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

The American Academy of Pediatrics' (AAP) Task force on Sudden Infant Death Syndrome released its five-year update in October, 2005. The task force endorsed previous recommendations to combat SIDS but focused primarily on recent research and offered updated research-based advice. The recommendations can be accessed from the Academy's Web site at www.aap.org. National SIDS data indicate the following trends:

• A 50% decrease in SIDS nationwide since 1992, but the decline is leveling off
• Greatest SIDS incidence occurs at 2-3 months of age
• Small shift in the age of SIDS deaths with slightly higher proportions of deaths in the neonatal period and after six months of age
• Two to three times higher rates for SIDS than the national average among African American and American Indian/Alaska Natives
• Decrease in the seasonal occurrence of SIDS with SIDS deaths spread evenly acrosss the seasons (historically there was a higher frequency in colder months)

Two recommendations, discouraging bedsharing among parents and their infants and support for pacifier use, have sparked controversy and remain contested by breastfeeding advocates. Because SIDS risks are higher when bedsharing with young infants, the AAP suggests that infants sleep in a separate sleep environment designed for them (crib), near parents (room sharing) but not with them in the same bed. The mechanics of the protective effect of pacifiers remains unclear.

The AAP's recommendations include:

• Follow Back to Sleep - place infants wholly on the back (supine) and do not use the side sleep position. The SIDS risk for usual back sleepers positioned on the stomach remained high (7-8 times higher risk). Side or stomach sleep position doubled SIDS risks.
• Use a firm sleep surface - do not put soft materials or objects (pillows, quilts, comforters, sheepskins) under a sleeping infant.
• Keep soft objects and loose bedding out of the crib - if blankets are used they should be tucked so that an infant's face remains uncovered or use a sleep sack.
• No smoking during pregnancy and do not expose infants to secondhand smoke.
• Provide a separate but nearby sleeping environment - use a crib, bassinet or cradle that meets Consumer Product Safety Commission standards.
• Consider using a pacifier at nap time and bedtime - introduce a pacifier after breast feeding is firmly established (after one month), do not coat pacifiers in sugar-based solutions, practice good hygiene by cleaning and replacing pacifiers often and do not reintroduce a pacifier if it has fallen from a sleeping infant's mouth.
• Avoid overheating - lightly clothe infants for sleep and avoid over-bundling them.
• Avoid commerical products marketed to reduce SIDS risks.
• Do not use home monitors as a SIDS risk reduction strategy.
• Help keep infants from developing flat heads (positional plageiocephaly) - offer them tummy time when awake and observed, and provide "up-right cuddle time" by holding them.
• Continue the Back to Sleep Campaign - intensify public education for secondary caregivers (child care providers, grandparents and others), for African American and American Indian/Alaska Native populations and health care professionals (particularly hospital newborn nursery and Neonatal Intensive Care Unit staff)

Participants at the ITS-SIDS In-Depth TA training were discussing the Safe Sleep Policy and the time interval for checking a sleeping infant during overnight care. It appears that some home providers are inconsistent in applying their Safe Sleep Policy while infants sleep at night. Several questions were raised and the Division of Child Development's (DCD) input was solicited. Lorie Pugh with DCD responded.

Q: Does the sleep policy remain in effect during nighttime care? What are your recommendations?
A: Regardless of the hours of operation, if a provider is licensed to care for infants aged 12 months or younger, the operator must maintain compliance with Safe Sleep Policy rules. The rules do not specify how often a provider must check on a sleeping infant. The frequency a provider checks on a sleeping infant is specified in their Safe Sleep Policy. The provider may adjust the frequency with which s/he checks sleeping infants during overnight hours, however the specified frequency must be indicated in the Safe Sleep Policy. It should also be reflected in the required documentation such as a Sleep Chart.

Q: Is it possible that over night-caregivers can stipulate that they will check sleeping infants on a different schedule than daytime infants?
A: Yes, caregivers can indicate in the Safe Sleep Policy that they will check sleeping infants on a different schedule during overnight hours. The frequency needs to be outlined in the policy.

The North Carolina Tobacco-Use Quitline, 1-8000-QUIT-NOW (1-800-784-8669) was launched on November 17 to coincide with the Great American Smoke-Out. The Quitline, available for all N.C. residents, provides free, evidence-based, proactive English and Spanish cessation counseling services for teens and adults in the state who want to stop using tobacco products. Hours of operation are 8:00 a.m. until midnight, seven days a week.

The American Academy of Pediatrics' Web site, www.aap.org/healthtopics/childcare.cfm is a wealth of information for a host of health issues of concern to physicians, parents, and child care providers. Topics about caring for kids range from defining the different types of child care available and knowing what to look for in a quality program to preparing your child for child care. Information is available in print and audio formats. You can also access the AAP's SIDS and child care on-line slide presentation. Don't be surprised if it looks familiar! North Carolina's ITS-SIDS curricula served as a model for the AAP's child care training on SIDS.

ITS-SIDS 5th Edition CD Completed and Ready for Release

The ITS-SIDS Curriculum has been updated and some chapters have been reorganized. The 5th Edition CD is ready for release to active, certified ITS-SIDS trainers. A mailing is scheduled in early January 2006. Make sure your contact information is correct. If you have moved or changed your contact information since June 2005 please notify the ITS-SIDS Project by email at [email protected].

ITS-SIDS Level 1 Training of Trainers

On November 1, 2005, Kathie Boling, Sharon Ware and Jackie Quirk participated in a Level 1 ITS-SIDS Trainer session. The basic ITS-SIDS train-the-trainer certification is now the responsibility of the N.C. Child Care Health and Safety Resource Center and the Infant/Toddler Specialist Program. Existing ITS-SIDS trainers will continue to provide ITS-SIDS training to help providers meet their licensing requirements. However, only Infant/Toddler Specialists and Child Care Health Consultants will participate in new ITS-SIDS train-the-trainer sessions. The University of North Carolina at Chapel Hill is expected to make the on-line ITS-SIDS training available to Child Care Health Consultants in June 2006.

In-Depth Technical Assistance Training (In-Depth TA)

The ITS-SIDS Project has successfully transitioned to an In-Depth Technical Assistance (In-Depth TA) Training mode. The purpose of the In-Depth TA Training is to equip participants with information and tools as they assist child care providers in developing or revising their Safe Sleep Policy. Pre-TA and Post-TA surveys were developed to help assess infant sleep practices, to identify areas of improvement and to engage providers in matching their practices with their Safe Sleep Policy for compliance with licensing requirements.

From December 5-9, 2005, five In-Depth TA Training sessions on Safe Sleep Policy Development and TA provision were offered by Christine O'Meara, the ITS-SIDS Project Director. Over 100 participants attended representing more than 45 counties. Agencies participating included Smart Start Partnerships, Child Care Resource and Referrals, Cooperative Extension and Public Health Departments. Two In-Depth TA teleconference trainings will be held January 3rd and 4th for participants that were unable to attend the regional trainings.

ITS-SIDS eNET

The ITS-SIDS electronic Network/Information and Exchange for Trainers (eNET), a web-based bulletin board discussion forum, is ready for certified ITS-SIDS trainers and In-Depth TA participants only. If you are interested in participating in discussions on the ITS-SIDS eNET send an email to [email protected]. In the subject line insert "eNET access."

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