- The Washington Times - Tuesday, August 8, 2000

One in five "crib deaths" over a 30-month period happened in a child care setting, a study released yesterday says.
This finding is "very worrisome," one pediatrician said, because it is three times greater than what researchers expected to find.
The researchers estimated that 7 percent of cases of sudden infant death syndrome (SIDS) would be in child care settings, given the average number of days and hours infants spent in such care.
Instead, the study, which reviewed 1,916 SIDS cases between January 1995 and June 1997, found that 391 of the deaths, or 20.4 percent, occurred in child care settings.
While doctors advise parents and caregivers to put infants to sleep on their backs to reduce the risk of SIDS, the study indicates that child care providers especially those who run day care businesses in their homes may not be heeding the advice, according to Dr. Rachel Y. Moon, whose study appeared yesterday in Pediatrics, the journal of the American Academy of Pediatrics.
"Parents must discuss sleep position with any caretakers of their infants," she said.
SIDS refers to the sudden death of a seemingly healthy infant who simply stops breathing. It occurs most often in the baby's own crib, which is why it has been called "crib death."
The disease, which is still not understood, once claimed thousands of lives each year.
However, the number of SIDS cases has dropped by about 40 percent, or around 2,000 deaths a year, since 1992, when public health officials began recommending that babies be put to sleep on their backs. This recommendation was based on studies that showed low SIDS rates in countries where babies routinely were laid on their sides or backs.
Dr. Moon, a pediatrician at Children's National Medical Center, and her colleagues reviewed SIDS cases in 11 states, including Maryland.
They found that 80 percent of deaths occurred when the babies were under their parents' care. However, 391 deaths were in child care, including 234 deaths that occurred in family day care or private homes where nonrelatives watch children.
Another 83 deaths occurred in the homes of relatives, such as grandmothers or aunts.
Fewer SIDS cases occurred in professional, licensed child care centers (49 deaths) or in the babies' homes under the care of nannies or baby sitters (25 deaths).
In Maryland, there were 197 SIDS deaths during the study period. Most occurred at home while the infant was under the parent's care.
However, 28 deaths, or 14 percent, occurred in child care. These included 20 deaths while in family child care, four deaths at a relative's home, three deaths in the care of a baby sitter or nanny, and one death in a child care center.
Based on a sample of 99 deaths, Dr. Moon found, about a third of deaths occurred in the first week of child care.
An "extremely large percentage" of these babies were found on their stomachs, even though parents reported that at home, the babies slept on their backs, she wrote.
Babies who are used to sleeping on their backs at home but are placed on their stomachs in child care have a two to four times higher risk for SIDS, said Dr. Moon. This is because the babies who sleep on their backs haven't yet developed their upper-body strength, she added.
"Babies should never be left to sleep on their stomachs or on soft bedding," said Phipps Cohe of the SIDS Alliance in Baltimore.
Parents should talk about SIDS risk-reduction tips with child care providers, relatives, nannies, baby sitters and "everyone who cares for their infant even if someone is just watching the baby for a couple of minutes," Ms. Cohe said.
Recent Census Bureau reports say that 1.7 million babies younger than 1 have employed mothers, and 17 percent of children spend time in child care during that first year.
Dr. Moon's findings are "very worrisome," said Dr. John Kattwinkel, chairman of an American Academy of Pediatrics SIDS task force.
The highest risk period for SIDS is when infants are 2 months to 5 months old, which is often the time mothers return to the workplace after childbirth, Dr. Kattwinkel said.
"It's just one other bit of evidence from a national health standpoint that tells us we ought to be educating day care centers and grandparents … as well as parents" about putting babies to sleep on their backs, he told the Associated Press.
A spokeswoman for the Child Care Action Campaign, an advocacy group in New York, declined to comment on Dr. Moon's findings.
"But we can comment on the importance of quality child care … and that most states don't have formal accreditation process and there's no national standards for quality child care," said the spokeswoman.
Other states in the study were Arizona, California, Colorado, Florida, Massachusetts, Michigan, Minnesota, Missouri, New Hampshire and New Jersey.

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