Protecting Infants in Our Care from SIDS

What Are the Risk Factors for SIDS?

We don’t know exactly what causes death in cases of SIDS. However, several factors have been identified which appear to increase the chances that an infant will die of SIDS. By eliminating these risk factors from our homes and child care environments; we greatly reduce the risk of SIDS among the infants in our care. Parents and caregivers need to understand the important principles of SIDS prevention, including the following:

Infants should never sleep on their tummies. Infants who sleep in the prone position (on their tummies) are at increased risk for SIDS. Parents and caregivers are strongly advised to place infants on their backs for any sleep, at nap time and at night. Never position an infant on his tummy or on his side for sleep. Tummy time is important, and infants do benefit from spending some time in a prone position while they are awake and alert. This allows them to develop the shoulder, arm and neck muscles that they will need later for crawling and turning over. But it is very important that tummy time occur only when an infant is awake and under the watchful eye of a parent or caregiver.

Babies should sleep on a firm, smooth surface. It is important that infants be placed on a smooth and firm sleeping surface, not on a fluffy or soft surface such as sofas, waterbeds and soft mattresses. Heavy plush items such as comforters, stuffed toys or pillows should never be placed in the crib with a baby. The presence of loose fluffy items in the crib or placement of the baby on too soft a surface increases the risk of SIDS.

Don’t over-heat the house or over-dress babies. Infants, who are dressed in too many layers of clothes, have too many heavy blankets on, or sleep in very hot rooms are at higher risk for SIDS. In general, infants need the same number of layers as the adults and older children in the same environment need for warmth and comfort. When an infant is sleeping, provide a light blanket, loosely placed over the baby below shoulder level. Don’t cover babies with plush comforters or heavy quilts.

No smoking where infants sleep, live and play. Infants who are exposed to smoke at home or in child care have a higher chance of dying from SIDS. Infants born to mothers who smoked during pregnancy are also at a higher risk.

Co-sleeping with siblings or others puts infants at higher risk of dying from SIDS. The risk is also elevated if the infant is co-sleeping with individuals under the influence of drugs or alcohol. The Amer- ican academy of Pediatrics (AAP) recommends that infants sleep in a separate crib or bassinet.

What Can Child Care Providers Do?

Educate families. By educating families and program staff, and by openly discussing SIDS prevention (along with other important health topics), providers have an important role in SIDS prevention. Such efforts can reduce the risk of SIDS among the infants in care during child care program hours and can also influence the health and safety of children at home. Most parents consider child care providers to be trustworthy experts in children’s health, development and safety. Share your experience and expertise freely with parents. Include the importance of SIDS prevention in your health policies and share resources.

Create and enforce program policies, which reduce risk. Program policies should reinforce the principles of SIDS prevention. Program staff must be trained in these principles and compliance with policies should be closely monitored. Such policies include:

• Back to Sleep Policy. Make it an absolute rule that all infants in your care must be placed on their backs for sleeping (unless the child has a note from health care provider specifying otherwise). Hang “Back to Sleep” posters on the wall in the nap area to promote the policy. Train all staff in the importance of this rule and monitor nap time to be sure it is followed. Discuss the Back to Sleep Policy with the parents of infants during the enrollment process.
• No Smoking where children are present. California’s Community Care Licensing regulations specify that “smoking is prohibited on the premises” of all licensed child care facilities, including both child care centers and family child care homes. All children must be protected from the effects of second hand smoke, which can include increased risk of SIDS as well as increased risk of respiratory illnesses or symptoms.
• Keep cribs free of plush items. Place infants on smooth, firm bedding at nap time. Don’t place stuffed toys, pillows, comforters or quilts in their cribs. Cover sleeping infants loosely with light blankets only.
• Ambient temperature policy. To avoid over-heating infants, dress them in comfortable clothes; don’t bundle them up in too many warm layers. Keep infants’ sleeping area at a comfortable ambient temperature, not too hot. The National Standards recommend maintaining the indoor temperature between 65° and 75° in winter and between 68° and 82° in summer inside child care facilities (AAP, 2002). Assess children’s warmth and need for more or less layers of clothes or coverings by feeling their fingers, toes, and nose (the baby should be should be feel warm but should not be perspiring or panting at rest).

For assistance in creating health policies in your program which address SIDS prevention and for resources to use in educating families and staff, call the Child Care Healthline at 800-333-3212.

References and Resources

AAP, APHA & MCHB (2002). Caring for our children: National health and safety performance standards: Guidelines for out-of-home child care programs. Online at http://nrc.uchsc.edu/CFOC/index.html.

Centers for Disease Control and Prevention. SIDS Information Index at www.cdc.gov/reproductivehealth/SIDS/index.htm.

AAP Task Force on Sudden Infnt Death Syndrome (2005). Policy Statement online at www.aap.org

National Institute of Child Health and Human Development (NICHD). Fact sheet: Sudden infant death syndrome. Accessed online at www.nichd.nih.gov/publications/pubs/sidsfact.htm.