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

It's the Law! Back To Sleep and Safe Sleep Policies to Reduce SIDS in Child Care Mandated

A law requiring that child care providers position babies on their back for sleeping, put into practice a safe sleep policy and receive training around safe sleep practices will go into effect on December 1, 2003. The law is designed to reduce the risks of Sudden Infant Death Syndrome (SIDS) in child care. The law also stipulates cooperation among investigators when investigating reports of abuse or neglect in child care facilities.

The Senate unanimously voted in favor of House Bill 152 Tuesday afternoon, July 8. The evening before, on July 7, the House passed the bill by a vote of 111-1. Rep. Gorman (R) from Craven County cast the lone dissenting vote.

Before it became law yesterday, HB 152 had undergone significant revisions since it was initially proposed by Rep. Alexander on February 22.

Revisions to the Bill

Changes to the original house version include the removal of the unauthorized administration of medication and associated criminal penality. The Senate passed a separate bill, SB 226 - "Unauthorized Administration of Medicines By Child Care Facility" also know as "Kaitlyn's Law" making it illegal to give medication to children in child care without parents' authorization. Violations are subject to Class F felony charges.

The issue of a waiver allowing a baby to sleep in a position other than on their back was heavily debated and resulted in a compromise. The law states that child care providers are to place a child, 12 months of age or younger, on the back for sleeping. The exceptions for the back sleep position for babies are: (l) a written waiver from a healthcare provider for babies 6 months of age or YOUNGER; and (2) for babies OLDER than 6 months, a written waiver from a parent or legal guardian. In both cases the child care provider must obtain a written waiver in order to place babies in a sleep position other than on their back.

Note: The written waiver from a parent or legal guardian exempting babies older than 6 months of age from being placed to sleep on their back does not follow best practices and the national safe sleep standard.

Key sections of both versions remain

The bill pertains to children 12 months of age or younger and would require that child care providers:

• place children in a back sleeping position that reduces the risk of SIDS
  
• develop and maintain a written safe sleep policy in accordance with rules adopted by the Child Care Commission
• discuss the safe sleep policy with the child's parent or legal guardian before the child is enrolled
• obtain a signed statement from the parent or legal guardian saying they have received a copy of the safe sleep policy and that the policy was discussed before the child's enrollment
• receive training in safe sleep practices

Another component of the law calls for interagency cooperation in investigating reports of child abuse and neglect in child care. The law states "The Department, local departments of social services, and local law enforcement personnel shall cooperate with the medical community to ensure that reports of child abuse or neglect in child care facilities are properly investigated."

New DCD Rules Support Safe Sleep Legislation

The Child Care Commission Rules Committee has started drafting rules that will enable child care providers to comply with the legislation discussed above. These rules will be presented to the Child Care Commission and are subject to public comment. It is hoped the rules will be in effect prior to December 1st. The proposed rules reinforce legislation outlined in HB 152 and will include a phase-in timeframe.

A recently published study finds that there does not appear to be any adverse health effects for putting healthy infants to sleep on their backs. In fact, a team of researchers suggests that placing babies on their back to sleep has added health benefits.

Besides lowering the risk of SIDS, babies who sleep on their backs appear to be:

~ less likely to develop fevers
~ are not as likely to get stuffy noses
~ less likely to develop otitis media (ear infection)

"Otitis media causes suffering in infants and young children, costs the American public an estimated $5 billion dollars per year, and results in overuse of antibiotics. The research showing that putting infants on their backs to sleep is saving lives is now revealing an outstanding additional benefit, the reduction of otitis media in infants," said James F. Battey, Jr., M.D., Ph.D., Director of the National Institute on Deafness and other Communication Disorders (NIDCD).

The research was spearheaded by Carl E. Hunt, M.D. and results published in the May 2003 issue of Archives of Pediatrics & Adolescent Medicine.

SIDS Risk Factors in the Sleep Environment

Results of a study paying special attention to the hazards in the sleep environment linked to SIDS was printed in the May issue of the journal Pediatrics. Researchers trying to unravel the disparity in SIDS deaths among African Americans through the Chicago Infant Mortality Study found that:

~ being placed on the stomach (prone) position at last sleep was associated with more than twice the risk of SIDS among the study population
~ a soft sleep surface was associated with more than five times SIDS risk
~ pillow use was associated with more than three times the risk
~ covering the head or face of a baby with bedding increased the SIDS risk three times
~ bed sharing with one or more people was associated with an increased risk of SIDS
~ the use of pacifiers during baby's last sleep and breast feeding for any period of time appeared to be protective against SIDS

The researchers state "[parents] should receive instruction that emphasizes supine [back] sleeping, firm bedding, not using pillows, and not sharing a bed with other children or sleeping with another person on a sofa."

Reference: Hauck, FR, Herman SM, Donovan M., et al. 2003. Sleep environment and the risk of sudden infant death syndrome in an urban population: The Chicago Infant Mortality Study. Pediatrics 3(5 Suppl.):1027-1214.

Accomplishments for Phase 1:

• 2,000 Child Care Providers trained
• 111 Trainings scheduled or completed
• 73 ITS-SIDS Trainers trained at six regional training sessions
• 46 of 49 targeted counties have ITS-SIDS Trainers
• ITS-SIDS training accreditated by the N.C. Nurses Association for 4.8 nursing hour credits
• Training Manuals distributed - 85 distributed
• ITS-SIDS Toolkits distributed to ITS-SIDS Trainers at the regional training sites
  
• Safe Sleep Checklist developed and distributed
• Supporting educational print materials reprinted
• 102 participants at six regional Licensing Consultants training sessions
• 3 quarterly newsletters published and distributed electronically
• ITS-SIDS Advisory Group established and meeting quarterly
• Outreach to N.C. Pediatricians through the N.C. Pediatric Society
• Technical assistance provided as requested to trainers, providers,
  policy makers, the N.C. Child Care Commission, media and national programs
• Presentations and training workshops at statewide child care conferences
• Participation in a national teleconference sponsored by the American Academy of Pediatrics
  

Tasks for Phase 2 of the ITS-SIDS Project which begins July 1, 2003:

• Follow-up with ITS-SIDS Trainers to conduct child care provider training
• Follow-up Phase 1 Licensing Consultants - Post-test Survey
• Setting up regional training for Licensing Consultants
• RECRUITING ITS-SIDS Trainers for Phase 2 targeted counties
• Revising the ITS-SIDS Training Manual to include data and Legislation updates
• Develop ITS-SIDS eNET