Aug. 7, 2000 -- Here's one more thing for working mothers and fathers to worry about: A new study suggests that a significant number of the babies who die of sudden infant death syndrome (SIDS) do so while in the care of someone other than their parents. But experts say there's a simple way to ensure your child stays safe: Just make sure your day care provider knows to always put the baby to sleep on his or her back.
Putting babies to sleep on their stomachs is a major risk factor for SIDS, also known as crib death. Public awareness of this danger has increased dramatically in recent years, thanks in part to media campaigns that emphasize putting babies to sleep on their backs. But the study, published in the journal Pediatrics, suggests many child care providers are not getting the message.
"What we've found is that child care providers many times don't know that the back is the best position," study author Rachel Moon, MD, of Children's National Medical Center in Washington, tells WebMD. "Just as you would talk to the child care provider about what to feed the baby or what diapers to use on the baby, you need to talk to them about sleep position as well."
SIDS is the leading cause of death in the first year of life, affecting about 5,000 babies in the U.S. each year. Most SIDS deaths occur before 4 months of age. The National Institute of Child Health and Human Development says African-American babies are two to three times more likely than white babies to die of SIDS, and Native American babies are about three times more likely.
In Moon's survey of close to 2,000 babies who died of SIDS, 20% died while in day care, either in a center or in a home where a relative or other person was providing the child care -- a percentage the researchers call "disproportionatelyhigh, considering the number of infants reportedly in child care." Babies who died of SIDS in day care were more likely to be white; born to older, well-educated mothers; and have no history of exposure to secondhand smoke. The majority of deaths occurred during the week, between the hours of 8 a.m. and 4 p.m.
Compared with infants who died at home, infants who died in child care were twice as likely to be found on their stomachs, and were five times as likely to have been placed on their stomachs before their deaths. The survey also found that 82% of infants who died during their first week in child care were found on their stomachs.
Although some people still advocate putting babies to sleep on their sides, Moon says sleeping on the back is always preferable.
"What I tell parents is that until the baby can roll over, put your baby on the back," Moon says. If a baby is placed on his side, the lower arm should be brought forward as a brace to stop him from rolling over onto his stomach.
The American Academy of Pediatrics' campaign to raise awareness about the need to put babies to sleep on their backs has been extremely successful in reducing rates of SIDS in the last decade, says John Kattwinkel, MD, chair of the Task Force on Infant Positioning and SIDS. The National Center for Health Statistics indicates that the percentage of infants who sleep on their stomachs decreased from 70% in 1992 to 24% in 1996.
"The campaign has been very successful, but it's leveling off," Kattwinkel, a professor of pediatrics at the University of Virginia Health Sciences Center in Charlottesville, tells WebMD. "The SIDS rate is leveling off, as is the number of babies sleeping on their stomachs. This continues to be a matter of education."
The National Institute of Child Health and Human Development offers these additional recommendations to keep babies safe during sleep and curb the risk of SIDS:
- Make sure the baby sleeps on a firm mattress or other firm surface.
- Avoid using fluffy blankets or covering.
- Do not place pillows, sheepskins, blankets, or comforters under the baby.
- Do not put babies to sleep on waterbeds.
- Do not put soft, stuffed toys in a crib or near a sleeping baby.