Sudden Infant Death Syndrome in Child Care Settings

• Published in: Pediatrics (Evanston) 2000-08, Vol.106 (2), p.295-300
• Main Authors: Moon, Rachel Y, Patel, Kantilal M, Shaefer, Sarah J. McDermott
• Format: Article
• Language: English
• Subjects: Analysis. Health state; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Cause of Death; Child care; Child care services; Child Day Care Centers - statistics & numerical data; Day care centers; Emergency and intensive care: neonates and children. Prematurity. Sudden death; Epidemiology; Female; General aspects; Health aspects; Humans; Infant; Infants; Intensive care medicine; Male; Medical sciences; Pediatrics; Prone Position; Public health. Hygiene; Public health. Hygiene-occupational medicine; Retrospective Studies; Risk Factors; SIDS; Sleep; Sleep positions; Sudden Infant Death - epidemiology; Sudden Infant Death - etiology; Sudden Infant Death - prevention & control; Sudden infant death syndrome; United States
• ISSN: 0031-4005; 1098-4275
• DOI: 10.1542/peds.106.2.295

The incidence of sudden infant death syndrome (SIDS) in the United States has decreased with decreased prone sleeping. Extrapolating from Census Bureau data, approximately 7% of SIDS should occur in organized child care settings (ie, child care centers or family child care homes). However, 2 states have reported higher rates of SIDS in child care. To determine the percentage of SIDS deaths occurring in child care settings, and to ascertain associated factors. A retrospective study of SIDS deaths from January 1995 through June 1997 was conducted. Data were abstracted from SIDS databases in 11 states. Characteristics of SIDS cases occurring in child care settings, including sleep position, were compared with those occurring in the care of parents. Univariate and multiple logistic regression analyses were performed. A total of 1916 SIDS cases were analyzed for this study. Of these deaths, 20.4% occurred in child care settings. Compared with deaths in the care of parents, those occurring in child care settings were more likely to occur on weekdays between 8:00 AM and 4:00 PM; infants were older; not black; and their mothers were more educated. Infants in child care were more likely to be found prone in univariate analysis, but the association was not significant in multiple logistic regression analysis. However, in multiple regression analysis, infants in child care were more likely to be last placed prone or found prone, when the usual sleep position was side or supine. A large proportion (20.4%) of SIDS cases occur in child care settings. Factors associated with SIDS in child care settings include older age, race, and highly educated parents. Previous studies have reported that unaccustomed prone sleeping puts infants at high risk for SIDS; this characteristic was found to be associated with SIDS in child care and may partly explain the high proportion of SIDS cases in child care settings. Parents must discuss sleep position with any caretakers of their infants. In addition, further efforts to educate child care providers about the importance of supine sleep for infants must be ongoing.