Sunday, 19 June 2011

SIDS: Missouri child-care facilities must put babies on backs to sleep

SIDS Resources of Missouri recommends the following sleep practices to protect children up to a year in age from sudden infant death syndrome or accidental suffocation:
• Practice the ABCs of safe sleep: Babies should sleep Alone, on their Backs in a safety-approved Crib at nighttime and nap time.
• Babies should not be exposed to smoke, and mothers should not smoke during pregnancy.
• Nothing should be in the crib except the baby — no wedges, bumper pads, pillows, stuffed animals, quilts or blankets.
• Consider using a wearable blanket, such as a sleep sack or footed sleeper, instead of blankets.
• The mattress should be firm and well-fitted. If more than two fingers can be placed between the side of the mattress and the crib, the mattress is too small.
It's been 15 years since the American Academy of Pediatrics first recommended putting babies on their backs to sleep to prevent sudden infant death syndrome and accidental suffocation.
Yet, until now, Missouri has failed to incorporate the potentially life-saving practice in any of its child care licensing rules.
That's why SIDS prevention advocates are celebrating a forthcoming state rule that requires licensed child-care facilities in the state to place infants a year and under on their backs at nap time.
"This is a very important rule," said Lori Behrens, executive director of SIDS Resources of Missouri. "We're glad we have it on the books, and it gives us the lead that we need to get in with child-care providers — especially those home-care providers — to do our education on safe sleep."
The rule is in addition to another new one that child safety advocates said has long been lacking: At least one staff member trained in CPR must be on duty at all times in both licensed centers and licensed home day cares.
In an interview earlier this spring, Margaret Donnelly, director of the Missouri Department of Health and Senior Services, said both rules were highly significant and would save lives. The department regulates child care in the state through its Section for Child Care Licensing.
The "back-to-sleep" rule is expected to go into effect by late summer and the CPR regulation by January 1. They will affect about 2,200 centers and another 1,440 licensed home-based child cares. From 2007 to 2009, the Missouri Child Fatality Review Program, which reviews unexpected deaths in young children in Missouri, recorded two infant deaths in licensed child care facilities because of SIDS or suffocation.
The new rules do not, however, apply to the unknown number of legally unlicensed home-based child-care businesses in Missouri, estimated to number well over 5,000, nor to the 670 faith-based child-care centers in churches and other settings that are exempted from licensing in Missouri.
Nevertheless, it's a start, say advocates of quality child care, many of whom have been waiting for such changes.
Missouri has not had a wholesale revision of its child-care rules in two decades. Efforts within the past five years by the state to update those rules have faltered because of budget cuts, changes in leadership and concerns on the part of smaller providers about costs and the scope of regulation. About two years ago, state licensing officials lost funding for consultants to help with the effort, because of state revenue shortfalls. Officials said then that the state would attempt to do the revisions piece by piece.
The new back-to-sleep and CPR requirements are the first new rules to come out of that process. Another rule mandating disaster plans is still under review by the state. Those plans would deal with evacuations, lockdowns and other procedures in the event of weather disasters, fires, kidnapping, bomb threats or other emergencies.
"We are very pleased that child-care licensing has taken this step in the right direction," said Carol Scott, executive director of Child Care Aware of Missouri. "But it's been 20 years almost since we revised the licensing rules in Missouri, and we've learned a lot in 20 years. Over that time, organizations like the American Academy of Pediatrics have made strong suggestions about better protections for children. Missouri hasn't kept up with those recommendations."
Many established licensed child-care providers — particularly accredited ones with independent reviewers — have been abiding by the back-to-sleep rule on their own for more than a decade.
"If I'm giving advice out to parents, I tell them, 'You just need to put your child to sleep on their backs,'" said Lynn Navin, director of the University Child Development Center on the campus of the University of Missouri-St. Louis, which has had such a policy for years. "Too many children are dying because of policies that could be in place that are not."
Susan Horn, head of school of the Downtown Children's Center in St. Louis, said that most of her parents expected to have a back-to-sleep policy and that the center had had one for years. The center posts the policy and prevention message in its handbook, its enrollment papers and on posters in all its classrooms, she said.
"I actually was surprised it wasn't a licensing rule," Horn said. "Just, to me, it's obvious."
But such practices aren't always adhered to in child care — particularly in home-based child care businesses where providers often aren't regulated, have little or no training and are generally older. Until this rule, it had not been a given that licensed centers and homes were adhering to back-to-sleep practices.
National researchers on SIDS have long lamented that most children are dying in home-based care, where providers put babies on their tummies for naps because that is how they raised their babies years ago.
A study nearly a decade ago by Rachel Moon, a pediatrician and SIDS researcher with Children's National Medical Center, determined that 20 percent of all SIDS deaths occur in child care, when that rate should be about 8 percent given babies sleep more hours at home than in child care.
Behrens, of SIDS Resources, said the back-to-sleep rule should be just a start.
"I think that every child-care provider should receive training on exactly what safe sleep means, and that every center and home should have a safe sleep policy — something in writing that says this baby will sleep on their back," she said.
She notes that SIDS Resources also does not recommend crib bumpers or any other type of suffocation hazard in a crib, and advises parents to use blanket sleepers or wearable swaddlers instead of plain blankets.
Navin has personal experience. In the 1980s — long before current research about SIDS prevention — an infant died of SIDS during her first job in a child-care center in another state. When a parent asks Navin to put her child on his or her tummy for a nap because that is what they do at home or the child sleeps better, Navin has no problem saying no.
"It's been 25 years, and I can still see that little baby that was dead in the crib, and I won't do it. I won't."

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