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					MEMO
TO:          Licensed Child Care Providers and Applicants

FROM:        Olmsted County Child Care Licensing Unit
             328-6400

DATE:        December 27, 2001

RE:          Required Sudden Infant Death Syndrome (SIDS) Training


Legislation passed in the 2001 legislative session requires that all staff persons, caregivers,
or helpers that assist in the care of infants in a licensed childcare program, must receive
training on reducing the risk or SIDS. This training must be completed at least once every five
years.

The Department of Human Services (DHS) has directed us that providers are required to
sleep an infant on his/her back. This is not a matter of provider or parent discretion. The
only exception would be if the provider has documentation from the child’s doctor stating that
the child should sleep on his/her tummy. Providers must use an approved crib, port-a-crib, or
playpen. Infants should not be sleeping in car seats, swings, infant seats, etc.

Recent research reports that babies who normally sleep on their backs are at much
greater risk of SIDS if someone places them on their tummy for sleep for the first time.
Researchers believe that back sleepers do not learn to raise their heads and turn them from
side to side and may end up in the face down position during sleep. Keep in mind that it is
also important to have “tummy time” during the waking hours.

Applicants and substitutes can complete the required SIDS training by doing the
following:
    • Read the enclosed information.
    • Complete the enclosed questionnaire.
    • You will receive one hour of training towards the annual training requirement.
    • All substitutes and/or helpers must also read the enclosed information and return the
      completed questionnaire, prior to providing care to infants. Feel free to make copies as
      needed.

Feel free to contact your licensor if you have any questions.
                                                                                  1/07 JW Corr
RATIONALE FOR TRAINING

Legislative Statute: Effective July 2001, Minnesota state statute requires that all staff of child care
centers and family child care programs complete a one hour training on reducing the risk of Sudden
Infant Death Syndrome (SIDS). Training must be completed every 5 years. This same requirement
was instituted for foster parents in 2005.

Research: An 11-state study reviewed SIDS deaths in child care settings from 1995 –1997. In the
11 states, the rate of SIDS in child care ranged from 9% to 40% with Minnesota having the highest
rate of SIDS in child care settings. (Moon et al. Sudden Infant Death Syndrome in Child Care. Pediatrics. Vol.
106 No. 2 August 2000.)

Studies in several countries have found that babies who are accustomed to sleeping on their backs
have an 18 times greater risk of SIDS when placed on their tummies to sleep. (Mitchell et al. Changing
Infants Sleep Position Increases Risk of Sudden Infant Death Syndrome. Archives of Pediatric and Adolescent Medicine.
Vol. 153 Nov. 1999.) (Cote et al. Circumstances Leading to a Change to Prone Sleep in SIDS Victims. Pediatrics. Vol. 1
06 No. Dec. 2000)

Trends: Since the 1994 recommendation to place babies on their backs to sleep, the SIDS rate has
decreased 53% in the United States including Minnesota.

Since the 2001 state mandated SIDS risk reduction training of child care providers began, SIDS
deaths in Minnesota licensed child care settings have declined from 32.3% (1995-1997) to 10%
(2002-2005).

The hazards of soft bedding and bed sharing have become more apparent and have resulted in some
deaths being attributed to accidental suffocation.

Standard of Care: Placing babies on their backs for sleep is now standard infant care practice.

Liability: In Minnesota, several lawsuits have occurred following the sudden and unexpected death
of an infant in which providers were ordered to pay civil damages to parents. Awards were granted
because, at the time of death, provider placed baby to sleep on an adult bed rather than in a crib as
required by child care licensing regulation. Other civil damage suits related to child care providers not
following recommendations for back sleep position are now pending.

KEY CONTENT

I.     Facts About SIDS

1.   Definition of Sudden Infant Death Syndrome (SIDS):
                • Sudden Infant Death Syndrome is the sudden and unexpected death of an infant,
                    usually under one year of age, which remains unexplained after the performance of
                    an autopsy, an examination of the scene of death, and a review of the medical case
                    history.

2.   Characteristic features of a SIDS death:
               • There are no warning signs and no way to identify which infants will die of SIDS.
               • Death usually occurs suddenly and silently during sleep.
               • SIDS is the major cause of death in children ages 1 month to 1 year.
               • Peak age is 2 to 4 months.
               • 90% of SIDS occurs under 6 months of age.
               •     Affects approximately .5 babies per 1000 live births or about 2,162 per year in the
                     US, and about 25 in Minnesota.
               •     Appears to be irreversible – CPR is not effective.

3.    SIDS is not:
               •     a genetic disease.
               •     suffocation.
               •     regurgitation or choking.
               •     related to immunizations.

4.    Proposed Causes of SIDS:
               • May be a variety of causes or mechanisms.
               • A large proportion of SIDS may be due to a brainstem abnormality.
               • Delayed brain development of arousal response or cardio respiratory control.

II.     Strategies to Reduce the Risk of Sudden Infant Death

1. Based on research reports from other countries, the American Academy of Pediatrics in
   partnership with other health organizations launched a public education campaign in 1994 called
   BACK TO SLEEP. The original recommendation of back or side sleeping was changed in 1996 to
   state that back is the best sleep position for babies.

2. Since the 1994 recommendation to place babies on their backs to sleep the SIDS rate has
   decreased 53% in the United States, including Minnesota.

3. Follow the recommendations of the Back to Sleep Campaign:

               •     SLEEP POSITION: Place baby on his /her back to sleep. Discuss with parents the
                     sleep position which their doctor has recommended and consistently follow that
                     recommendation. While most physicians advise the back sleep position as the
                     standard of care, there are exceptions for which another sleep position may be
                     medically recommended. If so, obtain a written doctor’s order for the alternative
                     sleep position. There is no increase in choking or other problems with babies
                     sleeping on their backs.
               •     BEDDING: Use an approved crib, port-a-crib, or play pen and firm mattress or
                     pad. Do not use fluffy blankets, quilts, or comforters over or under the baby. Never
                     place a baby on a water bed, adult bed, sheepskin, pillow or other soft materials for
                     sleep.
               •     TEMPERATURE: Babies should be kept warm, but they should not be allowed to
                     get too warm. Keep the temperature in the baby’s room so that it feels comfortable
                     to you.
               •     SMOKE-FREE: Create a smoke-free zone around the children in your care. No
                     one should smoke around the children. Babies and young children exposed to
                     smoke have more colds and other upper respiratory tract infections as well as an
                     increased risk of SIDS.
               •     NO BEDSHARING: Keep the baby’s sleep area close, but separate from where
                     adults or siblings sleep. Never sleep with the baby on a sofa, couch or bed.
               •     PACIFIER USE: Babies are born wanting to suck. Some even suck their thumbs or
                     fingers before they’re born. It can be an important method of self-soothing.
                     Consider offering a clean pacifier at nap time, but don’t force baby to take it. If
                     breastfeeding, wait until baby is 1 month old or breastfeeding is well established.
                 Although the mechanism is not known, the reduced risk of SIDS associated with
                 pacifier use during sleep is compelling. (Mayo Clinic. Com/health/pacifiers
                 Pacifiers: Are they good for your baby? Oct. 2005.) (The Changing Concept of
                 Sudden Infant Death Syndrome. Pediatrics. Vol. 116 No. 5. Nov. 2005.)

4. Avoid hazards of soft bedding in cribs/port-a-cribs ─ The Consumer Product Safety
   Commission warns against adding extra mattresses, pillows, soft bedding or cushions to cribs or
   port-a-cribs. Such items have contributed to SIDS and suffocation deaths.

5. Keep in mind that SIDS is complex and that placing a baby on his or her back for sleep position
   will not completely eliminate all occurrences of SIDS; but it does reduce the risk. Babies die in
   all sleep positions, including on their backs.

III.   Appropriate Infant Care Practices
1. Discuss sleep position with parents in the intake interview.
              • Tell parents, that as a licensed provider, you are required to place a baby on his or
                 her back for sleep, unless you have written documentation from the baby’s doctor.
              • Identify and document what position the doctor has recommended for each child.
              • Follow this recommendation consistently.
              • Communicate this to all caregivers and substitutes.

2. A baby who usually sleeps on his back should never be placed on his tummy to sleep – even if
   the baby’s fussiness is relieved by tummy sleeping. Studies in several countries have found that
   babies who routinely sleep on their backs are at an 18 times greater risk of SIDS when placed
   on their tummies to sleep, especially the first few times they are placed in the tummy down
   position.

3. Tummy time is important.
           • Place the baby on his/her tummy when awake and playing and being observed.
           • Limit the baby’s time in car seats, infant seats, bouncers, swings etc.
           • The use of the tummy time strengthens neck and shoulder muscles.

4. Do not use devices or products to maintain the baby’s sleep position. None have been tested for
   safety nor have they been demonstrated to be effective.

5. Once the baby becomes more mobile and begins rolling over, the baby can sleep in the position
   he/she chooses and does not need constant monitoring during sleep to return him/her to the back
   sleep position. Continue to follow safe bedding recommendations and remove fluffy bedding,
   pillows, stuffed toys, etc.

6. Know and practice infant and child CPR.




                                                                                          JW Forms 1/2007
CPR—CHILD & INFANT
NO SIGNS OF LIFE AND NO PULSE

After checking an ill or injured child

  1. Give cycles of 30 chest compressions and 2 rescue breaths.
  2. Continue CPR until—
        • Scene becomes unsafe.

        • You find signs of life.

        • AED is ready to use.

        • You are too exhausted to continue.

        • Another trained responder arrives and takes over.



RESCUE BREATHING—CHILD & INFANT
PULSE, BUT NO BREATHING

After checking an ill or injured child
1. Give 1 rescue breath about every 3 seconds.
   • Pinch nose shut.

   • Make seal over child’s mouth.

   • Blow in to make chest clearly rise.



(TIP: Each rescue breath should last about 1 second.)
(TIP: Because children are smaller than adults, do not tilt the head
back as far to open the airway.)

2. After about 2 minutes, recheck signs of life and pulse for no more
   than 10 seconds.
                 Reducing the Risk of Sudden Infant Death Syndrome
1.    According to studies in several countries, how much greater is the risk of SIDS when babies
      that are accustomed to sleeping on their backs are placed on their tummies to sleep?
         A) 5 times       B) 10 times          C) 18 times         D) 25 times

2.    Since the 1994 recommendation to place babies on their backs for sleep, the SIDS rate has
      dropped by what percentage in Minnesota?
         A) 13%          B) 23%             C) 43%              D) 53%

3.    At what age does SIDS usually occur?
         A) 2 – 4 months B) 4 – 6 months   C) 6 – 8 months           D) 8 – 10 months

4.    Removing fluffy blankets, quilts, comforters and bumper pads from a crib can reduce the risk of
      accidental suffocation. True or False

5.    A baby should never be put to sleep on a waterbed, sheepskin, beanbag chair or adult bed.
      True or False

6.    Too many layers of clothing or blankets can overheat a baby, therefore increasing the risk of
      SIDS. True or False

7.    Babies and young children exposed to smoke have more colds and other upper respiratory
      tract infections as well as an increased risk of SIDS. True or False

8.    The back sleeping position will eliminate all occurrences of SIDS. True or False

9.    The use of the tummy down position when baby is awake is appropriate and strengthens neck
      and shoulder muscles. True or False

10.   Devices to maintain a baby’s sleep position have not been tested for safety and should not be
      used. True or False

11.   Once a baby becomes more mobile and can roll from back to tummy or tummy to back easily
      on his/her own, the baby can sleep in any position. True or False

12.   Licensed providers are required to sleep an infant on his/her back, unless they have written
      documentation from a doctor stating the baby should sleep in a different position.
      True or False

13.   As a licensed provider, it is my responsibility to ensure that all substitutes and caregivers place
      babies on their backs for sleep. True or False

I have read the enclosed information on how to reduce the risk of SIDS. I understand that, as a
licensed day care provider, substitute or helper, I am required to sleep infants on their backs, unless
there is written documentation from a doctor stating that a different sleep position is required.

___________________________________                    _________________________________
Signature of provider, substitute or helper            Date


                                                                                             JW corr 1/07 final
                 Reducing the Risk of Sudden Infant Death Syndrome
14.   According to studies in several countries, how much greater is the risk of SIDS when babies
      that are accustomed to sleeping on their backs are placed on their tummies to sleep?
         A) 5 times       B) 10 times          C) 18 times         D) 25 times

15.   Since the 1994 recommendation to place babies on their backs for sleep, the SIDS rate has
      dropped by what percentage in Minnesota?
         A) 13%          B) 23%             C) 43%              D) 53%

16.   At what age does SIDS usually occur?
         A) 2 – 4 months B) 4 – 6 months   C) 6 – 8 months           D) 8 – 10 months

17.   Removing fluffy blankets, quilts, comforters and bumper pads from a crib can reduce the risk of
      accidental suffocation. True or False

18.   A baby should never be put to sleep on a waterbed, sheepskin, beanbag chair or adult bed.
      True or False

19.   Too many layers of clothing or blankets can overheat a baby, therefore increasing the risk of
      SIDS. True or False

20.   Babies and young children exposed to smoke have more colds and other upper respiratory
      tract infections as well as an increased risk of SIDS. True or False

21.   The back sleeping position will eliminate all occurrences of SIDS. True or False

22.   The use of the tummy down position when baby is awake is appropriate and strengthens neck
      and shoulder muscles. True or False

23.   Devices to maintain a baby’s sleep position have not been tested for safety and should not be
      used. True or False

24.   Once a baby becomes more mobile and can roll from back to tummy or tummy to back easily
      on his/her own, the baby can sleep in any position. True or False

25.   Licensed providers are required to sleep an infant on his/her back, unless they have written
      documentation from a doctor stating the baby should sleep in a different position.
      True or False

26.   As a licensed provider, it is my responsibility to ensure that all substitutes and caregivers place
      babies on their backs for sleep. True or False

I have read the enclosed information on how to reduce the risk of SIDS. I understand that, as a
licensed day care provider, substitute or helper, I am required to sleep infants on their backs, unless
there is written documentation from a doctor stating that a different sleep position is required.

___________________________________                    _________________________________
Signature of provider, substitute or helper            Date


                                                                                             JW corr 1/07 final

				
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