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Is Your Day Care Safe for Sleeping Babies?

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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.

"We support the AAP's sleeping position statement, and we actually require parents to sign a release if they don't want us to do that," says Legg. "There is a fine line between doing [back to sleep] and accommodating parents' specific wishes. We let them know the research on the implication of children sleeping on their stomachs and SIDS."

She says Bright Horizons' position on stuffed animals and soft bedding is similar: They can educate parents, but if someone insists on a certain stuffed animal, they allow it.

Both Legg and Moon say that a parent can -- and should -- play a big role in making sure their child benefits from safe sleep practices.

"Parent involvement is the key to everything in ensuring they get the kind of care they want for their children," says Legg. "I think it is perfectly allowable for parents to have conversations with their providers, whether it is a family day care provider or a center, to ask to see copies of their policies and procedures related to safety and health, to ask questions, and certainly to give directions to the caregiver on sleeping positions."

She says parents also should request that smoking not be allowed near their children. "They can certainly make those kinds of requests even if it is not a policy of the facility they are using. It could be that the facility says, 'we can't do that,' and that would be a decision point for the parent," says Legg.

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