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Nighttime child care: inadequate sudden infant death syndrome risk factor knowledge, practice, and policies
Rachel Y Moon1, Debra E Weese-Mayer, Jean M Silvestri
1Division of General and Community Pediatrics, Children's National Medical Center, Washington, DC 20010, USA. rmoon@cnmc.org
Insights
Twenty percent of nighttime child care centers place infants in the prone position, despite Back to Sleep recommendations. Improved education on safe sleep practices is needed for providers and parents to reduce sudden infant death syndrome (SIDS) risks.
Area of Science:
- Pediatrics
- Public Health
- Child Care Research
Background:
- Millions of US children have parents working nonstandard hours, increasing demand for extended-hour and nighttime child care.
- Sudden Infant Death Syndrome (SIDS) is a concern, with 20% of cases occurring in child care settings.
- Child care providers' sleep position practices for infants require investigation due to potential risks.
Purpose of the Study:
- To assess adherence to Back to Sleep recommendations in nighttime child care centers.
- To determine awareness of safe sleep environments among providers.
- To evaluate the presence and effectiveness of written policies for SIDS risk reduction.
Main Methods:
- A descriptive, cross-sectional survey was conducted.
- Licensed US child care centers offering evening and nighttime care, specifically those with infants under 6 months old, were recruited.
- Data were collected from 110 centers across 27 states.
Main Results:
- Infants were placed prone in 20% of surveyed centers, often due to parental requests or concerns about infant comfort, despite SIDS risk reduction awareness.
- Only 18.2% of centers maintained uncluttered sleep environments.
- Written policies were present in 59% of centers, but their existence did not correlate with avoiding the prone position, and many providers were unaware of policy content.
Conclusions:
- A significant minority of nighttime child care centers continue to place infants prone, indicating a gap in awareness or misinformation regarding safe sleep environments.
- While the Back to Sleep campaign has raised awareness, universal adoption of non-prone positioning is not achieved.
- Enhanced educational initiatives for child care providers and proactive parental advocacy are crucial for improving infant safe sleep practices in child care settings.
Background:
Millions of children in the US have parents who work alternative shifts. As a result, extended-hour and nighttime child care centers have increased in number to meet the needs of parents working nonstandard hours. Recognizing that 20% of sudden infant death syndrome (SIDS) occurs in child care settings and that child care providers may place infants prone, it is important to determine sleep position practices in nighttime child care centers.
Objective:
To determine if nighttime child care centers 1) follow Back to Sleep recommendations; 2) are aware of the need for a safe sleep environment; and 3) have written policies directing proper SIDS risk reduction practices.
Design:
A descriptive, cross-sectional survey of licensed child care centers in the US offering evening and nighttime care. All nighttime centers caring for infants <6 months old were recruited for the study.
Results:
Out of 153 eligible centers, 110 centers in 27 states completed the survey. Infants were placed prone in 20% of centers, although only 1 center placed infants exclusively prone. Infants slept in cribs in 53.6% of centers, but slept in uncluttered sleep environments in only 18.2% of centers. Smoking was prohibited in 86.4% of centers. The most commonly cited reason for avoiding prone altogether was SIDS risk reduction; however, 10 centers that cited SIDS risk reduction continued to place infants prone at least some of the time, because of parental request or concerns about infant comfort. Over half (59%) of the centers had written policies; however, presence of written policy was not associated with avoidance of prone position. In over one third of centers with written policies, providers were unaware of the content of the policy.
Conclusions:
Twenty percent of nighttime child care centers place infants prone at least some of the time. Most providers who place infants prone do so because of lack of awareness or misinformation about safe sleep environment. Although the Back to Sleep campaign has been effective in communicating the risks of sleeping prone, nonprone positioning is not universal among nighttime child care providers. Additional educational efforts toward child care providers remain necessary. In addition, parents as advocates for their own infants need to be proactive in assuring that safe sleep practices are implemented in child care settings.