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Is Your Day Care Safe for Sleeping Babies?


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May 11, 2001 -- The specter of sudden infant death syndrome, commonly called SIDS, looms large in the imagination of many a new parent. Fortunately, parents can follow a few simple steps, outlined by the American Academy of Pediatrics, or AAP, to reduce the risk of SIDS: Put infants to sleep on their backs; get rid of fluffy, soft bedding and unsafe cribs; and eliminate second-hand smoke.

But the simple message hasn't filtered down to everyone. Though some SIDS cases occur in child care centers and family child care settings, many of these facilities are still unaware of the need for SIDS risk reduction. A new survey, published in the May journal Pediatrics, found that state regulations for licensing these child care facilities and ensuring that these recommendations are put into practice do not adequately address the issue of sleep safety for infants.

"We know from past studies that 20% of babies die of SIDS at child care centers, and we also know that a lot of child care providers, for various reasons, don't put babies to sleep on their backs and don't follow other safety guidelines that the AAP and the Consumer Product Safety Commission [CPSC] have been recommending," study author Rachel Y. Moon, MD, tells WebMD.

"One way to educate child care providers is through the regulatory process, [so] we looked at what states are doing on a regulatory basis to make sure that babies in child care centers are safe when they take naps," says Moon. Moon is an assistant professor of pediatrics at George Washington University and a pediatrician at Children's National Medical Center in Washington, D.C.

The researchers reviewed each states' regulations concerning four areas of sleep safety: sleep position for infants under six months old, crib safety, bedding safety, and smoking in facilities. "What we found was that a lot of states don't really regulate this very heavily; a lot states have very old regulations," says Moon. "I think there are only six states that stated babies should be placed to sleep on their back or on their side."

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.

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