Resource Center

Other Child Care Resources

National Association for Regulatory Administration (NARA)/ National Child Care Information and Technical Assistance Center

The 2005 Child Care Licensing Study: Executive Summary. 2006.
The purpose of the 2005 Child Care Licensing Study is to report two aspects of child care licensing from 2005 for all 50 states and the District of Columbia on state child care licensing programs and policies and child care center licensing regulations. Twenty- four states require that centers place infants on their backs to sleep in order to reduce the risk of Sudden Infant Death Syndrome. Twenty states allow physicians to authorize a different sleep position; five states allow parents to make this authorization. Seventeen states prohibit soft bedding/ materials in cribs.

Available for full-text downloading: http://www.nara.affiniscape.com/displaycommon.cfm?an=1&subarticlenbr=99

Moon RY, Kotch L, Aird L.
State child care regulations regarding infant sleep environment since the Healthy Child Care America-Back to Sleep campaign.
Pediatrics. 2006 Jul; 118(1):73-83

Background: Despite overall decreases in sudden infant death syndrome deaths and prone sleeping, the proportion of sudden infant death syndrome deaths that occurs in child care settings has remained constant at approximately 20%. In 2003, the American Academy of Pediatrics' Healthy Child Care America program launched its own Back to Sleep campaign to promote the Back to Sleep message for those who care for young children. Objectives: The purpose of this study was to evaluate the effectiveness of the first 2 years of the Healthy Child Care America-Back to Sleep campaign in improving child care regulations by assessing the inclusion of the elements of a safe sleep environment in the individual state regulations for child care centers and family child care homes. Methods: We examined regulations available in October 2005 for licensed child care centers and family child care homes in the 50 states and the District of Columbia for specific regulations pertaining to (1) sudden infant death syndrome risk-reduction training for child care providers, (2) infant sleep position, (3) crib safety, (4) bedding safety, (5) smoking, and (6) provision of information about sleep positioning policies and arrangements to parents before the infant is enrolled in child care. Results: Since 2003, when the Healthy Child Care America-Back to Sleep campaign began, 60 of the 101 state regulations for either child care centers or FCCHs have been revised. More than half of these regulations written since 2003 mandate a non prone sleep position and restrictions on soft bedding in the crib, and the change in these regulations since 2003 is statistically significant. However, of the 101 existing state regulations, only 49 require that infants sleep nonprone, 18 mandate sudden infant death syndrome training for child care providers, 81 have > or = 1 crib safety standard, and 43 restrict soft bedding in the crib. Only 4 regulations require that parents be provided with sleep policy information. Conclusions: The initial 2 years of the Healthy Child Care America Back to Sleep campaign have been successful in promoting safe infant sleep regulations. Efforts must continue so that safe sleep regulations exist in all jurisdictions.

Full-text available at: http://www.pediatrics.org

American Academy of Pediatrics, Task Force on Sudden Infant Death Syndrome.
The Changing Concept of Sudden Infant Death Syndrome: Diagnostic Coding Shifts, Controversies Regarding the Sleeping Environment, and New Variables to Consider in Reducing Risk
Pediatrics. 2005 Nov; 116(5):1245-55. E-pub 2005 Oct 10

There has been a major decrease in the incidence of sudden infant death syndrome (SIDS) since the American Academy of Pediatrics (AAP) released its recommendation in 1992 that infants be placed down for sleep in a non prone position. Although the SIDS rate continues to fall, some of the recent decrease of the last several years may be a result of coding shifts to other causes of unexpected infant deaths. Since the AAP published its last statement on SIDS in 2000, several issues have become relevant, including the significant risk of side sleeping position; the AAP no longer recognizes side sleeping as a reasonable alternative to fully supine sleeping. The AAP also stresses the need to avoid redundant soft bedding and soft objects in the infant's sleeping environment, the hazards of adults sleeping with an infant in the same bed, the SIDS risk reduction associated with having infants sleep in the same room as adults and with using pacifiers at the time of sleep, the importance of educating secondary caregivers and neonatology practitioners on the importance of "back to sleep," and strategies to reduce the incidence of positional plagiocephaly associated with supine positioning. This statement reviews the evidence associated with these and other SIDS-related issues and proposes new recommendations for further reducing SIDS risk.

Free full-text available at: http://aappolicy.aappublications.org/cgi/content/full/pediatrics;116/5/1245#SEC15

Moon RY, Sprague BM, Patel KM.
Stable prevalence but changing risk factors for sudden infant death syndrome in child care settings in 2001.
Pediatrics. 2005 Oct; 116(4):972-7

Objective: A total of 20% of sudden infant death syndrome (SIDS) cases in the 1990s occurred in child care settings. This is much higher than the 8% expected from Census Bureau data. Factors that were associated with child care SIDS included older age; white race; older, more educated mothers; and unaccustomed prone position. Since these findings, much emphasis has been placed on promoting a safe sleep environment in child care. The objectives of this study were to determine the proportion of SIDS occurring in child care in 2001 and to assess risk factors for SIDS in child care. Methods: We conducted a retrospective review of all SIDS deaths that occurred in 2001 in 13 US states. Information regarding demographics, SIDS risk factors, and child care arrangements were collected and analyzed. Deaths that occurred in child care were compared with deaths that occurred during parental care. RESULTS: Of 480 deaths, 79 (16.5%) occurred in child care settings. Of these child care deaths, 36.7% occurred in family child care homes, 17.7% occurred in child care centers, 21.3% occurred in relative care, and 17.7% occurred with a nanny/babysitter at home. Infants in child care were more likely to be older and to die between the hours of 8 am and 4 pm and less likely to be exposed to secondhand smoke. There was no difference in usual, found, or placed sleep position between child care and home deaths. Approximately one half of the infants who died of SIDS in both settings were found prone, and 20% of deaths in both settings were among infants who were unaccustomed to prone sleep. Conclusions: The proportion of SIDS deaths in child care has declined slightly but still remains high at 16.5%. Infants in child care are no more likely to be placed or found prone and no more likely to be on an unsafe sleep surface. Educational efforts with child care providers have been effective and should be expanded to unregulated child care providers. In addition, there may be other, yet-unidentified factors in child care that place infants in those settings at higher risk for SIDS.

Free full-text downloading available at: http://pediatrics.aappublications.org/cgi/content/full/116/4/972

North Carolina Healthy Start Foundation/ Blue Cross Blue Shield of North Carolina/ CJ Foundation for SIDS.
Baby’s Easy Safe Sleep Training Kit (BESST kit).
2005. 20p.

The BESST kit is an educational flip chart and guide that offers important tips about infant safe sleep and ways to reduce the risks of SIDS. This tool is aimed primarily assist parents, caregivers, childcare providers, healthcare professionals and others in raising awareness about, and reducing the incidence of SIDS. The kit includes tabletop flip chart with 16 illustrations, training guide, presentation tips, prop ideas, outreach tips and samples of safe sleep materials from the North Carolina Healthy Start Foundation. The kit is also available in Spanish.

Available from: http://www.nchealthystart.org/BESST/flip_chart_info.htm

C J Foundation for SIDS
Face Up to Wake Up: SIDS Risk Reduction Resource Kit
Hackensack, NJ: C J Foundation for SIDS, 2004.

This culturally appropriate kit is intended to support the reduction of racial and ethnic disparities in Sudden Infant Death Syndrome (SIDS) among American Indians. The kit includes a manual designed not only to assist the educator in both one-on-one and classroom instruction but also to enhance the instructors' current level of understanding regarding SIDS. To further assist instructors, two videos in both VHS and CD-ROM format are also included. There is also a resource CD that contains posters, brochures and other educational materials ready to be printed. These resources can be used to educate through display, distribution and individual instruction.

Available from:
CJ Foundation for SIDS
Don Imus-WFAN Pediatric Center
Hackensack University Medical Center
30 Prospect Avenue
Hackensack, NJ 07601
(888) 825-7437 (Toll-free)
(201) 996-5111
(201) 996-5326 (Fax)
http://www.cjsids.com

First Candle/SIDS Alliance
Como Superar La Muerte De Un Bebe [Sudden Infant Death Syndrome: Surviving the Death of a Baby].
Baltimore, MD: First Candle/ SIDS Alliance. 2004. 11 p.

This brochure serves as an aid to parents who have lost a baby to Sudden Infant Death Syndrome (SIDS). It covers topics like grieving process parents undergo, coping with birthdays, anniversaries and holidays, trying for another baby, children's reactions to death, how grandparents undergo double grief, how childcare providers react to the grief. Furnishes contact information to stop unsolicited reminders of the baby's death. Presents suggestions to friends and relatives in a do's and don'ts format to assist SIDS parent’s grief. Includes two poems entitled "Last day" by Deborah R. Gemmill and "The journey of living on" by Sharon A. Dunn.

Available from:
National SIDS/ID Program Support Center (NSIDPSC)
1314 Bedford Avenue, Suite 210
Baltimore, MD 21208
(410) 415-6628
(800) 221-7437 (Toll-free)
(410) 653-8709 (Fax)
kathleen.graham@firstcandle.org (E-mail)
http://firstcandle.org/health/health_human.html

McClain M, Arnold J, Longchamp E, Shaefer J.
Bereavement counseling for sudden infant death syndrome (SIDS) and infant mortality: Core competencies for the health care professional.
Stony Brook, NY: Association of SIDS and Infant Mortality Programs (ASIP), 2004. 39p.

This guide presents core competencies essential for the health care professional to provide appropriate and effective bereavement counseling and support for a family. Part I focuses on understanding and using infant mortality statistics. It lists various data sources like National Center for Health Statistics (NCHS), Title V Information System (TVS), Peristats by March of Dimes, State Health Facts Online by Henry J. Kaiser Family Foundation, and Infant Mortality Knowledge path developed by Georgetown University's National Center for Education in Maternal and Child Health (NCEMCH). Lists leading causes of Infant Mortality and current trends in Infant Mortality. Part II includes risk reduction for SIDS and Infant Mortality. Part III focuses on bereavement counseling for SIDS and Infant Mortality. It lists steps while counseling the bereaved parents, counseling children about death and grief, counseling grandparents, and counseling day care providers and foster parents. Part IV covers the impact of grief counseling on the health care professional. Also includes references and suggested reading list on infant mortality statistics, risk reduction education, bereavement counseling support, helpful books for children, list of ASIP publications and collaborating organizations. Includes list of organizations dealing with grief and bereavement.

Available from:
The Association of SIDS and Infant Mortality Programs (ASIP)
National SIDS& Infant Death Project IMPACT
8280 Greensboro Drive, Ste 300
McLean, VA 22102
(800) 930-7437
(703) 902-1260
(703) 902-1320 (Fax)
info@sidsprojectimpact.com (E-mail)
http://www.sidsprojectimpact.com

Free full-text downloading available at: http://www.sidsprojectimpact.com/_assets/documents/pdf/BerCouns--CoreComp.pdf

American Academy of Pediatrics (AAP), Task Force on Infant Sleeping Position and SIDS.
Infant Sleep Position and SIDS: Questions and Answers for Health Care Providers.
Bethesda, MD: National Institute of Child Health and Human Development (NIH). November 2003. 12 p.

This brochure, a product of the national 'Back to Sleep' campaign in the United States, presents questions and answers for health care providers on infant sleeping position and sudden infant death syndrome (SIDS). The 'Back to Sleep' campaign was initiated in June 1994 to alert new parents and health professionals to sleeping position as a possible risk factor for SIDS. The brochure answers the following questions: What advice should health care providers give to parents on ways to reduce the risk of SIDS? What sleep position is safest for full-term babies in hospital nurseries? Is the side position as effective at reducing the risk of SIDS as the back sleep position? Will babies choke if they are placed on their backs; does back sleeping cause infants to have flat heads? Why should parents and caregivers avoid soft surfaces for their infants to sleep on? Can a baby ever be placed on his or her stomach; Are there any circumstances when a baby should be placed to sleep on his or her stomach? How should preterm babies be placed for sleep? What advice should a heath care provider give to a parent or caregiver whose infant has difficulty sleeping in the back position? How often should parents or caregivers check on an infant during sleep to make sure the baby has not rolled into the stomach position from the back position? At what age can parents and caregivers stop placing their babies on their backs to sleep? Should parents or caregivers use products that are designed to keep babies on their backs or sides during sleep? What advice should health care providers give to parents of babies in childcare? Does bed sharing reduce the risk of SIDS? Information on the campaign's history is included.

Available from:
National Institute of Child Health and Human Development (NICHD)
Back to Sleep Campaign
31 Center Drive, 31/2A32
Bethesda, MD 20892-2425
(800) 505-CRIB
(301) 496-7101 (Fax)
http://www.nichd.nih.gov

Free full-text downloading available at: http://www.nichd.nih.gov/publications/pubs/upload/BTS_QA_Healthproviders.pdf

Moon RY, Oden RP.
Back to Sleep: Can we Influence Child Care Providers?
Pediatrics 112(4): 878-882, October 2003.

Objective: Despite the fact that 20% of sudden infant death syndrome (SIDS) deaths occur in child care settings, many child care providers continue to be unaware of the association of SIDS and infant sleep position and/or are misinformed as to the risks and benefits of the various sleep positions. The objective of this study was to determine whether an educational program for child care providers regarding SIDS and safe sleep environment is effective in 1) providing basic information and understanding regarding SIDS risk reduction practices, 2) changing child care provider behavior, and 3) promoting development of written sleep position policies. Methods: We designed a 60-minute educational in-service for child care providers, to be led by a trained health educator. All providers who attended the in-service were asked to complete surveys before and after the in-service. Surveys assessed provider knowledge, beliefs, and practices. A 6-month follow-up interview was conducted with childcare centers that had providers participating in the in-service. Results: A total of 96 childcare providers attended the educational in-service. Providers who were using the supine position exclusively increased from 44.8% to 78.1%. This change in behavior was sustained, with 85% of centers placing infants exclusively supine 6 months after the intervention. Awareness of the American Academy of Pediatrics recommendation of supine as the preferred position for infants increased from 47.9% to 78.1%, and 67.7% of centers continued to recognize supine as the recommended position 6 months later. The percentage of centers that reported written sleep position policies increased from 18.8% to 44.4%. Conclusions: A targeted educational in-service for child care providers is effective in increasing awareness and knowledge, changing child care provider behavior, and promoting development of written sleep position policies. This change is sustained over at least a 6-month period (18 references).

Free full-text downloading available at: http://pediatrics.aappublications.org/cgi/reprint/112/4/878

National SIDS/ ID Program Support Center (NSIDPSC)
Training manual about Sudden Infant Death Syndrome (SIDS) in Child Care Settings.
Baltimore, MD: National SIDS & Infant Death Program Support Center. 2003.

The Training Manual provides up to date information regarding SIDS research and best practices to reduce the risk in childcare settings. Section I includes training guide which provides tips on conducting the Train-the Trainer Workshop and/or the child care provider workshop. Section II includes presentation/training script, presentation script is intended to assist trainers in conducting a workshop for child care providers, provides guidelines, suggestions in conducting a power point slide workshop. Training script includes trainer's notes reminding trainer's important points and information with each power point slide. Section III includes materials about SIDS to the trainers. Section IV provides supplemental information that could contribute to increase knowledge about SIDS. Packet includes a CD-ROM.

Available from:
National SIDS/ID Program Support Center (NSIDPSC)
1314 Bedford Avenue, Suite 210
Baltimore, MD 21208
800-221-7437 (Toll-free)
410-415-6628
410-653-8709 (Fax)
kathleen.graham@firstcandle.org (E-mail)
http://firstcandle.org/health/health_support.html

American Academy of Pediatrics; American Public Health Association; National Resource Center for Health and Safety in Child Care.
Reducing the Risk of Sudden Infant Death Syndrome (SIDS). Applicable Standards from Caring for Our Children.
Elk Grove, IL: American Academy of Pediatrics. 2002.

This booklet presents the standards for SIDS prevention in childcare settings, providing critical information for childcare providers, government policy makers, health care consultants, and parents. It includes standards for caregiver qualification and training, proper sleep position, bedding, and reporting as well as related health policies. 12 references.

Available from:
American Academy of Pediatrics
141 Northwest Point Boulevard
Elk Grove Village, IL 60007-1098
(866) 843-2271 (publication orders)
(888) 227-1770 (outside the U.S. and Canada); (847) 228-1281
(847) 228-1281 (Fax)
hcca@aap.org (E-mail)
http://www.aap.org

Free full-text downloading available at: http://nrc.uchsc.edu/SPINOFF/SIDS/SIDS.htm

Sanders DB Ed.
Helping Children Grieve: Sudden Infant Death Syndrome.
Rancho Cordova, CA: California SIDS Program. 2001. 8 p.

This booklet is directed at persons who care for children who have lost a sibling to sudden infant death syndrome (SIDS), including parents, grandparents, childcare providers, clergy, teachers, and other friends and relatives. When a baby dies suddenly with no warning, the whole family must cope with confusing emotions. Surviving siblings need a way to express their feelings, they need help and support, and they need to feel loved and valued. The booklet discusses the types of emotions that children may feel while grieving for an infant sibling who has died, including fear, anger, guilt, and sadness. The booklet also discusses when parents or others should worry about a child's reactions to the death; the importance of everyone talking about the death; what one should and should not say about where the baby went; siblings' participation in the funeral; ways in which siblings can remember the brother or sister who died; and how the level of understanding of death differs with a child's age.

Available from:
California SIDS Program
11344 Coloma Road, Suite 560
Gold River, CA 95670-6304
(916) 851-7437
(800) 369-7437 (in CA)
(916) 851-5937 (Fax)
info@californiasids.com (E-mail)
http://www.californiasids.com

Sanders DB Ed, Tarano E trans.
Ayudando a los ninos con su pena: Sindrome de muerte infantil repentina [Helping Children Grieve: Sudden Infant Death Syndrome].
Rancho Cordova, CA: California SIDS Program. 1999. 13 p.

This booklet is directed at Spanish-speaking persons who care for children who have lost a sibling to sudden infant death syndrome (SIDS), including parents, grandparents, childcare providers, clergy, teachers, and other friends and relatives. When a baby dies suddenly with no warning, the whole family must cope with confusing emotions. Surviving siblings need a way to express their feelings, they need help and support, and they need to feel loved and valued. The booklet discusses the types of emotions that children may feel while grieving for an infant sibling who has died, including fear, anger, guilt, and sadness. The booklet also discusses when parents or others should worry about a child's reactions to the death; the importance of everyone talking about the death; what one should and should not say about where the baby went; siblings' participation in the funeral; ways in which siblings can remember the brother or sister who died; and how the level of understanding of death differs with a child's age.

California Department of Health Services, Maternal and Child Health Branch
Sudden Infant Death Syndrome: What Childcare Providers and Other Caregivers Should Know.
Rancho Cordova, CA: California SIDS Program. 2001. 13 p.

This booklet provides child care providers with information about sudden infant death syndrome (SIDS). The booklet covers the following topics: basic facts about SIDS, to help reduce the risk of SIDS, emergency procedures the child care provider should follow in a suspected SIDS case, how the child care provider may feel after the death, the investigative process that the law requires after every unexplained infant death and questions that investigators will probably ask the provider, how to explain the death to the other children in the child care group, questions to expect from the parents of the SIDS victim, and questions to expect from other parents whose children also are in the provider's care. The booklet stresses over and over that no one is to blame for a SIDS death. A form for recording emergency telephone numbers is included.

California Department of Health Services, Maternal and Child Health Branch
Sindrome de muerte infantil repentina (SIDS): Lo que deben saber las guarderias infantiles y personas que cuidan ninos [Sudden Infant Death Syndrome (SIDS): What Childcare Providers and Other Caregivers Should Know].
Rancho Cordova, CA: California SIDS Program. 2001. 13 p.

This booklet provides Spanish-speaking child care providers with information about sudden infant death syndrome (SIDS). The booklet covers the following topics: basic facts about SIDS, emergency procedures the child care provider should follow in a suspected SIDS case, how the child care provider may feel after the death, the investigative process that the law requires after every unexplained infant death and questions that investigators will probably ask the provider, how to explain the death to the other children in the child care group, questions to expect from the parents of the SIDS victim, and questions to expect from other parents whose children also are in the provider's care. The booklet stresses over and over that no one is to blame for a SIDS death. A form for recording emergency telephone numbers is included.

Moon RY, Biliter WM, Croskell SE.
Examination of State Regulations Regarding Infants and Sleep in Licensed Child Care Centers and Family Child Care Settings.
Pediatrics 107(5): 1029-1036, May 2001.

Twenty percent of sudden infant death syndrome (SIDS) occurs in childcare settings. Although the incidence of SIDS in the United States has decreased with increased awareness of the risks of prone infant sleeping, smoke exposure, soft bedding, and unsafe sleep environments, avoidance of these risk factors is not universally practiced in child care settings. Advocacy through state childcare regulatory agencies and legislative bodies may be effective in more widespread awareness and avoidance of risk factors. The objective of this study was to determine what individual state regulations for licensed child care centers and family child care settings exist regarding: 1) sleep positions for infants under 6 months old, 2) crib safety, 3) bedding safety, and 4) smoking in the facilities. A descriptive survey of regulations for licensed childcare centers and family childcare settings in the 50 states and the District of Columbia were examined. Fifteen states use regulations adopted before publication of the first policy statement of the American Academy of Pediatrics on infant sleep position and SIDS in 1992. Six states require childcare centers to place infants non prone. Sixty-three percent of states require cribs in child care centers to meet at least one safety standard, and 45.1 percent require this in family child care homes. Six states have provisions limiting the use of soft bedding in child care centers, and four have such bans for family child care homes. Seventy-one percent of states prohibit smoking in childcare centers during hours of operation; 17 percent of states have similar requirements for family childcare homes. It was concluded that many states use childcare regulations that were written before the initial policy statements of the American Academy of Pediatrics regarding safe sleep environments for infants. Even those more recently adopted regulations do not adequately address sleep safety for infants. Pediatricians need to become more proactive in promoting safety regulations in child care. Adoption of new regulations can aid in education of childcare providers and, thus, improve the safety for infants in childcare.

Free full-text downloading available at: http://pediatrics.aappublications.org/cgi/reprint/107/5/1029

National SIDS /ID Program Support Center (NSIDPSC), Infant Mortality Risk Reduction Work Team
Sudden Infant Death Syndrome and the Child Care Provider.
Rockville, MD: Health Resources and Services Administration (DHHS/PHS), Maternal and Child Health Bureau. April 2000. 4 p.

This brochure is intended to educate childcare providers about SIDS and its risk factors. Childcare providers who do not follow current recommendations for infant sleep position and bedding may be subject to legal action if an infant dies of SIDS while in their care. The law requires a police investigation in all cases of unexplained death. Providers who have lost an infant to SIDS will be questioned by the police as well as by licensing and insurance agencies. The police investigation may be difficult for the provider and others close to the infant, but it is important in that it helps determine the cause of the infant's death, helps everyone learn more about SIDS and other causes of infant death, and confirms that no one was to blame for the infant's death. Childcare providers can prepare for the possibility that an infant is found unresponsive in their care by being educated in emergency procedures by their local SIDS program, maintaining up-to-date infant CPR certification, and conducting practice drills on what should be done if an infant is found unresponsive in their care. Childcare providers should discuss infant sleep position with all the parents they deal with, and they should have specific policies to address the issue. Nine important recommendations for reducing the risk of SIDS are included.

Available from:
National SIDS/ ID Program Support Center (NSIDPSC)
1314 Bedford Avenue, Suite 210
Baltimore, MD 21208
(800) 221-7437 (Toll-free)
(410) 415-6628
(410) 653-8709 (Fax)
kathleen.graham@firstcandle.org (E-mail)
http://firstcandle.org/health/health_support.html

Free full-text downloading available at: http://firstcandle.org/FC-PDF3/sids%20&%20child%20care%20provider.pdf

Moon RY, Patel KM, McDermott-Shaefer SJ.
Sudden Infant Death Syndrome in Child Care Settings.
Pediatrics 106(2): 295-300, August 2000.

The incidence of sudden infant death syndrome (SIDS) in the United States has decreased with decreased prone sleeping. Extrapolating from Census Bureau data, ~7 percent of SIDS should occur in organized childcare settings (i.e., child care centers or family child care homes). However, 2 states have reported higher rates of SIDS in childcare. The objective of this study was to determine the percentage of SIDS deaths occurring in childcare settings, and to ascertain associated factors. A retrospective study of SIDS deaths from January 1995 through June 1997 was conducted. Data were abstracted from SIDS databases in 11 states. Characteristics of SIDS cases occurring in child care settings, including sleep position, were compared with those occurring in the care of parents. Univariate and multiple logistic regression analyses were performed. Results showed that out of a total of 1916 SIDS cases analyzed for this study 20.4 percent death occurred in child care settings. Compared with deaths in the care of parents, those occurring in child care settings were more likely to occur on weekdays between 8:00 AM and 4:00 PM; infants were older; not black; and their mothers were more educated. Infants in childcare were more likely to be found prone in univariate analysis, but the association was not significant in multiple logistic regression analysis. However, in multiple regression analysis, infants in childcare were more likely to be last placed prone or found prone, when the usual sleep position was side or supine. Conclusions indicate a large proportion (20.4 percent) of SIDS cases occur in childcare settings. Factors associated with SIDS in childcare settings include older age, race, and highly educated parents. Previous studies have reported that unaccustomed prone sleeping puts infants at high risk with SIDS in childcare and may partly explain the high proportion of SIDS cases in child care settings. Parents must discuss sleep position with any caretakers of their infants. In addition, further efforts to educate childcare providers about the importance of supine sleep for infants must be ongoing.

Free full-text downloading available at: http://pediatrics.aappublications.org/cgi/reprint/106/2/295

California Department of Health Services, Maternal and Child Health Branch
Sudden Infant Death Syndrome: Training Guide for Training of Emergency Personnel
Rancho Cordova, CA: California Sudden Infant Death Syndrome Program. 2000.

This trainer’s guide is intended to prepare emergency personnel for their role in supporting SIDS family members, childcare providers, foster parents, and other caregivers at a critical time. This guide provides tools needed to present a series of training modules on SIDS. Each module can be presented individually at different times or in one session for a total training time of two hours. Guide is organized into six chapters.

Cullen A, Kiberd B, McDonnell M, et al.
Sudden infant death syndrome--are parents getting the message?
Irish Jrl Medical Science 169(1):40-43, Jan-Mar 2000.

Background: Factors that place an infant at increased risk of sudden infant death include the prone sleep position, overheating and parental smoking, while practices such as bottle-feeding, co-sleeping and the use of pacifiers remain controversial. Major publicity campaigns have been undertaken, which have included the distribution of printed material and extensive media coverage. Aims: To examine if Irish parents follow the currently recommended childcare guidelines to reduce the risk of sudden infant death and to examine factors that may have impact on their acceptance. Methods: A random selection of 197 infants from the Birth Register of the Eastern Health Board. Parents were interviewed and a semi-structured survey questionnaire was completed. Results: Forty one per cent of infants are still placed on their side to sleep, an inherently unstable position. First time parents are more likely to place their infants on their backs. Over 60% of infants are exposed to one or more adults smoking in the home despite parental knowledge of its association with sudden infant death syndrome (SIDS). Sixty eight percent of infants are over wrapped at night and parental understanding of what constitutes over wrapping is poor. Thirteen per cent of infants regularly co-sleep with their parents and 20% of these parents smoke. Pacifier use is common. Conclusions: Future programmes should target first time parents, should provide clear information regarding appropriate infant thermal environment, and should ensure regular updating of medical personnel so that they can instruct families on best current practice. Smoking remains a significant health issue with an impact on sudden infant death.

For Full-text: http://www.ijms.ie/Portals/_IJMS/Documents/169140.pdf

Moon RY, Biliter WM.
Infant Sleep Position Policies in Licensed Child Care Centers after Back to Sleep Campaign.
Pediatrics 106(3): 576-580, September 2000.

Background: Since the Back to Sleep (BTS) campaign was initiated in 1994, the rate of prone sleeping has decreased to approximately 20 percent. However, childcare centers may have an increased rate of prone sleeping in infants. In 1996, a study of licensed childcare centers demonstrated that 43 percent were unaware of the association between sudden infant death syndrome (SIDS) and prone sleeping and that 49 percent positioned infants prone. Objective: To determine effectiveness of a mailing from the BTS campaign to licensed child care centers by assessing the following: 1) child care center awareness of the recommendations of the American Academy of Pediatrics regarding infant sleep position and 2) implementation of the recommendations of the American Academy of Pediatrics in child care center practice. Design: A descriptive, cross-sectional survey of licensed childcare centers in the metropolitan Washington, DC, region. All licensed child care centers caring for infants <6 months old in Washington, DC, and Montgomery, Prince Georges, Howard, Anne Arundel, Frederick, and Charles Counties in Maryland were recruited for the study. Results: Out of 236 eligible centers, 172 completed the survey. Seventy-five percent (129) of the centers were aware of recommendations regarding infant sleep position. Infants were placed prone in 27.9 percent of centers, although only 2.9 percent placed infants exclusively in the prone position. The most common reasons for avoiding prone position entirely were SIDS risk reduction and licensing regulations. Half of the centers had a written policy regarding sleep position. Twenty centers who were aware of the dangers of prone sleeping continued to place infants prone at least some of the time, largely because of parental request. Only 56.9 percent of centers had heard of the BTS campaign despite the mass mailing. The mailing resulted in policy change for 14 centers. Conclusions: Since 1996, the percentage of licensed child care centers in the greater Washington, DC, area that are aware of the association between SIDS and infant sleep position has increased from 57 percent to 75 percent. In addition, the rate of placing infants prone in these centers has declined from 49 percent in 1996 to 27.9 percent in this study. When childcare centers are aware of the risk of prone sleeping, the most likely reason for continued prone placement is parental request. Although media and mailings have been largely effective in communicating BTS information to many childcare centers, non prone positioning is not universal among childcare providers. Additional educational efforts toward child care providers and parents remain necessary.

Free full-text downloading available at: http://pediatrics.aappublications.org/cgi/reprint/106/3/576

First Candle/SIDS Alliance
Sudden Infant Death Syndrome: Surviving the Death of a Baby.
Baltimore, MD: SIDS Alliance. 2000. 11 p.

Free full-text downloading available at: http://firstcandle.org/FC-PDF3/surviving.pdf

Nelson EAS, Taylor BJ, et al.
International Child Care Practices Study: Infant Sleeping Environment.
Early Human Development 62(1): 43-55, April 2001.

The International Child Care Practices Study (ICCPS) has collected descriptive data from 21 centers in 17 countries. In this report, data are presented on the infant sleeping environment with the main focus being sudden infant death syndrome (SIDS) risk factors ( bed sharing and infant using a pillow) and protective factors (infant sharing a room with adult) that are not yet well established in the literature. Using a standardized protocol, parents of infants were surveyed at birth by interview and at 3 months of age mainly by postal questionnaire. Centers were grouped according to geographic location. Also indicated was the level of SIDS awareness in the community, i.e., whether any campaigns or messages to "reduce the risks of SIDS" were available at the time of the survey. Results showed that birth interview data were available for 5488 individual families and 4656 (85 percent) returned questionnaires at 3 months. Rates of bed sharing varied considerably (2-88 percent) and it appeared to be more common in the samples with a lower awareness of SIDS, but not necessarily a high SIDS rate. Countries with higher rates of bed sharing appeared to have a greater proportion of infant’s bed sharing for a longer duration (>5 h). Rates of room sharing varied (58-100 percent) with some of the lowest rates noted in centers with a higher awareness of SIDS. Rates of pillow use ranged from 4 percent to 95 percent. Conclusions showed that it is likely that methods of bed sharing differ cross-culturally, and although further details were sought on different bed sharing practices, it was not possible to build up a composite picture of "typical" bed sharing practices in these different communities. These data highlight interesting patterns in childcare in these diverse populations. Although these results should not be used to imply that any particular childcare practice either increases or decreases the risk of SIDS, these findings should help to inject caution into the process of developing SIDS prevention campaigns for non-Western cultures.

Full-text available at: http://www.sciencedirect.com/science/journal/03783782

Green, M. and Palfrey, J. S. (Eds.).
Bright Futures: Guidelines for health supervision of infants, children, and adolescents. (2nd ed.) (Rev.).
Arlington, VA: National Center for Education in Maternal and Child Health, 2001. 338 pp.

These Bright Futures guidelines provide health professionals and families with practical information, effective preventive techniques, and health promotion materials. The guidelines begin with a brief description of the Bright Futures program and an introduction to health supervision. Individual chapters focus on infancy, early childhood, middle childhood, and adolescence. Each chapter covers age-specific information about the preparation families can do before a health visit, strengths and issues of the age group, and developmental charts. Appendices include (1) the Bright Futures periodicity schedule, (2) medical history, (3) recommended immunization schedule, (4) hearing screening, (5) vision screening, (6) iron-deficiency anemia screening, (7) screening for elevated blood lead levels, (8) hyperlipidemia screening, (9) hypertension screening, (10) tooth eruption chart, (11) sexual maturity ratings, (12) sexually transmitted disease prevention and screening, (13) safe, quality child care, (14) a bibliography, and (15) a list of participants in the first edition of these guidelines. [Funded by the Maternal and Child Health Bureau]

Free full-text downloading at: http://www.brightfutures.org/bf2/pdf/index.html.

National Conference of State Legislatures

This website provides summary of Sudden Infant Death Syndrome (SIDS) laws from 50 states. Offers a brief description of each law with links to more information.

http://www.ncsl.org/programs/health/sidsleg.htm

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