Daycare Workers Must Check Baby’s Sleep Position EVERY 15 MINUTES!

This kind of stuff draws interesting comparisons to adult safety in the workplace. Under Bill C-45 in Canada, you can’t be found liable if you can prove you did your due diligence – “reasonable steps” taken to prevent accident or injury. REASONABLE is the word here.

For example, my department at the mine I work at provides workers with respirators when they need them. To get a respirator, you have to take a respiratory protection training course, have a medical consultation with a qualified nurse or doctor to make sure you are medically fit to use a respirator, and then we perform a respirator fit test to make sure the worker is using a mask that actually provides protection for their face shape. This is much more than most companies actually do.

However, after all this happens, we can’t stop the person from wearing a respirator with a beard, for example, which would impede the seal and potentially let contaminants in, or if someone who isn’t medically fit somehow gets their hands on a respirator and wears it anyway, that’s beyond our responsibility.

Technically we COULD have “respirator police” wandering around site getting everyone they see wearing a respirator to show their fit test cards or make sure they are clean shaven, but the majority of people would consider this to be unnecessary and a big waste of time and money, because we’ve already taken many reasonable steps, already above and beyond what most companies do to ensure that people are using respirators safely and we’re confident we wouldn’t be found liable.

Sadly, when kids are involved, it doesn’t seem like any kind of due diligence is ever enough.

Unfortunately, this is policy is a direct effect of daycare centers being sued every 5 minutes when a SIDS death occurs. New parents can’t accept the fact that their infant died so they sue anyone and everyone they can. Daycare centers have started doing this in response to the lawsuits (although not sure that there has been any benefit other than staff being VERY attentive) which may be a good thing.

Just how many bona fide SIDS deaths have occurred in licensed, inspected, rule-abiding daycares?

For that I can only say : only on America 🙂
But if we put the craziness that has to do with
SIDS, it’s nice to know thar there is awareness that babies suppose to sleep on their tummy as well. In my country the over-worrying about SIDS cause parents to let their babies sleep only on their back, which is problematic developmntaly wise.

I’m with SKL on this one. Life became so much more pleasant at my house when I threw out the baby sleep rule book and let my daughter sleep on her tummy, in her swing and just about anywhere she would actually sleep (which was just about nowhere). Sleep, for both baby and mom, is far more important than the very small risk of SIDS.

I can’t speak for all daycares but I can say that there has never been a SIDS death at the daycare my child attended in the 13 years of its existence. I’ve never heard of a baby dying from SIDS at any daycare in my city. Babies are not dying of SIDS in daycares at such alarming rates that we need sleep charting every 15 minutes (I also never cared to be told what each diaper contained when my kid was on daycare and didn’t think that needed yo be charted either).

I’m going to agree with a poster above who said at least they aren’t turning them onto their backs (yet). My twins were preemies and spent 10 days in NICU. The NICU nurses always put them to sleep on the bellies and by the time we brought them home that is what they were used to. I tried to put them to sleep on their backs and it just wasn’t happening. Flopped them onto their bellies and they were good to go. They are 7 years old now and are still tummy/side sleepers. 🙂

@SKL would you mind posting some links/websites from what you’ve read? I would love to put my twins to sleep on their tummies but personally knowing someone whose baby dies of SIDS (over twenty years ago, mind you) I’m still hesitant. Reading some good info about it would put me at ease.

Its probably excessive – however, the required provider:infant ratio is generally very small, ranging from 1:6 down to 1:3. I doubt that doing a quick check and making a mark in a box is going to take enough of the provider’s time to get worked up about it.

Eric, the fraction of infants that suffer SIDS is less than 0.1% of the kids born every year. Still, that is not a REMOTE chance, it is quite significant. It is in fact thousands of times greater than your odds of buying a winning a lottery ticket (even corrected for sleep at day-care centers only).

SIDS deaths are more common than auto deaths for children birth-11 months by a factor of ~20 for 2009. See National Vital Statistics Reports, Vol 59, No. 4, March 16, 2011. You seem to be comparing infants to all children with your 5x number. This is illogical. SIDS is in fact the most significant cause of infant death for infants without abnormal symptoms or laboratory findings. For 2009, there were 2168 SIDS deaths and 1620 deaths by all external causes of mortality combined (cars, falls, firearms, drownings, poisoning, airway obstruction, etc.).

Stranger abductions are far rarer than you quote. The NCMEC lists 279 infant (birth – 6 months) stranger abductions between 1983 and 2011. That really is a remote chance. Only 7 of those were not recovered unharmed.

The funny thing about this blog (not the commenters) is that one of its ostensible goals is to point out when people are worrying about tiny risks and neglecting large ones, but it often gets the risks grossly wrong.

As a previous daycare worker in an infant room, I can say that we were only one step away from this anyways. I remember the tedious charts, having to write down what time the baby ate, how much, when the fell asleep, when they woke up, every diaper change, and what was inside said diaper. Most of the parents would either forget to take the paper or would glance at it and throw it away in the room’s trashcan. It was frustrating to have to do it, but the daycare admin stayed on top of it and made sure we were not slacking off with the paperwork. I agree, it is not about child’s safety or well being as much as it is about liability.

I can say, however, that this is just one more piece of paperwork that the teachers have to handle. Honestly, it seems like a lot and that it would be hard to do, but daycare workers are pros at paperwork.

Random tidbit: One of the things I hated most about the liability/stupid rules of daycare was the amount of diaper changes we had. In the 6 wks-9 months class, we had to change diapers every hour, no matter how dry they were. In the 9-18 months class, we had to check diapers every hour and change whoever needed to be changed, and change everyone every 2 hours, no matter how dry. It was humiliating to constantly have to explain this to parents when they asked why they were going through diapers so quickly.

Of the 2168 SIDS deaths in 2009 in the US, how many of those babies were sleeping on their backs?

Or is it just taken as an assumption that the only way babies die during sleep is if they are on their stomachs?

Is it possible to determine via autopsy whether a child was purposely suffocated with a pillow or died of SIDS?

Just wanting a bit more information so I can understand the issue better.

Effectively, they’re saying you’re bad parents for allowing your kid to have a blanket. I’ll hazard a guess there’s a lot bigger chance they get either sleepless, stressed or simply cold.

Preventing SIDS is a worthwhile cause, but since there is no definitive cause linked to the whole thing, this doesn’t seem necessary.

Delurking- Just to challenge you a bit on your stats, but what the original post asked was “Primarily, what are the chances my child will die of SIDS while napping at daycare in a crib with no bumper and no blanket?”

According to researcher Rachel Wood, about 20% of SIDS deaths are at daycare with 60% of those happening at home daycares. So only 8% of SIDS deaths are happening in the type of center described by this post.

My point is that while the difference between placing baby prone on inappropriate surfaces with bumpers and blankets and placing baby on the back on an appropriate surface without bumpers in blankets has merit based on years of research, the added benefit of checking every 15 mins to determine sleep position likely does not.

I do have to question: If the day care workers aren’t changing the babies’ sleep position what is the purpose does logging it serve? If a caregiver was going to lie about checking the babies on a regular schedule wouldn’t they also lie about the babies’ positions? If the purpose is to follow the back-to-sleep and other AAP guidelines wouldn’t that require intervention if a baby sleeps on their stomach or side? If the purpose is to limit liability wouldn’t knowing, and charting, that a baby was not sleeping according to guidelines make them look worse in court?

@Donna Little infants spend so much tine sleeping? Really?

Call me a lucker and hate me, but mine did. There are kids like that. You do not hear about them that often, because their parents have nothing to complain about.

“Because my little infant didn’t sleep at all. My little infant refused to sleep all day and then screamed non-stop from 2 to 8 every night. ”

That sounds like a very difficult baby.

Mollie, this refers to shaken baby syndrome (another one of those, oh, the child died, someone must be at fault,) http://www.npr.org/2011/06/29/137471992/rethinking-shaken-baby-syndrome

The thing that I got out of hearing this on the radio is that an expert is needed to do an autopsy on a baby. Those experts are generally not available (even a doctor to an autopsy is not available for adults in many areas of the country.) People tend to rush to conclusions without considering all the facts. (Like, was the baby ill prior to the death.)

The questions you ask are good ones.

I am just glad that 1) I did not need to put my kids in daycare and 2) that nothing happened to them, because like in the link above, someone would probably have been charged with murder because of the “some one must pay for this” mentality.

I love this blog, but I might go a little rougue here. I put two infants in FT care at 8-10 weeks. I liked knowing when they ate last (bottles), how long they slept, and if they pooped. Unfortunately, the person with your baby for most of the day is not always the one who is there when you pick the baby up. If you’re trying to keep an eye on something, like the baby hasn’t eaten or slept well in the last 3 days, those sheets really come in handy.

That being said the best thing is to establish a good relationship with the staff. They know you, know your baby and can be a great resource.

Most licensed daycares don’t use bumpers or these days blankets, but my daughters infant room was kept reasonably warm, so getting chilly wasn’t an issue.

Checking every 15 minutes was usually nothing more than a pass by, and a light touch to ensure everything was OK. It’s really not that time consuming. Plus our state has a 1:5 ratio at that age, and there were usually two teachers per room.

Now some centers (5 star) go completely overboard on paperwork and detailing your child’s activity during the day. They have to in order to keep their 5-star rating.

I think daycare centers are concerned about liability, but the good ones? the ones you want your child to be in? They are more concerned with parents being comfortable and confident with the center and the care.

First-time mothers of newborns can be pretty intense. Even ones, like me, who grow into much more free-range parents. 🙂

Part of me likes the idea of documenting enough to keep a good track on the babies (and I guess I get the legal thing) but that often seems a tad unnessary. I do think it’s a good idea to note when Baby seems out of normal.

My parents recently revealed to me they would sometimes leave me in my baby swing at night when I was just too collicky to tolerate anything else. Somehow I survived to be reasonaly well-adjusted.

“I do not know what the diagnostic power of autopsies is in your hypothetical case.

What issue are you trying to understand better?”

Delurking, I want to understand if the strategy of checking (or correcting) a baby’s sleep position is actually preventing an otherwise unexplainable death from lack of oxygen.

From Wikipedia: “Sudden infant death syndrome (SIDS) is marked by the sudden death of an infant that is unexpected by medical history, and remains unexplained after a thorough forensic autopsy and a detailed death scene investigation.”

So I ask again: How can an autopsy differentiate between SIDS and intentional suffocation?

It may be one of those taboo subjects, but infanticide does happen. Perhaps, like sexual molestation once was, this is one of those things people never believe could happen in their own family, and hence, deny that possibility with vehemence. I don’t at all intend to suggest that all cases of SIDS are infanticide, just a portion could be, based on lack of identification of exact cause of death.

“An infant is at the highest risk for SIDS during sleep, which is why it is sometimes referred to by the terms cot death or crib death.”

“Crib death” doesn’t necessarily mean death while asleep. It means the baby died in the crib. Just like “I went to bed with her” doesn’t alway mean sleeping, it just identifies the place the action happens.

“The cause of SIDS is unknown, but some characteristics associated with the syndrome have been identified.”

If the cause is unknown, it’s unknown. Period. It means there is no quantitative, empirical evidence revealing a specific precipitating factor, so that’s why I ask if it is a.) preventable and b.) prevented by strategies such as the one delineated in Lenore’s post above. Suffocation is preventable (some physical outside force acted on the infant to deny it adequate oxygen, so if someone or something is “suffocating” the baby, removing that would be prevention). However, SIDS is still cause “unknown” and “unexplained,” so that doesn’t give us a concrete prevention strategy, at least in my understanding.

“There are many risk factors and medical causal relationships proposed for SIDS.”

Proposed, not proven. It is also proposed that most commercial shampoos, deodorants, and other cosmetics contain chemicals that might be linked to the development of certain cancers. Does that mean it is proven that using xyz shampoo causes cancer? Why not pull all carcinogenic cosmetics from the shelves? Would that strategy be effective? Some might say yes, in fact, that strategy would be more serving of life than denying sleeping infants a blanket and checking them at regular intervals and perhaps repositioning them to be on their backs.

“Infanticide and child abuse cases may be misdiagnosed as SIDS due to lack of evidence. Accidental suffocations are sometimes misdiagnosed as SIDS.”

So. With all of these variables in place, taking the “unexplained” and insisting that all parents and caregivers must do x, y and z with babies seems, at best, more like superstition than preventive care.

I think we have become very superstitious as a society. We do not accept the death of any infant or child as “natural.” We want it all to be preventable. We think it is “wrong” that any baby would die, and so we have come up with “suggestions” to “prevent” SIDS, an unexplained cause of death. None of these suggestions seem to have been proven empirically to do more to keep your child alive than would throwing salt over your shoulder and praying really hard.

I like the idea of parents, especially, choosing to do what, given their unique circumstances, is “optimal” for their specific kid. These blanked “musts” are like so many “musts” these days: children must be supervised at all times, they must not walk alone, parents and institutions must not accept even the most minimal risk for any injury or highly unlikely criminal scenario.

I disagree, because I think that on the altar of “safety,” we sacrifice our own integrity, the integration of all that we require to thrive: rest, ease, comfort, well-being, learning, growth, development, joy, play, connection, community… you name it.

In my heart, there is more to life than a narrow definition of “safety.”

EricS,
Sorry, something of order 0.1%, or even 0.01% is not remote in everyday language. Your personal definition of “remote” is the outlier.

Infant sleep deaths are not typically caused by a sudden cessation of breathing. It is typically a confluence of multiple factors including external stressors like sleep position and immature cardiorespiratory development and arousal response that leads to an insufficient response. So, due to some stressor (like bad sleep position) the infant begins breathing less well. The infant does not shift position or wake up because of its immaturity and lack of strength, which leads to further oxygen deprivation (see, e.g., Pediatrics 128, e1341, 2011 and Biol. Neonate. 65, 194, 1994). This takes long enough that 15 minutes intervals are reasonable for checks.

So, yes, if an average caregiver notices an infant in an unusual position or with bluish skin, they will know what to do. They will move the baby just to check on it and that will be enough to save its life.

There are no quantitative absolutes, there are costs and benefits to every safety measure. If there are a bunch of infants sleeping in a room, in a day care room where there are typically three or fewer infants per staff member, the cost of looking at the infants every 15 minutes is low enough that this is not a ridiculous measure. It is much more reasonable than what day-care centers typically do to prevent stranger abductions.

I don’t see anything wrong with “looking at” the infants every 15 minutes. Marking the sleep position on the chart is much more than looking. You can “look at” multiple babies in a couple of seconds while holding another child.

If this were the only paperwork requirement, that would be a different matter.

Frankly, I don’t have a problem with my baby being “looked at” frequently as long as nobody disturbs her normal, healthy sleep by rolling her onto her back. Daycare workers are paid, after all. As someone noted, having an unfamiliar caregiver changing the baby’s normal sleep routine can be a risk factor.

As much as I hate to say it, some babies are going to die. The idea that this is 100% preventable is leading people to make ridiculous decisions and policies. The cause of SIDS is by definition unknown. Someone picked tummy sleeping as the culprit, but the % of SIDS cases involving back sleepers is too high to let that sit. Correlation does not equal causation. If there is an identifiable cause, let’s find it and save the babies that back-to-sleep isn’t saving, without harming the babies back-to-sleep is harming.

Honestly, I think some of this is also to get as much work out of these low-paid workers as possible. My mom owns a daycare and when people pay for daycare, they don’t want the provider to have a second of rest or down time. They make absurd requests of providers so they can get the most for their money. The lower paid a worker is, the more likely they are to have to do things like this. It’s a lack of respect, and it’s an aspect of control that parents can have since they can’t be there with their kids. Plus, like I said before, childcare is a major expense so they want to feel like they are getting their money’s worth. Most stuff like this arises from parental complaints of some kind. Someone raises a stink, so something like this gets implemented. Or, they will have a freak SIDS death and parents want someone to blame, so they blame the daycare. Never mind that children have died of SIDS in their parent’s arms.

Delurking:

It sounds like you really care about survival, and supporting the thriving of people. I share that with you.

Crimes against children have dropped precipitously in the same timeframe. Does this mean that the current logic of keeping children supervised at all times is “working”? What accounts for the drop in crimes against kids? This entire “Free Range Kids” movement has its foundation in challenging the idea that “because what we’re doing is ‘working’ to keep kids safe, we have to keep it up, nay, do it ever more to the extreme, to save that ONE EXTRA CHILD who could have come to harm if we hadn’t been so vigilant…”

So if you breastfeed or don’t breastfeed, put the baby to sleep sunny side up or over-easy, check on her every three hours or every five minutes, use J&J Baby Shampoo or something you concocted from organic herbs and oils, put the baby in the car and drive it to the playground instead of walking there with the stroller… stuff still happens. And we don’t always know why. So why act as though we control it all? We make our best guesses and go with it.

In the name of “health,” the medical profession has brought us myriad “solutions” and “cures” that have, ironically, led to a state of ever more compromised well-being.

I hear how important life is to you, and I value life too. I don’t necessarily think of living with the primary directive of preventing injury or death as living.

I’m so glad I never had to have my kids in day care. A few of them would have hated it and never slept based on some of these rules.

Kid #2 had colic, reflux and was easily overstimulated. he slept in his carseat the first 3 or 4 months of his life because if he laid flat the reflux would get him and he would just scream and scream and scream. It was 2 weeks before I figured out the carseat thing (he hated the swing and bouncy seat).

Kid #3 HAD to have a blanket over her face to sleep. From the time she could coordinate her arms to pull it up over her face that’s how she slept. That was around 2 months old. The blanket I gave her was a threadbare receiving blanket I had when I was little. She slept like that every nap and all night all the time. She’s 9 1/2 now and still sleeps with a blanket over her head.

And the whole flipping baby over thing…I would have been ticked if that had been policy (as someone above stated). My kids all learned to roll pretty early and once they could roll all five of them preferred to sleep on their tummies. I always put them to bed on their backs but they’d flip themselves either before they fully fell asleep or sometime in the night. Turning them back over would just wake them up and make them cry and for what? They’d just turn right back onto their stomachs as soon as they could. I can’t imagine the sleep lost trying to force a rolling baby to stay on its back. (the earliest my kids were rolling was 3 months on the dot, latest was 5 months).

Sorry, I typed .01% above but I was figuring it at .1%. The 4000 out of 4 million number is correct math, but American SIDS Institute puts the rate lower than that.

mollie,
“Crimes against children have dropped precipitously in the same timeframe. Does this mean that the current logic of keeping children supervised at all times is “working”? ”

No, and few credible people make that claim. The most convincing piece of evidence is that crimes against everyone have fallen without similar safety measures being taken for adults. Medical research is more carefully controlled than that, certainly in the case of SIDS.

“In the name of “health,” the medical profession has brought us myriad “solutions” and “cures” that have, ironically, led to a state of ever more compromised well-being. ”

This is quite an accusation. You have evidence that our well-being is lowered as a result of medical research? It looks like the opposite to me. Certainly the numbers for things that are measurable are on my side. If you are simply claiming that in an alternate universe where there was less medical advance you would be happier despite the extra suffering and death, there is nothing I can say.

“I don’t necessarily think of living with the primary directive of preventing injury or death as living.”

Neither do I. I compare costs to benefits. The problem with this web site as a promoter of the free range kids movement is that in its criticism it often fails to distinguish between cheap efforts that have the potential to save 1 in 10,000 and expensive efforts that might save 1 in 10,000,000.

Speaking of correlation, how’s this logic:

1) Doctors and baby health “experts” advise back sleeping.

2) Those who get good prenatal care and go to well visits and those who read up on baby health are the ones most likely to hear back sleeping recommendation and consider following it.

3) Those who get good prenatal care and go to well visits and those who read up on baby health are also those most likely to do other things that are good for baby, such as keep cigarette smoke away from them, make sure they have a reasonably new mattress,

follow recommended doses on meds, observe baby’s individual indications of health issues, check in on baby periodically, hold baby more, breastfeed, hire responsible caregivers, be sober while caring for baby, have the means to check into potential health concerns, not prop bottle with dish towels around baby’s neck (yes I know of someone who did this), not secretly abuse baby, have baby full-term and healthy, and probably 50 other risk factors for infant death.

4) Back sleeping is likely to be correlated with lower SIDS rates.

Does not prove that back sleeping is best for anyone who does not have existing health issues.

Delurking, no, I don’t think they can effectively control for those factors because there is such a small sample of people who are educated, health-conscious, have financial means, AND refuse to follow the back-to-sleep recommendation. I also do not think they have really tried to do so after putting the recommendation out.

I am sure they did research, but research can lead to false conclusions, as has been proven many times.

Also, I believe that with more kids back-sleeping, they should have more data on the problems caused by the resulting loss of sleep and other developmental issues. Though again, stats may be skewed since tummy sleeping is now so rare among many groups. Maybe they are comparing results of educated back-sleeper families with those of economically disadvantaged tummy-sleepers and finding no issue due to skewed stats, but the issue is very clear to me. They should be informing parents about these potential problems so parents can make an informed decision.

Should it not be up to parents to decide whether they want to risk a tiny and undefined chance of breathing problems (which they could deal with in multiple ways if they thought the risk concerning), versus the fairly high likelihood that sleep deprivation is going to lead to developmental issues?

@eathomelive – Yep in Chicago we could spend more on daycare for an infant than we pay to rent a 3 bed apt in a decent neighborhood. I want to be certain we would be getting our money’s worth and I do have a high level of respect for what the people in the daycares we checked out do. In a comment above someone mentioned that they like the data poops/feeds etc – the things you would see if you were home and just naturally around – the charts are a huge help in shift changes.

It is not absurd to want to know the ins and outs of things that happen during the day. For example, my wife and I have readily given long updates ad nauseum to pediatricians and nurses to help pinpoint problems. So konwing the baby’s rhythm and if there were interruptions has proven valuable.

The fact that back sleeping makes kids less able to survive sleeping on their stomachs should give us pause. What other capabilities is back sleeping suppressing / destroying?

SIDS was still very rare even when almost every baby slept on his/her tummy. Tummy sleeping does not kill healthy babies.

Sounds like suicide watch at the nuthouse or the county jail. Maybe we’re teaching babies for their potential futures?

I’m a parent of two, and a former childcare worker. I cannot for the life of me understand what purpose being served by this kind of bureaucratic micro-management of healthy, sleeping babies.

If infant humans were so at risk of dying in their sleep that they simply have to be checked on every fifteen minutes, we would be extinct as a species by now.

“shanada, on March 9, 2012 at 05:59 said:
There are some research going on that found the correlation between SIDS and vaccinations. Be cautious about giving vaccations to babies…way too much toxic, mercury in little bodies.”

Please stop spreading dangerous lies.

Here is some information from a source that has actually bothered to check their facts. It took me ten seconds on Google to find this.

http://www.youngausskeptics.com/2009/05/vaccines-mercury-and-you/

@ delurking – What does this particular checklist tell you that is remotely helpful? As stupid as I think they are personally, the pee/poop chart at least provides information that could be medically helpful (i.e. My kid hasn’t pooped in 3 days. What can I do?). What information does knowing your child slept on her back at 11:15am and was still sleeping on her back at 11:30 am tell you that would be remotely useful as a parent/physician? I was a SAHM for the first year of my child’s life and I didn’t know this information since I didn’t check on my child every 15 minutes. The chart may, and that’s a HUGE may, be useful in an autopsy, but I don’t think that daycare centers need to do paperwork in a remote possibility that it will be helpful post-mortem.

There’s two wrinkles in this, one is that children are much more likely to die of SIDS in daycare. Especially in the first week, the risk skyrockets.

However, every 15 minutes would not be enough to prevent this anyway. It takes less than 15 minutes to die.

Hmmm, has anyone checked the increase in childhood learning issues, autism, and other stuff to see if it corresponds with the back to sleep campaign? Someone upthread mentioned something, but it would be interesting to see.

I let my oldest sleep on her stomach the most, mostly on my tummy. She also was the early turner. My second and third slept mostly on back. They are the ones with more issues with learning, muscle development, vision stuff.

SIDS gives me nightmares. I’ll explain why at the end (Trigger Warning for those who have experienced an infant loss)

But let me answer a couple of things:

1)shanada: there is no “toxic mercury” in infant vaccines. Please join the rest of us in 2012 since thimerosol was removed from vaccines 10+ years ago and only existed in multi-dose vaccines, never in single dose vaccines (i.e. vaccines that came from 1 vial for 1 person, not 1 vial for multiple persons).

2)the AAP guidelines now are “Back to Sleep, Tummy to Play” or something like that, because parents were NEVER putting a child on their tummy and developmental delays were noted. So now the recommendations at least say put the kid on his/her tummy for periods during the day

3)SIDS is rare. It generally occurs between 3-9 months but the honest range is birth to about 2. Yes, autopsies can often rule out other causes of death (suffocation leaves visible signs to the trained eye) but SIDS is often what we call a “diagnosis of exclusion” meaning that every other cause they checked wasn’t there so SIDS is the only one left.

4)The incidence of SIDS deaths has dropped since the back to sleep campaign. However, it still occurs even now.

5)The AAP also says once a child can roll over easily, you don’t need to keep adjusting the sleeping position.

I don’t get the “no blankets” thing at the daycare. My kids, too, required swaddling for sleep. My younger one slept in an infant tummy crouch (you older mothers will remember that position) until she was about 12 and too big to sleep that way. She had a terrible time learning a new sleeping position.

Lastly: the only case of SIDS I ever saw was in a 2 day old infant. Due to go home from the hospital that day, baby X had a blood test drawn at 5 am. When I went to pick up baby X to feed xe (as the nurse in the room, I fed all the “in” babies – awake, crying babies were fed before waking the sleepers ), xe was dead and cold. Sometime in that 20 minutes, the baby had died. Would 15 minute checks have saved that baby? Maybe – but doubtful. The baby was awake, vigorous and crying at 5 am, and dead 20 minutes later. Lying on xe’s side, as most hospital babies were then (25 years ago), warmly swaddled and dead.

SIDS IS *Sudden* infant death. You can’t really prevent if from never happening.

@shanada

You clearly need to see some real data. For example: http://www.fda.gov/BiologicsBloodVaccines/SafetyAvailability/VaccineSafety/UCM096228 which clearly shows that mercury in vaccines is no longer an issue…it it ever was. You’ve been reading too much of Andrew Wakefield’s fraudulent garbage.

Seems the questions is always how much is too much. My SIL sporadically works in daycare/ childcare and when she watched my son last summer, she always gave me those sheets trackign everything related to care, which honestly seemed like overkill to me. Some of it because she made sure to record what he ate even though I packed his meals. Some of it because I don’t really need to know when exactly he was changed… if there’s something unusual, then note it. By why note the routine? Then again, I’d hope that any child care provider kinda knows the kids they work with (I teach alternative high school, and if I can get to know the daily habits of my 50 different students, then I should think a classroom of a much smaller ratio could also get a general feel for daily habits as I give a lot of credit to people who work with children for wanting to get to know them.)

@SKL– I’d love to talk more with you about the importance of sleep in children! (Totally serious.) With our son, we learned just how important sleep is (and not just to him.) When my toddler is shorted even a mere hour of sleep– which wouldn’t seem like anything to most parents– he’s a completely different baby. And not in a good way. He acts like a typical toddler with no impulse control, lots of melt downs, and is extra clingy. But catch him up on sleep, and he’s almost the exact opposite. My journey through our joint sleep deprivation and back into health (plus all the reading I have done on sleep) have really made me reconsider the importance of sleep.

I would also be very interested in the data on SIDS occurrence in people who fit SKL’s list of factors, as I fall into the category of people who meet all of those criteria and choose to ignore the back-to-sleep recommendation after much research while pregnant and sleeplessness after discovering that my kids refuse to sleep on their backs. During my 3-year-old’s first five months, she napped sitting in a swing, but the only way she slept longer than an hour was belly to belly, in bed with me. She still usually sleeps on her belly. As I type this, my 3 week old is laying on his belly on my belly, If I attempt to lay him down on his back, the screams will wake the neighborhood. He’ll nap for 45 min or less in a swing or bouncy seat. but for the 3-ish hours between feedings, it’s mom’s belly/ chest or nothing. I have never been happier than when we brought him home from the hospital, as that was the longest sleepless 3 days ever, with seems like dozens of nurses who had no problem waking us from sleep by insisting I not drowse off holding him or ever let him sleep on his belly.

What in the world is wrong with all of you who are arguing about the statistics on SIDS???
Have you no heart?
The way you talk sounds so much more bizarre than the idea of checking a sleeping child every few minutes.

@Susan may I know what exactly do you complain about?

Ok, having read some more comments now… I totally get where delurking is coming from. If with some simple precautions – eg. making sure your baby doesn’t overheat, which can be done by using the right weight sleeping bag – lives can be saved, it is totally worth it.

Also, checklists are used to make sure that staff do what they say/are told to do. If they simply had a policy that said they would check every 15 or however many minutes, how many would just not do it because no one would ever find out? Admittedly, they also could just put fake data on the list. But the checklist could be a prompt for some at least.

And this is not a direct response to the post itself, but some people here seem to sometimes confuse free-range parenting with “natural parenting”. I am all for allowing my child enough freedom to enable her to explore the world at her own pace, find her own solutions to problems and learn to be self-reliant. But I didn’t think more than 5 seconds about having her vaccinated because I know my history and it isn’t that long ago in the scheme of things that parents felt lucky if their child made it to 5 without dying of some horrible illness. But the only link that has to free-range parenting is that the anti-vaccination brigade is just another group of people who try to make parents worry and feel guilty about doing what they think is best for their kids for logical reasons.

Pat, what would charting the sleeping positions at a particular interval going to do to actually save a child from dying of SIDS (please see MI Dawn’s comment, hers is not the only story like that I’ve heard.)? If, somehow, it really *is* going to save a child’s life then parents should be doing it at home since a larger percentage of SIDS deaths occur at home than at daycare?

In Guatemala, where my kids are from, they keep babies heads covered pretty much all the time when they are out. Even when it was 90 degrees F out, babies’ heads were always covered by light blankets. My eldest could not sleep without something covering his head. So I gave him an afghan with lots of holes in it and called it done. He was 6 months old when he came home, and I put him in the crib with (gasp!) grib bumpers and his afghan, and let him sleep however he wanted to. If he fell asleep in the backpack/stroller I had, I would take it off and plop it in the middle of his room and let him sleep, even if it looked hugely uncomfortable to me. He somehow survived my terrible parenting.

When we went back to Guatemala to get son #2, who was 5 months old at the time, one of the first things his foster mom said was, “This kid will not sleep on his back.” She was right. He still doesn’t. And again, he is still alive.

We need to stop deciding that fragile babies and healthy babies all should be treated equally.

Does anyone know about SIDS rates in other countries? Is the US the only place where “back to sleep” is recommended? Do other countries track SIDS, or has anyone else found correlation between sleep position and SIDS?

I echo Donna’s question — just because the concept of a checklist isn’t useless where it isn’t useless, doesn’t mean this particular checklist does a dime’s worth of good in this particular situation. So we can repeat the question: how does this checklist process prevent SIDS?

That’s one of those things that really gets my goat. If I say “I don’t agree with your overly paranoid opinion” there is a proportion of the population that seems to hear that as me saying “I want my children/your children to die horribly.” No, I don’t want my children, or anyone’s children to die. I want them to live. Which they cannot do if they are bubble wrapped and velcroed to my side and monitored every second of every day.

I’m in the process of moving my son from one day care to another — not my choice but he qualifies for special services but can only get them if I can get him situated for 2 hours a day in our tiny home town, far from where I work, and the school will only bus in our tiny town. *grr*

Some day cares have huge sheets of what they do/check; some just have rules; some are laissez-faire. One day care we interviewed has pages and pages of curriculum and has web camera service where you can log in and see your kid (or kid’s classroom) online. (Which sounds like a nice cheer-up for mom or dad, but a huge source of paranoia for the staff! It also has a daunting progress chart for each toddler for each day.)

I know there was an informal rule of when sleeping babies were checked in his daycare, and when diapers were checked… having the charts come home helped me know whether he was drinking enough, peeing enough, pooping enough. The only way to do that was with charting. If there are a lot of kids/caretakers (more than state mimimums, for instance) in a room, or someone has to call for backup while they hit the bathroom themselves, it would make sense to have a chart of what’s been checked.

If you don’t like a standardized approach with charts and things, you do have the option of trying a different daycare.

Is there a documented case of someone intervening with a sleeping infant and preventing a death that would otherwise have been categorized as “SIDS”?

If babies lying on their backs, hooked up to monitors, surrounded by medical care, still die of “SIDS,” what, exactly, does “prevention” look like?

“SIDS” rates had dropped 25% between 1982 – 1992, the decade before the “back to sleep” campaign began. Up until that time, decision-making about sleep position for infants was based on tradition, ease and comfort more than safety. So why was the rate dropping?

A catch-all for every infant death that cannot otherwise be explained: “SIDS.”

Nearly impossible to differentiate from infanticide: “SIDS.”

Far more prevalent in populations where health, economic and social circumstances are compromised: “SIDS.”

Something rare and tragic for worried, educated, middle-class parents to obsess about: “SIDS.”

And if we don’t toe the line, place baby on her back, question policies that “monitor” and “chart” babies at proscribed intervals or insist on certain positions for sleep, we are labelled “careless.”

“So you want babies to die?” Um, no. No, I don’t. And I also don’t want to pretend that this particular protocol mentioned above, which fails to meet needs for efficiency, rest, ease, comfort, or sustainability, is a strategy that meets needs even for safety or well-being.

Now there’s a funny for you – “this blanket is not suitable for sleep.” I would have woken my kid with the guffaws of laughter over that one.

Just today a website put up something about a guy losing his baby due to putting an adult pillow in the crib. Claims he put the pillow on the baby’s legs and somehow the baby ended up covering his face with it.

I don’t know. I am sure freak accidents happen, but so does infanticide.

Someone above noted that some states won’t autopsy a baby to find out the cause of death, but rather use the catch-all SIDS without first ruling out every other cause. (Not surprising at all.) So it seems clear that the SIDS statistics are still over-stated. I really think that if there was enough of an inquiry into each “SIDS” death, we would find that the vast majority of babies have almost zero avoidable risk whether they sleep on their tummies or not – and those who do could find out their child has a specific risk. However, since SIDS is rare and it would cost a lot to do that level of inquiry on every case, this is not likely to happen.

Now if I had given birth to my children and raised them through infancy, knowing what I now know, if I were the worrying type, I might have inquired into whether testing was available for certain risk factors. I would rather pay for a test to give me peace of mind than make my child sleep on her back and place upon her a significant risk of developmental issues. I paid thousands for vision therapy which was caused by the fact that my daughter didn’t spend enough time on her tummy as an infant. She also had other issues which she has been working through over the years. In hindsight, I would rather have paid for a test or monitor and let her sleep on her tummy, if I had that option. (More likely, I just would have one “tummy sleeping” without the test, as it worked for almost every child in history. But if the Back-to-Sleep campaign were giving me nightmares, I might need more comfort.)

I didn’t have the time to do research into risks and stats on SIDS when I had my baby. I was too busy being a mum. So all I had was the overload of advice… In hindsight, I’m pretty sure that the main messages were about ways to reduce suffocation – so not really SIDS as such but obviously important advice – and apart from some common sense things like the smoking and some pre-existing risk factors some babies may have, I remember the only genuine risk factor I learnt about was the overheating. I contacted the SIDS prevention organisation once to inquire about sleeping bags with sleeves for winter and they advised against it for that reason.

Sorry nothing to do with the daycare centre, but it would be so much better if the advice on preventing infant deaths would be more common sense and backed up with scientific data instead of treating every new parent like an idiot who needs to be scared into making sure they don’t smother their child.

All of this makes me wonder whether it even make much sense to talk about SIDS as a “thing” that can be prevented, as though it’s really just the way of saying “unexplainable infant deaths.” How do you prevent something for which the cause is, by our current understanding, unknowable? It sounds a bit like calling “I don’t know” an “answer” to something, as though “I don’t know” actually identified something, as opposed to being a way of saying that the thing is not identified. KWIM?

I don’t believe in fate. But if science had an answer for everything already, there’d be no need for scientists anymore. Or in other words, I believe there is an explanation for all infant deaths, we just haven’t been able to find the causes yet.

Which is what parents and carers should be told instead of being made paranoid. Pseudo-science does more harm than complete ignorance sometimes and our media is full of it.

Anywho, I had to conclude that I clearly don’t know enough about this topic to make an informed opinion on whether or not that childcare rule is over the top. Though other commenters do seem to know more about it and it sounds like it is just another result of the fear of liability that lots of institutions have to deal with nowadays.

I worked in a daycare/preschool back in 89, the infant room, there was a grandmotherly older lady that watched the babies, and if there were more than 3 they’d get in an assistant. They’d look at the disposable diaper & decide if it needed changing – and if pooped, changed right away. I worked with the ones that were walking up to 2 years old – and our only schedule was snacktime and then naptime right afterwards. One worker would sit in the dimmed room with the kids sleeping on mats (in all sorts of positions) with a light blanket over them.

Our first didn’t sleep more than 3 hours at at time for the first 18 months, and for the first 4 months, slept on the floor with me on a comforter, as put her in her crib, she’d scream bloody murder.

Both my girls slept on their sides/stomachs. *laugh* i guess a cat hopping into the crib is right out. When they’d cry, the cat would hop in and go sniff them.

Mollie,
You beat me to it. Untill there is a definition of what constitutes SIDS, all of these studies and statistics are worthless. As far as “Shaken Baby Syndrome” is concerned, it needs to be defined as well. In my opinion both of these are a result of media hype and hystaria. A friend of mine was convicted of murdering his daughter, by shaking her, in 1985. No autopsy was done. The Medical Examiner stated that it was obvious how the baby died. My friend couldn’t find an independant ME to do an autopsy. One stated that if the cause of death was not SBS, he would be accused of helping a child abuser get off the hook.

Years ago, it was considered dangerous to put a baby to sleep on its back. In fact, my parents’ neighbor’s infant died just a few years ago when he vomited while on his back and choked to death.

I know that my baby snores when he’s on his back, but then he is 50 years old…(giggle)

As a long time insommniac, I believe that sleep is one of those things that should be damn near sacred. If my kid was asleep, the only reason I would wake him is if he was in physical danger. So when he got really tired after a missed nap at age 1 and face planted into his dinner, I picked him up and put him to bed (after getting incriminating pictures, of course). Otherwise, I didn’t care what conveyance he was sleeping in. He was asleep. Hallelujah.

Donna, Pentamom,

Most people are honest. If it is part of their job to look at the sleeping babies every 15 minutes, they will try to look at the babies every 15 minutes. If it is part of their job to mark the babies’ sleeping positions on a chart, they will do that. That fact is that there is much research across many fields showing that the simple act of having someone record a task results in their performing the task better. It is highly unlikely that there is research about this particular checklist, but there is enough about other checklists in general to make a simple checklist worth the effort.

Your concerns about unscrupulous employees dishonestly filling out checklists are out of left field. Are you OK with checking on babies every fifteen minutes but not OK with the checklist because there might be an employee who walks to each crib and picks up the checklist hanging from it and marks it without actually looking at the baby? The checklist is an irrelevancy in the general debate about the 15 minute checks, but it is highly likely to be of significant added benefit if the checks are performed.

As to there being non know scientific cause for SIDS: what is your threshold for action? Pediatricians studying the issue did a whole lot of research and determined that if everyone put infants to sleep on their backs, the death rate would likely decrease. The recommendation was adopted after many studies by the AAP, a large group of pediatricians. The death rate was cut in half. Why did that happen? No one knows all of the causal details, but the correlation is well-enough established. Do you demand to know all of the causal details before any medical intervention is tried? There are lots of medical interventions that work without detailed knowledge of the causal details. Look at headaches and suggested treatments. Do you suggest no one try to treat headaches until the details are understood?

And as for some of you positing that the medical community is foisting these things on us for their benefit, WTF? Seriously, WTF are you people thinking? How does it matter to a pediatrician’s personal benefit if an infant sleeps on its back or stomach?

Donna, I note that you didn’t read my post on March 9 at 4:44 where I explain why checking on the baby every 15 minutes is reasonable, and give references to both a review paper in Pediatrics and one of the early research papers on how SIDS deaths occur. I realize it is a long thread, but you can search within this page for posts with “delurking” in them by using CTRL-F on windows machines or CMD-F on Macs.

The point about checklists is not that they contain useful information. There is much research that shows that when people record something about a task during the performance of a task, they perform the task better. It is reasonable, given previous similar research in many fields, to think that the caregiver will be more likely to actually notice if something is wrong with the baby if they pick up a piece of paper and record something about the baby on it when they look into the crib. I note that I wrote this same thing in my previous post.

The “back-to-sleep” recommendation seems to have cut the incidence of SIDS, the number-one non-disease killer of infants (more than all accidental and criminal causes, combined), dramatically. The fact that the death rate was not dropped to zero because of it is a pretty weak criticism.

The thing is, does this affect the baby? They’re sleeping anyway. It may result in less interaction with other babies maybe, but with better planning and organisation that can be improved.

I understand it fuels the idea that you should never let your kids out of your sight but it’s for parents to work out what they do at home. It really isn’t making any difference to the child’s development if the carers check them every 15 minutes.

SKL,
I give more weight to arguments that have more research support. The medical community is not treating this like a closed case, there is plenty of research ongoing. The weight of the evidence is dramatically in favor of the back-to-sleep campaign as a net benefit. If there are further or other refinements that can produce further benefits, great, when the weight of the evidence becomes enough that the consensus among experts is that there should be a recommendation on them, it will be issued.

Furthermore, this is only tangentially related to the post and my response to it, which is related to the utility of checking on infants while they are asleep, regardless of their sleeping position. I am arguing that this is not a ridiculous thing to do in a day-care center. You keep diverting the discussion, starting with your very first line: “Oh, you did NOT just get me started on sleep position and SIDS!”. If you have evidence that recommending to the entire nation that they put their kids to sleep in some other position would be a bigger benefit, go ahead and publish it, and the medical community will take a look. If it has been published but isn’t getting traction, it is probably because it has been evaluated and found wanting.

Donna,
Yes, I have two children. No, I did not check on them every 15 minutes during the night. It is absurd that you suggest that a parent waking up every 15 minutes to check on an infant has the same cost as a day-care worker checking on children every 15 minutes during the day.

Your middle paragraphs are a mishmash of misunderstandings. The fact that you again assert that there is no evidence that a death by SIDS is able to be prevented if caught withing seconds implies that you simply refused to read what I wrote or look at the cited review paper. Your vague statement of hypotheticals following this is backed by no evidence whatsoever. Your histrionic “horrible neglect” is inapposite, no one has argued that not checking is neglect, only that checking in a day-care center is reasonable.

Your final paragraph demonstrates a complete misunderstanding of how scientific consensus evolves and how the recommendations are developed. The idea that nobody considers the big pictures is absurd, and a smear against the researchers who developed the guidelines. Researchers do incorporate findings of other research on different topics.

To clarify your thinking:

You (and SKL) claim that the “back-to-sleep” campaign has not saved as many lives as claimed. OK, how many fewer lives have actually been saved, and what is the confidence level of that number? You claim that sleep deprivation caused by back-sleeping in the few months before an infant is strong enough to roll over contributes to “a whole host of things”. OK, how many people are affected and to what degree? What is are the confidence levels of those numbers. Presumably you have some measure of these supposed ills that we can compare to the (overestimated by some amount that you know) number of infants lives’ that have been saved by the back-to-sleep campaign? I assume you will explain how you balance the infant lives lost due to sleep death vs. the claimed behavioral issues, learning issues, developmental issues, obesity, and sleep deprivation in parents which leads to car accidents, work accidents, and even shaken baby syndrome and other infanticide in extreme cases.

Your assertion that researchers and the recommendation committees do not consider these things is simply false. The reason back sleeping is recommended is because the evidence that it is a net benefit is strong.

SKL, how many more infant deaths you would be willing to accept in order to eliminate the problems you believe are caused by the back-to-sleep campaign? Just give me a ballpark number. Or, are you claiming that zero more deaths would result if the recommendation were reversed?

Were you at the AAP task force on SIDS meetings? The pediatrics paper I cited has references to at least twenty-eight papers dealing with reservations about babies sleeping on their backs. If the particular bad things you are worried about are not cited in the task force report, it is because they aren’t credible enough to be worth citing. How about you post the references where this mounting evidence is found. Then I will do a citation analysis and quickly quantify how credible the rest of the scientific community finds it. My guess is “not very”. I mean, seriously, you managed to find a someone somewhere that says that a baby sleeping on its back until it is strong enough to roll into whatever position it feels like (typically 4-6 months) results in obesity later in life. Donna’s assertions are even more ludicrous. Yeah, back-sleep leads to car wrecks, work accidents and infanticide. Let’s see some numbers on that.

delurking –

I didn’t say that a daycare worker checking on an infant every 15 minutes has the same cost as you doing so at home. I said that it is not necessary anymore than it is necessary for you to do so at home. Just because something has a low cost does not mean that it has any validity. And I have yet to see any convincing evidence that checking a sleeping infant every 15 minutes has any validity in saving infant lives.

Disagreeing with you does not mean that I didn’t read what you wrote. You seem to view SIDS as disease, such as AIDS, cancer, the flu. It simply is not that and I am not going to treat it as it is. SIDS is defined solely as “the unexpected, sudden death of a child under age 1 in which an autopsy does not show an explainable cause of death.” It has no known cause(s). No symptoms. SIDS is nothing more than a cause of death put on a death certificate when all known causes of death are ruled out or no autopsy was performed. It has no validity beyond that. It is not an entity of it’s own.

The idea that “we have no idea what caused this child to die” is a leading cause of death is fairly devoid of meaning. It simply means that an autopsy was not done or nothing could be determined in a number of childhood deaths, not that all the deaths were actually caused by the same thing. SIDS could be one major blight on childhood or many, many small blights. We don’t know.

And you have a very naive belief of researchers, not SKL and I. The fact is that researchers solely research what they are funded to research. The SIDS prevention organizations get funding that is 100% dedicated to preventing SIDS. They are absolutely not researching the entire well being of the baby. Their goal is simply to reduce SIDS. And back-to-sleep may, in fact, be the best that we have to attempt to reduce SIDS at this time. That does not automatically mean that it is the best thing for every child in every situation.

Delurking, we understand that this is a very important issue to you.

What hasn’t been explained, however, (at least I don’t think it has) is how an every-15-minute checking and documenting of baby’s sleep position prevents death, or anything else. We aren’t talking about *changing* the sleep position; we’re talking about looking and then checking a box. So a baby sleeping on his/her tummy will continue sleeping on his/her tummy, right?

“Most people are honest. If it is part of their job to look at the sleeping babies every 15 minutes, they will try to look at the babies every 15 minutes. If it is part of their job to mark the babies’ sleeping positions on a chart, they will do that. That fact is that there is much research across many fields showing that the simple act of having someone record a task results in their performing the task better. It is highly unlikely that there is research about this particular checklist, but there is enough about other checklists in general to make a simple checklist worth the effort.”

None of that really addresses my point, though — is there any evidence that really, genuinely, truly, honestly looking at a baby every fifteen minutes does anything to reduce SIDS?

Merely asserting the usefulness of the check sheet to verify that the checking up is done begs the question. Is checking up every 15 minutes on a schedule doing any good to prevent something that happens in “seconds” at unpredictable mom
.”
“but there is enough about other checklists in general to make a simple checklist worth the effort.”

That doesn’t make any sense. That “checklists in general” are useful for verifying that effective strategies are implemented tells us nothing about whether a strategy that someone decides to put on a checklist, is effective, as opposed to a complete waste of time that could better be spent promoting health and safety in other ways.

That’s about like saying, “It’s a known fact that babies are changed more regularly when the workers have to check off when they check their diapers, so therefore checking a box that indicates that you said ‘my Aunt Tilly’ every 25 minutes to them will prevent chickenpox.” It’s not whether checking the box makes the workers more likely to do the action (which is intuitively reasonable and is conceded), it’s whether the action is demonstrably helpful to the intended outcome.

Yes, checklists are valuable……for multi-step/multi-task activities, such as 1) preheat oven 2) assemble dry ingredients. 3) Combine flour, sugar, baking soda, and salt, etc.

The above is not a checklist. It is a list of times and list of sleeping positions.

“If your infant is in daycare, it’s important to know that about 20 percent of SIDS deaths happen in childcare settings, according to a study published in the journal Pediatrics in 2000.”
http://www.babycenter.com/baby-sleep-safety