1. Safe Sleep in Child Care
By: Alicia Hundley
Infant Toddler Specialist

2. Sudden & Unexpected Infant Death
Sudden and unexpected infant death (SUID)
a.k.a. Sudden and unexpected death in infancy (SUDI)
Most occur during sleep
SIDS
Suffocation, strangulation, entrapment
Undetermined/Other

3. What is A Suffocation, Strangulation or Entrapment Death?
Sleep-related infant deaths are typically due to accidental causes such as:
Suffocation-- when an object blocks his or her airway
Entrapment-- when he or she is lodged between two objects such as a mattress and wall
Strangulation-- when something presses on or wraps around his or her neck, blocking the airway

4. Suffocation

5. Strangulation

6. Entrapment

7. Entrapment

8. Suffocation, Strangulation and entrapment facts
The rate of fatalities attributed to unintentional suffocation and strangulation in the first year of life quadrupled between 1984 and 2004.
accounts for nearly 1,000 infant deaths annually.
Most are thought to be because of parental bed-sharing.

9. What is an undetermined or Other death?
Undetermined deaths - Exact cause of death cannot be determined because other factors are involved (i.e. bed sharing, extra bedding, use of pillows, etc.) Other deaths - a medical death such as heart disease, meningitis, pneumonia or infectious diseases. Conditions at time of death remained undiagnosed until the coronial process identified the cause.

10. What is A sids Death?
Sudden death which occurs before 1 year of age, usually in a previously healthy infant
Cause of death unexplained after thorough investigation; including complete autopsy, death scene investigation, and review of child’s health history
Conclusive evidence that no outside factors caused the death
A diagnosis of exclusion
SIDS is not predictable

11. Sids facts Every year there are about 2,200 SIDS cases (US)
It is the leading cause of death for babies from 1 to 12 months of age
Highest risk is at 2 to 4 months; 91% occur between 1 and 6 months of age
Seasonal trend: there are more SIDS deaths in winter months
More male babies die of SIDS
Unaccustomed tummy sleeping increases risk as much as 18 times.

12. Established risk factors
Prone/side sleep position
Maternal smoking during pregnancy
Environmental tobacco smoke
Overheating
Soft sleep surface
Late or no prenatal care
Young maternal age
Prematurity and/or LBW
Male sex
African American
American Indian
Co-sleeping

13. SIDS in Child Care
Two thirds of US infants younger than 1 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.

14. SIDS in Child Care
Approximately 20% of SIDS deaths occur while the infant is in the care of a non-parental caregiver.
60% in family child care
20% in child care centers
20% in relative care

15. SIDS in Child Care
Approximately 1/3 of SIDS-related deaths in child care occur in the first week, and 1/2 of these occur on the first day.
Something intrinsic to child care (Such as Stress or sleep deprivation)? Not that we’ve found yet
Unaccustomed tummy sleeping? Yes

16. Reasons caregivers place infants on their tummies to sleep
Lack of knowledge
Flat head
Bald spot
Startle (Don’t sleep as soundly)
Choking

17. Anatomy of sleeping baby

18. Creating a Safe Environment for Sleep
Make sure cribs are safe
The National Institute of Child Health and Human Development makes these recommendations to reduce the risk of Sudden Infant Death Syndrome (SIDS):

19. Creating a Safe Environment for Sleep
Make sure cribs are safe
Use firm crib mattresses
Place babies to sleep on their backs to sleep
Keep pillows, heavy blankets, comforters, stuffed toys, rattles, and squeeze toys out of cribs
If a thin blanket is used, make sure it does not reach higher than the baby’s chest and that the ends of the blanket are tucked under the crib mattress

20. Creating a Safe Environment for Sleep
Make sure cribs are safe
Make sure babies’ heads and faces are uncovered while they sleep
Remove bumper pads and wedges from the crib
Watch for strangulation hazards. Make sure that there are no dangling cords from blinds or drapes near cribs

21. Creating a Safe Environment for Sleep
Make sure cribs are safe
Lower the crib height of the mattress when children begin to sit or stand. The distance from the top of the mattress to the top of the crib rail should be at least 20 inches
Watch for signs that infants have outgrown their cribs. When they can pull themselves off the crib floor by holding onto the railing, the crib is no longer safe and the child should be moved to a cot or mat.

22. Creating a Safe Environment for Sleep
Safe Sleep Policy
Caregivers should have a written policy from their administrator that describes the practices to be used to promote safe sleep when infants are sleeping.

23. Creating a Safe Environment for Sleep
Safe Sleep Practices
All staff, parents, volunteers and any other people who care for infants in the child care setting should follow these required safe sleep practices as recommended by the AAP:

24. Creating a Safe Environment for Sleep
Back to Sleep
Infants up to twelve months of age should be placed for sleep in a back position for every nap or sleep time unless the infant’s physician has completed a signed waiver indicating that the child requires an alternate sleep position.

25. Creating a Safe Environment for Sleep
Safe Sleep Environment
Infants should be placed for sleep in a safe sleep environment; which includes:
A safety-approved crib (must meet USCPSC standards and have been purchased on or after June 28, 2011) with a firm crib mattress covered by a tight fitting
sheet.

26. Creating a Safe Environment for Sleep
Extra equipment
no monitors or positioning devices should be used and no other items should be in a crib occupied by an infant except for a pacifier.

27. Creating a Safe Environment for Sleep
Infant furniture
Infants should not sleep in a car safety seat, been bag chair, bouncy seat, infant seat, swing, jumping chair, highchair, chair, futon, or any other type of furniture/equipment that is not a safety approved crib.

28. Creating a Safe Environment for Sleep
Car Seats
If an infant arrives at child care in a car safety seat, the caregiver should immediately remove him for the seat and place him in a crib on his back.

29. Creating a Safe Environment for Sleep
Falling asleep
If an infant falls asleep in any place that is not a safe sleep environment, staff should immediately move him to a crib on his back.

30. Creating a Safe Environment for Sleep
Co-sleeping
Only one infant should be placed in each crib.

31. Creating a Safe Environment for Sleep
Loose Bedding
Soft or loose bedding should be kept away from sleeping infants and out of safe sleep environments.
These include, but are not limited to: bumper pads, pillows, quilts, comforters, sleep positioning devices, sheepskins, blankets, flat sheets, cloth diapers, bibs, etc. Also blankets and other items should not be hung on the sides of the crib.

32. Creating a Safe Environment for Sleep
Toys
Toys, including mobiles and other types of play
equipment that are designed to be attached to any part of the crib should be kept away from sleeping infants and out of safe sleep environments.

33. Creating a Safe Environment for Sleep
Temperature
When caregivers place infants in their crib for sleep, they should check to ensure that the temperature in the room is comfortable for a lightly clothed adult, check the infants to ensure that they are comfortably clothed, and that bibs, necklaces, and garments with ties or
hoods are removed.

34. Creating a Safe Environment for Sleep
Supervision
Infants should be directly observed by sight and sound at all times, including when they are going to sleep, are sleeping, or are in the process of waking up.

35. Creating a Safe Environment for Sleep
Swaddling
Swaddling infants when they are in a crib is not necessary or recommended, but rather one-piece sleepers should be used.

36. Creating a Safe Environment for Sleep
Swaddling
There is evidence that swaddling can increase the risk of serious health outcomes, especially in certain situations. The risk of SIDS is increased if an infant is swaddled and can roll from back to stomach. There is also an increased risk of developmental dysplasia of the hip and overheating with swaddling.

37. Creating a Safe Environment for Sleep
Pacifier Use
If pacifiers are allowed, staff should inspect them for tears or cracks. They should be cleaned with soap and water and allowed to air dry, prior to use. Pacifiers should never be clipped or tied to an infant’s clothing.

38. Questions???