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The American Academy of Pediatrics' Safe Sleep (formerly called Back to Sleep) program, which began encouraging caregivers to put infants to sleep on their backs in 1995, is generally considered responsible for an over 50 percent drop in SIDS rates from 1995 to 2005.
But though infants are far less likely to die of what used to be called "crib death" in general, it has emerged that there is a particularly risky time in an infant's life: the first week of daycare. Sleep experts now know that approximately 20 percent of SIDS deaths happen in childcare settings, most commonly in the first week.
It's a scary statistic for parents already nervous about leaving their infants. But you're not helpless, and you're not alone. There are many things you can do to ensure your nanny, sitter, or childcare provider follows safe sleep practices.
Why does it happen?
It's notable that so many of the approximately 1,500 yearly SIDS deaths occur while babies are being cared for by a non-parent, because a child spends so much less time sleeping with the carer during the day than at night with parents. Plus, as the most relevant study to date found, infants "who die in child care have 'low risk' demographics: Caucasian; older, more educated parents; more likely to be in a crib without pillows or blankets; and less likely to have secondhand or in utero smoke exposure."
The answer may lie with the stress and disruption of sleep patterns during the transition into child care.
As the AAP says, many infant deaths occur when babies used to sleeping on their backs are placed to sleep on their tummies by a different caregiver. Babies who experience this "unaccustomed tummy sleeping" are 18 times more likely to die from SIDS.
In a study of babies under 3 months who began going to licensed child care centers, two researchers found that the babies’ typical sleep habits were generally disrupted as they transitioned to the new environment. Levels of cortisol, a.k.a. the “stress hormone,” were also higher during this transition time, and the infants’ day and nighttime rhythms were thrown off. The result? A higher risk of SIDS during this crucial transition period.
Krista Cossalter Sandberg, Executive Director Northwest Infant Survival & SIDS Alliance, notes that "Babies are sensitive to change. If they’ve always been put to sleep on their backs alone in the crib; if they've always been in a sleep sack and they're suddenly given a blanket; if they're put in a new sleep environment, there are issues."
What can you do?
Make certain that whoever is watching your baby knows about ,and follows, safe sleep practices, no matter if it’s the most expensive daycare in town or your own mom, best friend, or cousin.
SIDS experts point out that employees of licensed daycares are more likely to have had safe-sleep training.
"Some states have very rigorous standards, some do not. Unlicensed care is more of a roll of the dice. You don't have the oversight of the state," says Michelle McCready, Chief of Policy for Child Care Aware of America, the national member organization for child care agencies.
"Do your own inspection," McCready says. "Make sure the area where your child sleeps has fitted sheets, a firm mattress, the temperature in the room is not too hot, the area should be visible to your caregiver. Children should not be put on tummies and there shouldn’t be any objects in the crib: blankets, toys."
Child Care Aware of America has a comprehensive checklist that will help parents remember what to look for.
Typically, says McCready, parents provide sleeping clothing: a swaddle, a sleep sack. This should be used, and children should sleep on a firm mattress clear of any objects.
Need some help getting the conversation started or in making sure you've covered safe sleep thoroughly with your caregiver? Many agencies put out safe sleep literature you can print and bring with you when you visit your caregiver to discuss safe sleep.
The National Institute of Child Health and Human Development is a good place to look, as is the AAP's Healthy Child Care America program. If there is a language barrier between you and your care provider, many brochures are available in Spanish and use lots of pictures to illustrate safe sleep practices.
It may feel awkward to bring a brochure to someone who’s presumed an expert; one way to think about it is, you and your daycare are partners in your child’s wellbeing, and part of that is confirming you’re all on the same page.
Start looking for care during pregnancy
Why? Because not only are there frequently waiting lists for high-quality spaces – McCready says she’s seen 2-3 year waiting lists in some urban areas – but checking out a facility’s safety record can take some time.
Depending where you live, finding out about serious violations, even infant deaths, can be quite difficult. Sandberg tells a hair-raising story about a reporter who tipped her off that a second infant death had occurred in a local family in-home daycare center. “She’d had 30 violations in between the 2 deaths,” says Sandberg.
In one widely reported case, Shepard Dodd's daycare provider had been warned just 11 days before his death that car seats were not safe places to put children to sleep. But his parents never knew that, until after their son's death.
All licensed daycare agencies are inspected regularly (how often depends on your state's rules), and records of those inspections, complaints logged against facilities, and results of investigations are kept. Finding them is usually a matter of calling or visiting your local Child Care Resource and Referral Agency or accessing an online database.
Child Care Aware has a great map of the United States that's a good place to start.
Sounds easy enough, right? Not so much. I spent over an hour online and on the phone getting the details on just one citation on one facility local to me. It turned out to be two protruding screws in an area accessible to children.
No big deal, immediately fixed, but I had to make a bunch of phone calls and wait on hold to find that out. And while a new federal law may make that information more accessible soon, it’s not in place yet. So don’t delay.
Opinions expressed by parent contributors are their own.