Professional Documents
Culture Documents
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Revised 2012
Overview
Definition of SIDS
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Sleep-Related Deaths
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SIDS Facts
In 2005, there were about 2,200 SIDS cases (US)
It is the leading cause of death for babies from
1 to 12 months of age
Highest risk is at 2 to 4 months; 91% occur
between 1 and 6 months of age
Seasonal trend: there are more SIDS deaths in
winter months
More male babies die of SIDS
Unaccustomed tummy sleeping increases risk as
much as 18 times.
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Brainstem
dysfunction,
Arousal defect,
Gene
polymorphism
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Brainstem
dysfunction,
arousal defect,
gene
polymorphism
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Prone/side sleep
position
Maternal smoking
during pregnancy
Environmental tobacco
smoke
Overheating
Soft sleep surface
Late or no prenatal
care
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Rebreathing Theory
Infants in certain sleep environments are more
likely to trap exhaled CO2 around the face
Lie prone and near-face-down/ face-down
Soft bedding
Tobacco smoke exposure
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Brain Dysfunction
Kinney et al have found abnormalities in
autonomic control in the brainstem
Decreased neurotransmitter (serotonin) binding
Network dysfunction
Infants may not be able to sense and respond to
hypercarbia or hypoxia
Pre-AAP recommendation
Post-AAP
BTS Campaign
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Undetermined: US
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90
80
70
2.5
2
60
50
40
30
1.5
1
20
10
0
0.5
Deaths/1000 LB
Percent Prone
0
1992 1993 1994 1995 1996 1997 1998 1999 2000 2001
Prone-B
Prone-NB
SIDS-B
SIDS-NB
Sources: National Center for Health Statistics, National Infant Sleep Position study
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NISP, 2008
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Side
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Prone
Unaccus Prone
Unaccustomed Tummy
Sleeping
Increases risk of SIDS (as much as 18
times)
Mitchell et al, 1999
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AAP Recommendations:
Pertinent to Child Care
Sleep position
Plagiocephaly
Pacifiers
Soft bedding
Overheating
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Dont babies
sleep better on
their tummies?
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*Break*
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Avoidance of Plagiocephaly
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Pacifiers
Studies consistently
demonstrate a protective
effect of pacifiers on SIDS
Mechanism unknown
Decreased arousal
threshold (Franco)
Pacifiers dislodge within
15 minutes (Weiss and
Kerbl) to 1 hour (Franco
et al) of sleep
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Downsides of Pacifiers
Dental malocclusion
Differences appear after stop using pacifiers
AAPD Policy Statement: Non-nutritive sucking is normal
in infants and young children, unlikely to cause long-term
problems if stopped by age of 3 years
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Sleep Clothing
Alternative to
blankets
Cotton or fleece
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Avoid Overheating
Other Recommendations
Avoid second-hand smoke exposure of
the infant; maintain a smoke-free
environment
Do not use apnea monitors as a strategy
to prevent SIDS
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Legal Considerations
Litigation
Wrongful death
Loss to society
Neglect
Breach of contract between parents and provider
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www.healthychildcare.org/doc/SIDSSamplePolicy.doc
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Disadvantages
Easy: some may interpret this as having the intent to
relaxing the regulations; it may facilitate using side or prone
sleep position
Want to make sure that, whether you have a predeveloped waiver form or not, you document your
discussion with the parents about the risks, benefits,
and alternatives to back sleeping
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Licensing Requirements
National Resource Center for Health and
Safety in Child Care
http://nrckids.org
800/598-KIDS (5437)
Caring for Our Children: National Health
and Safety Performance Standards:
Guidelines for Out-of-Home Child Care
Programs, Third Edition (2011)
Individual state licensing information
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First Candle
Provide grief/bereavement services, support
services
1314 Bedford Ave, Suite 210, Baltimore,
MD 21208
Phone: 800/221-7437 or 410/653-8226
Fax: 410/653-8709
E-mail: info@firstcandle.org
Web site: www.firstcandle.org
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National SUID/SIDS
Resource Center
Provides information about SIDS and
other forms of infant death and stillbirth
Georgetown University
1-866-866-7437
www.sidscenter.org
info@sidscenter.org
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Summary
What SIDS is and is NOT
What are sleep-related deaths
Risk factors
Safe sleep practices to reduce the risk
Caring for Our Children: National Health and
Safety Performance Standards, 3rd Edition
Developing a safe sleep policy for your
program
Resources for more information
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Questions?
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Practice Scenarios
4 scenarios that child care providers
may encounter in their workplace
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Scenario 1
You are the child care provider. A parent of
a 2 month old baby requests that the child
sleep on the side, propped by a pillow.
This is how they do it at home. The
mother says, I dont want to worry about
my baby spitting up and it going down the
wrong way. What do you do?
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Scenario 2
A parent has requested that his baby be placed
on the stomach for naps. You showed him the
policy that babies are to be placed on the back
only unless there is a medical excuse. He takes
the medical waiver form to the pediatrician. The
pediatrician signs the waiver, but does not
indicate a medical reason. In fact, the
pediatrician has crossed through the section
that asks for a medical reason. What do you do?
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Scenario 3
You have just started as a new child care
provider in the infant room of a large child
care center. On your first day, you notice
that all of the other providers are placing
babies on their stomachs for naps. You
know from your training that back is best.
What do you do?
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Scenario 4
There is a new baby in the infant room.
She is 2 months old. The mother tried to
get the director to agree to put the baby
on the stomach for sleep, since that is
what they do at home. The director
refused, and the mother finally said that
was okay. You now place the baby on the
back for a nap. The baby cries and
refuses to go to sleep. What do you do?
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