scheduled Rest Periods and Sleep Arrangements Supine (back) sleep position for babies Physician’s 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 Revised – 12/08

Reducing the Risk Blankets are never used to cover a baby’s 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. Revised – 12/08

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 The mattress should fit snugly in the crib and the sheet must be a fitted sheet. Revised – 12/08

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! Revised – 12/08

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 infant’s assigned crib.

Revised – 12/08 When Babies Sleep at a PCA School 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.

Revised – 12/08 The Role of the Infant Nursery Staff While Babies Sleep Will visually check sleeping infants every 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 infant’s 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

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 body’s temperature also controls breathing. Babies sleep well in a cool environment (68°F) Revised – 12/08

Reducing the Risk Keep the environment smoke- free! Infants should never be exposed to smoke. Second-hand smoke is dangerous too. Revised – 12/08

Reducing the Risk Maintain air circulation in the sleeping environment Revised – 12/08

Safe & Comfortable Sleeping Revised – 12/08

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 baby’s breathing and coloring.! All staff, substitutes and volunteers are informed about / trained in Safe Sleep Policy and practices Revised – 12/08

Many PCA schools have a Safe Sleep Policy which parents and staff sign Revised – 12/08

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 Revised – 12/08

Tummy Time Revised – 12/08 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 baby’s Daily Report.

First Aid—Unresponsive 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 child’s parents or emergency contact. Call the parents of the other children. Do not disturb the scene (e.g., don’t try to tidy up). Notify licensing agency and insurance agency. Revised – 12/08

What to Expect if a Baby Dies Investigation –Several people will ask for the same information so they can help Law enforcement –Note baby’s health, behavior, etc. –Take photos. –Limit disturbance of the area Revised – 12/08

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. Revised – 12/08

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. Revised – 12/08

Healthy Child Care America Back to Sleep Campaign American Academy of Pediatrics 141 Northwest Point Blvd Elk Grove Village, IL –Phone: 888/ –Fax: 847/ – –Web site: Revised – 12/08

Partners and Resources Back to Sleep campaign – –Phone: CRIB (2742) –You can receive informational brochures, posters to provide to families and child care providers Revised – 12/08

Partners and Resources First Candle/SIDS Alliance –1314 Bedford Ave, Suite 210, Baltimore, MD –Phone: 800/ or 410/ –Fax: 410/ – –Web site: National SIDS and Infant Death Program Support Center –112 E Allegan, Suite 500, Lansing, MI –Phone: 800/930-SIDS or 800/ – –Web site: Revised – 12/08

Licensing Requirements National Resource Center for Health and Safety in Child Care and Early Education (NRC) – – 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) – Colorado State Licensing information Revised – 12/08

Practice Scenarios 4 scenarios that child care providers may encounter in their workplace Revised – 12/08

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 don’t want to worry about my baby spitting up and it going down the wrong way.” What do you do? Revised – 12/08

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? Revised – 12/08

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? Revised – 12/08

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