Published online July 3, 2006
PEDIATRICS Vol. 118 No. 1 July 2006, pp. 73-83 (doi:10.1542/peds.2005-3055)
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State Child Care Regulations Regarding Infant Sleep Environment Since the Healthy Child Care America-Back to Sleep Campaign

Rachel Y. Moon, MDa,b,c, Lauren Kotch, BSd and Laura Aird, MSd

a Division of General Pediatrics and Community Health, Goldberg Center for Community Pediatric Health
b Center for Health Services and Community Research, Children's Research Institute, Children's National Medical Center, Washington, DC
c Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC
d Early Education and Child Care Initiatives, Division of Developmental Pediatrics and Preventive Services, American Academy of Pediatrics, Elk Grove Village, Illinois

BACKGROUND. Despite overall decreases in sudden infant death syndrome deaths and prone sleeping, the proportion of sudden infant death syndrome deaths that occurs in child care settings has remained constant at ~20%. In 2003, the American Academy of Pediatrics' Healthy Child Care America program launched its own Back to Sleep campaign to promote the Back to Sleep message for those who care for young children.

OBJECTIVES. The purpose of this study was to evaluate the effectiveness of the first 2 years of the Healthy Child Care America-Back to Sleep campaign in improving child care regulations by assessing the inclusion of the elements of a safe sleep environment in the individual state regulations for child care centers and family child care homes.

METHODS. We examined regulations available in October 2005 for licensed child care centers and family child care homes in the 50 states and the District of Columbia for specific regulations pertaining to (1) sudden infant death syndrome risk-reduction training for child care providers, (2) infant sleep position, (3) crib safety, (4) bedding safety, (5) smoking, and (6) provision of information about sleep positioning policies and arrangements to parents before the infant is enrolled in child care.

RESULTS. Since 2003, when the Healthy Child Care America-Back to Sleep campaign began, 60 of the 101 state regulations for either child care centers or FCCHs have been revised. More than half of these regulations written since 2003 mandate a nonprone sleep position and restrictions on soft bedding in the crib, and the change in these regulations since 2003 is statistically significant. However, of the 101 existing state regulations, only 49 require that infants sleep nonprone, 18 mandate sudden infant death syndrome training for child care providers, 81 have ≥1 crib safety standard, and 43 restrict soft bedding in the crib. Only 4 regulations require that parents be provided with sleep policy information.

CONCLUSIONS. The initial 2 years of the Healthy Child Care America Back to Sleep campaign have been successful in promoting safe infant sleep regulations. Efforts must continue so that safe sleep regulations exist in all jurisdictions.

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Key Words: sudden infant death syndrome • risk reduction • regulation • child care • sleep position

Abbreviations: AAP—American Academy of Pediatrics • BTS—Back to Sleep • SIDS—sudden infant death syndrome • CCC—child care center • FCCH—family child care home • HCCA—Healthy Child Care America • CPSC—Consumer Product Safety Commission

Accepted Jan 20, 2006.




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D. Johnson
Back to basics: Efforts focus on training child care providers on safe sleep practices to reduce SIDS risk
AAP News, October 1, 2006; 27(10): 1 - 5.
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