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Is Your Day Care Safe for Sleeping Babies?

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In 1992, the AAP issued its Back to Sleep program, which recommended that infants sleep on their backs. The program has dramatically reduced SIDS cases, but the AAP continues to make additional recommendations on safe sleep.

The AAP released more safe sleep recommendations in 2000. "They talked about bedding, smoking, room temperature," Moon says. "While we are not saying all should be part of [each state's] standards, the AAP sleep position has been out since 1992 -- almost 10 years -- and there are 15 states that still use regulations that were written before 1992."

In the U.S., 63% of states require child care center cribs to meet at least one CPSC safety standard -- which may include proper distance between the slats, no missing or cracked slats, a snug-fitting mattress, mattress support and all screws and bolts securely attached, and working latches -- and only six states had provisions limiting the use of soft bedding, as recommended by both the AAP and the CPSC.

The researchers found that 29% of states don't prohibit smoking in child care centers. Yet "there is more and more evidence that shows, besides sleeping [on the stomach], smoke is probably the next most important risk factor for SIDS, and we know that ... the more smoke a baby is exposed to, the higher the risk."

Just because state regulations fall short of the ideal doesn't mean that all day care and home care facilities are disasters waiting to happen, adds Moon. "The Back to Sleep [educational campaigners] in different states have done a lot of work in educating child care providers and have made a huge impact," she says, they just haven't been able to reach everybody.

Additionally, many of the large, well-known national chains have their own rules that go above and beyond state regulations. "Chains, larger centers, and centers that cater more towards infants are more likely to have standards about infant sleep," Moon says.

Jackie Legg is senior vice president of operations at Bright Horizons Family Solutions, a national provider of more than 350 early childhood programs, mostly in the U.S. "We always go along with state requirements, but in most every instance that relates to health and safety, we go beyond that," Legg tells WebMD.

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