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

The winds of change are swirling around the ITS-SIDS Project. On June 30, 2006, the ITS-SIDS Project officially ends with the completion of the In-Depth Technical Assistance training year. The ITS-SIDS train-the-trainer torch is being passed from the North Carolina Healthy Start Foundation to the N.C. Child Care Health and Safety Resource Center. The 5th edition ITS-SIDS curriculum is being converted to a web-based train-the-trainer module. Once completed, the web-based ITS-SIDS training will be available only to Child Care Health Consultants, Infant-Toddler Specialists and others who qualify. Current, certified ITS-SIDS trainers DO NOT have to become recertified and can continue to provide training to childcare providers using the 5th edition (November 2005) curriculum. For more information about future ITS-SIDS trainer sessions contact the Family Health and Child Care Resource Line at 1-800-367-2229.

Hats Off to all ITS-SIDS Trainers and In-Depth TA Trainees

Strike up the marching band…let the ticker tape parade begin…roll out the red carpet…drum roll please….
Thanks, gracias, merci, domo arigatou to all of you who contributed to the success of the ITS-SIDS Project. You have trained tirelessly, followed-up on providers' questions and allowed your creative juices to flow in your delivery of trainings and parent education about infant sleep safety and SIDS! You have so often gone well beyond the call of duty. Your dedication, hard work and commitment to the health and safety of North Carolina's infants in child care are unparalleled. Thank you.

Your accomplishments:

• SIDS risks in North Carolina childcare settings have been reduced and resulted in safer infant sleep practices and environments
• Data suggests that fewer SIDS deaths have occurred in licensed N.C. childcare settings since the ITS-SIDS training began
• More than 30,850 childcare providers received ITS-SIDS training from February 2003 through June 2005
• 85 childcare providers received technical assistance around their Safe Sleep Policy from December 2005 through March 2006
• 45 childcare providers received follow-up technical assistance on their Safe Sleep Policy from January 2006 through May 2006

In-Depth Technical Assistance Training Results

A total of 115 participants attended the In-Depth TA training sessions in December 2005 and January 2006. Preliminary results from the Pre-TA and Post-TA surveys show a very high degree of awareness about the NC SIDS Law (99% Pre-TA; 100% Post-TA) and Safe Sleep licensing rules (98% Pre-TA, 100% Post-TA). Almost all, 96% of providers assisted, had attended the ITS-SIDS training prior to receiving the in-depth technical assistance. Direct results of the TA you provided include a 13.6% increase in the number of Safe Sleep policies in place (from 88% to 100%), a significant jump in the number of policies posted (from 35% to 80%) and more Safe Sleep posters posted (from 79% to 93%). Not only is there more compliance with the licensing rules because of the help you provided, there are also more opportunities for staff and parents to be informed about infants' sleep safety and SIDS risk reduction.

The percentage of babies observed sleeping on their back increased from 61% to 67% respectively, between the Pre-TA and Post-TA surveys. There was a corresponding decrease in the percentage of babies sleeping on their stomach, side or in a sitting position. Fewer infants were observed sleeping in swings and car seats while more were asleep in their cribs at the time of the Post-TA visit. However, family home child care providers need to be cautioned about allowing babies to sleep on sofas.

Questions & Answers

Q: Should I continue to collect the Pre-TA Survey and Post-TA Survey information?
A: No, the deadline for collecting and submitting the Pre-TA and Post-TA Survey information has passed. However, childcare providers continue to need your assistance either developing or refining their Safe Sleep Policy. If you found the Pre-TA/Post-TA surveys useful, we hope you will keep them in your toolbox and continue to use them.

Q: How do I get documentation that I attended the In-Depth TA Training?
A: If you need a Certificate of Completion for the In-Depth TA Training, we will be happy to provide it. Send an email along with your name and address to [email protected] and put "In-Depth TA Training Certificate of Completion" in the subject line. NOTE: Infant-Toddler Specialists will be able to get their certificate directly from Kathie Boling.

Q: Our agency no longer has an ITS-SIDS trainer but we have many childcare providers in the county that need to be ITS-SIDS recertified. How can I become an ITS-SIDS trainer?
A: To help meet the current demand of ITS-SIDS training for childcare providers, contact your regional Infant/Toddler Specialist or local Child Care Health Consultants to learn about their ITS-SIDS training schedule. Share this information with childcare providers. To apply to be an ITS-SIDS trainer, contact the Family Health and Child Care Resource Line at 1-800-367-2229.

Q: Where should I send ITS-SIDS Training rosters and evaluations?
A: Keep a copy of the ITS-SIDS Training roster for your records (for three years) and mail the original roster to the DCD Workforce Section at 2201 Mail Service Center; Raleigh, NC 27699-2201. Review the evaluations after each training and retain them for three years. (Refer to Chapter 6 in the ITS-SIDS Curriculum).

US Childcare Regulations to Reduce SIDS Risks

Researchers assessing childcare licensing rule changes since the American Academy of Pediatrics' Healthy Child Care American (HCCA) program's 2003 launch of its Back to Sleep Campaign initiative found that the proportion of Sudden Infant Death Syndrome (SIDS) deaths in childcare settings remained constant at 20%, despite positive regulatory changes to lower the risks in childcare settings. The authors evaluated the effectiveness of the HCCA's SIDS risk reduction campaign for the first two years. They examined regulatory components of a safe sleep environment for childcare centers and family childcare homes (FCCH) in 50 states and in the District of Columbia as of October 2005, to determine if childcare regulations had improved. The following regulation characteristics were assessed:

• sudden infant death syndrome risk-reduction training for childcare providers
• infant sleep position
• crib safety
• bedding safety
• smoking
• provision of information about sleep positioning policies and sleep-related arrangements to parents before an infant's enrollment

Of the 101 regulations for centers and FCCH analyzed, the authors found:

• 60 were newly revised and more than one-half of these require a non-prone sleep position and impose restrictions on soft bedding in the crib (statistically significant change)
• 49 require that infants sleep not sleep on the stomach
• 18 stipulate SIDS training for childcare providers
• 81 have one crib safety standard
• 43 restrict soft bedding in the crib
• 4 require parents be provided with sleep policy information

The authors concluded that the initial two years of the Healthy Child Care America Back to Sleep campaign were successful in promoting safe infant sleep regulations. They reinforced the message that regulatory efforts should continue in order to adopt safe sleep regulations in all childcare jurisdictions.

Reference: Moon RY et al. State Child Care Regulations Regarding Infant Sleep Environment Since the Healthy Child Care America-Back to Sleep Campaign PEDIATRICS Vol. 118 No. 1 July 2006, p. 73.

NOTE: Onset of the ITS-SIDS training pre-dates the AAP's Back To Sleep Campaign training for states. Elements of the ITS-SIDS curriculum were included in the AAP curriculum with permission from the North Carolina Healthy Start Foundation. Passage of the N.C. SIDS Law and corresponding changes to the N.C. childcare regulations were a direct result of the "Death in Day Care" series of articles and an editorial printed in the Raleigh News and Observer in February 2003.

U.S. Surgeon General Reports on Secondhand Smoke - More Dangerous than Previously Thought

On June 27, 2006 the U.S. Surgeon General Richard Carmona released a report on "The Health Consequences of Involuntary Exposure to Tobacco Smoke" as an update to the 1986 Surgeon General's report on the same topic. This report reaffirms and strengthens the 1986 findings but also reveals that secondhand smoke is more dangerous than previously thought. Chapter 5: Reproductive and Developmental Effects from Exposure to Secondhand Smoke states, "The evidence is sufficient to infer a causal relationship between exposure to secondhand smoke and sudden infant death syndrome." Findings and conclusions are based on a comprehensive review of the scientific evidence, a quantitative synthesis of the evidence about the effects of secondhand smoke and an assessment of sources of bias that might affect the interpretation of the research. Major conclusions about breathing secondhand smoke:

• causes premature death and disease in children and adults who are non-smokers
• increases risk of SIDS, acute respiratory infections, ear problems and severe asthma among children
• smoking by parents causes respiratory symptoms and slows lung growth in their children, a condition worsened by secondhand smoke exposure
• associated with childhood cancers including leukemia, lymphoma and brain tumors
• immediate adverse effects on the cardiovascular system for adults; causes coronary heart disease and lung cancer
• there is no risk-free level of exposure
• millions of Americans are exposed to secondhand smoke in their homes and workplaces despite progress in tobacco control
• eliminating smoking indoors fully protects non-smokers; separate ventilation systems cannot eliminate secondhand smoke exposure

The Surgeon General's Report is available on-line at www.surgeongeneral.gov/library/secondhandsmoke.

The N.C Department of Health and Human Services advises, "It is time to make N.C. work sites smoke-free" in order to reduce premature death and disabilities caused by exposure to secondhand smoke in the state.

North Carolina Healthy Start Foundation
Remember, the North Carolina Healthy Start Foundation will continue to be a resource for you!

• download PDF versions of many SIDS risk reduction materials from our web site www.NCHealthyStart.org
• order bulk materials with a click of your mouse
• access state SIDS statistics at the North Carolina Back To Sleep Campaign web page; look for SIDS stats updates in October 2006

North Carolina Division of Child Development (DCD)
The DCD can assist you with supporting educational materials and information at 1-800-859-0829 or 919-662-4499.

• order the English and Spanish Safe Sleep Rules for Caregivers mini-poster directly from DCD's Customer Service Department
• contact DCD about regulatory questions on Safe Sleep Policy requirements
• visit the DCD web site at www.ncchildcare.net for updates and information about SIDS for providers

North Carolina Child Health and Safety Resource Center
The Child Health and Safety Resource Center can assist with you information and technical assistance about childcare services and resources at
1-800-367-2229 or through their web site: www.healthychildcarenc.org/index.cfm.

• review the list of ITS-SIDS trainers by county on the web site (coming soon)
• inquire about ITS-SIDS trainer sessions
• access materials

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