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PEDIATRICS Vol. 106 No. 2 August 2000, pp. 295-300

Sudden Infant Death Syndrome in Child Care Settings

Received Jul 20, 1999; accepted Nov 29, 1999.

Rachel Y. Moon*, Dagger , §, Kantilal M. PatelDagger , §, and Sarah J. McDermott Shaeferparallel ,

From the * Department of General Pediatrics and Adolescent Medicine, Children's National Medical Center, Washington, DC; Dagger  Center for Health Services and Clinical Research, Children's Research Institute, Children's National Medical Center, Washington, DC; § Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC; parallel  Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD; and  Association of SIDS and Infant Mortality Programs, Baltimore, MD.

Background.  The incidence of sudden infant death syndrome (SIDS) in the United States has decreased with decreased prone sleeping. Extrapolating from Census Bureau data, ~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.

Objectives.  To determine the percentage of SIDS deaths occurring in child care settings, and to ascertain associated factors.

Design.  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.

Results.  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.

Conclusion.  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.  Key words:  sudden infant death syndrome, child care, prone position, sleep position.




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