Supporting Actions to Reduce the Risk of Sudden Infant Death Syndrome (SIDS) in Out-of-Home Child Care Settings

[摘要]

Statement of the Problem

• Sudden Infant Death Syndrome is the death of any infant under one year of age which remains unexplained after the performance of a complete post-mortem investigation including an autopsy, an examination of the scene of death and a review of the case history.¹
• Groups at highest risk for SIDS in the United States are African-American and Native American populations and infants in child care settings.²
• Approximately 13 million children under age 6 have both parents or their only parent in the work force, and 65 percent of mothers of young children are in the workforce.³
• Almost three-quarters of the infants and toddlers of working mothers are being cared for by someone other than their parent; 40 percent are cared for in centers and family child care homes.⁴
• Whereas although the incidence of SIDS in the United States declined with increased awareness of the risks of prone infant sleeping, smoke exposure, soft bedding and unsafe sleep environments, avoidance of these risk factors is not universally practiced in child care settings.⁵
• Evidence for the Problem
• New research has identified that approximately 20 percent of SIDS cases occur in child care settings.²
• The risk of SIDS is higher for infants who are put to sleep on their backs at home, but who are put to sleep on their stomachs in child care.⁵
• What Can Be Done to Reduce the Problem?
• Efforts to reduce the number of infants dying from SIDS have focused on identifying pre-and postnatal risk factors that can be modified through public health and medical intervention.⁶
• In June 1994, the U.S. Public Health Service initiated a national “Back to Sleep” education campaign in collaboration with the American Academy of Pediatrics, the SIDS Alliance, and the Association of SIDS Program Professionals. In addition to placing a healthy infant to sleep on his or her back, the U.S. "Back to Sleep” campaign advocates additional SIDS risk reduction measures which include keeping the infant in a smoke-free environment, keeping the temperature of the room the infant sleeps in at a comfortable level, and not placing soft bedding such as pillows, comforters, cushions or toys under the infant.⁷
• The “Healthy Child Care America’s Back to Sleep Campaign,” launched in January 2003, is designed to reduce the risk of SIDS in child care settings by building on the success of the “Healthy Child Care America Campaign” (launched in 1995 to improve the health and safety of children in child care settings) and the “Back to Sleep” Campaign. Through this campaign, a variety of coalition partners offer technical assistance and resources to promote the "Back to Sleep" message in child care programs, raise awareness and change practices in family child care homes and center-based child care programs and support states interested in safe sleep practices to include this topic within state child care regulations.⁸
• Recognizing that standards are important in improving the quality of care in child care settings, Caring for Our Children; National Health and Safety Performance Standards: Guidelines for Out-of-Home Child Care Programs, second edition, a joint collaborative project of the American Public Health Association (APHA) the American Academy of Pediatrics (AAP), the National Resource Center for Health and Safety in Child Care (NRCHSCC) and the Maternal and Child Health Bureau (MCHB), Health Resources and Services Administration, U.S. Department of Health and Human Services published in 2002, includes eight new standards on risk reduction for SIDS in child care centers.⁹
• Recognizing that only 11 States currently include safe sleep standards to reduce the risk of SIDS in their child care licensing standards, Healthy Child Care America’s Back to Sleep Campaign is providing technical assistance to States to support their efforts to improve the quality and reduce the risk of SIDS in child care settings.¹⁰
• Evidence of the Effectiveness of the Back to Sleep Interventions
• Since the introduction of the "Back to Sleep" Campaign, the number of infants in the United States who die from SIDS has been reduced from over 5,000 to fewer than 3,000 each year.⁴
• The decline in the number of SIDS deaths in the United States, as well as those in other countries around the world, has been attributed to the decreasing use of the prone position for sleep.¹¹
• Soft sleep surfaces, such as pillows, comforters, sheepskins, polystyrene bean-filled pillows, and older or softer mattresses, are associated with increased risk of SIDS.^12-14
• Head and face covering by loose bedding, particularly comforters or quilts, has also been shown to increase SIDS risk.¹⁵
• Maternal smoking during pregnancy has consistently been associated with increased risk of SIDS.^11,12

Recommendations APHA should support to reduce the Risk of SIDS in Child Care Settings

1. Urge all public health professionals and agencies to support efforts to reduce the risk of SIDS in child care settings by supporting the “Healthy Child Care America’s Back to Sleep Campaign” and disseminating the Campaign’s messages to the public health community.
2. Encourage all States and child care licensing/regulatory agencies to adopt the SIDS risk reduction standards from Caring for Our Children National Health and Safety Performance Standards: Guidelines for out-of-Home Child Care Programs-second edition in order to reduce the risk of SIDS in child care programs.

References

1. Willinger et al., NICHD, 1991 American Academy of Pediatrics, “Positioning and SIDS.” Pediatrics 1992;89:1120.
2. Moon, RY, Patel DM, Shaefer STM, “Sudden infant death syndrome (SIDS) in child care settings Pediatrics. 2000;106:295–300.
3. National Center for Children in Poverty, Newsletter, February, 2003
4. American Academy of Pediatrics, “Changing concepts of sudden infant death syndrome: Implications for the sleeping environment and sleep position.” Pediatrics 2000;105:650-656.
5. Moon RY, Biliter WM, “Infant Sleep Position Policies in Licensing Child Care Centers after Back to Sleep Campaign. Pediatrics. 2000;106:576-580.
6. Brooks JG. Risk related intervention for SIDS prevention: timely or premature? Pediatric Perinatal Epidemiol 1994;8:1-9.
7. Hoffman HJ, Damus K, Hillman L, Krongrad E. Risk factors for SIDS: results of the National Institute of Child Health and Human Development SIDS Cooperative Epidemiological Study. Ann NY Acad Sci. 1988:533:13-30.
8. Healthy Child Care America Back to Sleep Campaign Fact Sheet, American Academy of Pediatrics, 2003.
9. “Caring for Our Children National Health and Safety Performance Standards: Guidelines for Out-of-Home Child Care Programs”-second edition, National Resource Center for Health and Safety in Child Care, 2002.
10. Reducing the Risk of SIDS in Child Care Settings, 2002 American Academy of Pediatrics.
11. Hauck FR, Hunt CE.Sudden Infant Death Syndrome in 2000. Current Problems in Pediatrics, September 2000:237-268.
12. Hoffman HJ, Hillman LS, Epidemiology of the sudden infant death syndrome: maternal, neonatal, and post neonatal risk factors. Clin. Perinatol. 1992;19:717-737.
13. Mitchell EA, Scragg L, Clements M. Soft cot mattresses and the sudden infant death syndrome. New Zealand Med J. 1996:109:206-7.
14. Ponsonby AL, Dwyer T. Association between use of a quilt and sudden infant death syndrome: case-control study. BrMed J 1998:316:195-6.
15. Mitchell EA, Thompson JMD. Sheepskin bedding and the sudden infant death syndrome, J Pediatrics 1998:133:701-4.
16. Wilson CA, Taylor BJ. Clothing and bedding and its relevance to sudden infant death syndrome: further results from the New Zealand Cot Death Study. J Paediatr Child Health 1994; 30:506-12.

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[发布日期] 2003-11-18

[学科分类] 医学（综合）