Cases involving SIDS (Sudden Infant Death Syndrome) or SUID (Sudden Unexpected Infant Death) at child care facilities often call for strict scrutiny of the facility’s programs, policies, and procedures related to providing a safe sleeping environment. In this article, Child Care Operations & Child Supervision Expert, Janice Inman describes the standard of care for preventing infant crib death incidents in child care settings.
LOWERING THE RISK OF SIDS IN CHILD CARE SETTINGS – EXPERT ARTICLE
The first year of an infant’s life is a developmentally critical period, and SUID can occur any time from 1 to 12 months of age. SIDS, also known as crib death, is a sub-category of SUID and usually occurs during the first 4 months of life. SIDS accounts for 46% of the 4,000 SUID incidents occurring annually in the United States. In addition to SIDS, other SUID infant sleep-related fatalities resulted from the presence of entrapment or entanglement elements in the infant’s sleep environment.
The American Academy of Pediatrics (AAP) published safe sleep recommendations for infants, which initiated a campaign during the 1990’s to educate the general public about crib death. This effort evolved in 2012 into the “Safe to Sleep Campaign,” which has helped to decrease the number of crib deaths in the US. The “Safe to Sleep Campaign” promotes placing babies on their back (supine position), not their stomach (prone position), whenever baby is sleeping, as well as providing safe sleep environments for infants. The AAP safe sleep recommendations are supported by many organizations, including the U.S Department of Health and Human Services (HHS), the Centers for Disease Control and Prevention (CDC).
Throughout the course of my 40 year career, infant care programs made every attempt to reflect what was known to be the best practices at the time. With continued research and updated AAP recommendations regarding SIDS, childcare programs adjusted their infant sleep practices. For instance, prior to and in the early 1990’s, it was not uncommon for daycare infant classrooms to have an attached “napping/crib room.” Infant caregivers would look in on a sleeping baby in their care, or for a group of sleeping babies, a designated caregiver was assigned to “cover” the napping room.
Crib designs included a drop down side, and babies often slept in their crib with a special blanket, small pillow, or stuffed toy which was brought from home. Parents were routinely asked about their baby’s preferred sleeping position; to be placed on tummy or back? To assist with sleep, young infants would be swaddled, and caregivers would routinely cover babies with a blanket and pat their back. Through ongoing scientific research and analysis, juvenile equipment, products and safe sleep practices in regard to infant daycare practices have since changed. This has resulted in revised state licensing regulations that identify safer sleep practices for infant programs.
SIDS deaths have declined, however do continue to occur. Statistics indicate that as many as 20% of fatal crib incidents occur within child care settings and the risk of SIDS is higher for a younger infant who has recently entered into a new out-of-home child care setting (Human Resources and Service Administration). Thus, it is vital that the child care pre-enrollment process includes gathering information regarding the infant’s sleeping routine (including sleep positioning), medical history, individual preferences and temperament, and that a relationship of open communication is developed between the infant’s parent/guardian and child care provider. These will help to foster safe sleep practices both at home and in the child care setting.
Evaluating Safe Sleep Programs, Policies, and Procedures in Child Care Settings
The policies and procedures of child care facilities are shaped by state licensing regulations, national standards, and industry best practices, which together establish the standard of care. Within the context of a forensic investigation, our experts commonly investigate a range of relevant issues, including:
Policies and Procedures:
- Implementation and enforcement of an Infant Safe Sleep Policies and practices that require infants be placed on their back (supine position) only, and not on their side or their stomach (known as a prone position) for sleep
- Use of firm crib sleep surfaces that meet CPSC safety standards
- Exclusion of pillows, blankets, soft bedding, toys, bumper pads, and other items from the crib/ sleeping environment.
- Prohibition of the covering of the head or face of a sleeping infant with a blanket.
- Implementation of a signed waiver policy for any infant, who has a medical condition that prohibits them from being placed on their back for sleep.
- Development of procedures for the supervision of napping infants
- Supervision of the infant caregiver staff
- Elimination of possible entrapment or entanglement risks from the infant sleep area environment, (i.e. window bind cord, suspended crib mobile, pacifier or clothing strings, gap between crib and mattress).
- The location and visibility of cribs in the classroom.
- Guidelines for infant room temperature to keep baby from becoming overheated.
- Staff training including pre-hire and annual refresher-training that is specific to SIDS, infant safe sleep environments, safe sleep practices, and shaken baby syndrome.
- Establishing a primary caretaker structure for infant/toddler teachers.
CRIB DEATH INVESTIGATIONS
The Child Care and Supervision experts at Robson Forensic can assist in the review and examination of the program structure, policies, procedures, equipment, staffing, and supervision provided as it relates to the program’s infant sleep environment, in cases where a crib death has occurred.
To connect with an expert about your case, submit an inquiry or call us at 800.813.6736.
Childcare Operations & Child Supervision Expert
Janice Inman is a childcare and supervision expert with over 40 years of experience teaching pre-school through Junior Kindergarten, as well as serving as Director for large childcare facilities. In the course of her career, Janice worked as a teacher, School-age Extended care Director, Preschool Director, and Childcare Center Director at a number of private schools and child care centers, as well as experience in directing corporate childcare facilities. Her overall job responsibilities include, among others, thorough knowledge of licensing regulations, health and safety compliance, enrollment management, community involvement, educational programming, and the hiring, retention and training of staff & faculty.
1. Moon RY, Hauck FR, Colson ER. Safe Infant Sleep Interventions: What is the evidence for successful behavior change? Current Pediatric Reviews, 2016(12), pp.67-75
2. US Department of Health and Human Services, Health Resources and Service Administration. SIDS and Infant Death Program Manual and Trainer’s Guide. p. 65
3. Task Force on Sudden Infant Death Syndrome. (2016). SIDS and Other Sleep-Related Infant Deaths: Updated 2016 Recommendations for a Safe Infant Sleeping Environment. American Academy of Pediatrics. DOI: 10.1542/peds.2016-2938