Published online October 1, 2008
PEDIATRICS Vol. 122 No. 4 October 2008, pp. 788-798 (doi:10.1542/10.1542/peds.2007-3010)
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ARTICLE

Reducing the Risk of Sudden Infant Death Syndrome in Child Care and Changing Provider Practices: Lessons Learned From a Demonstration Project

Rachel Y. Moon, MDa,b, Trisha Calabrese, BSc and Laura Aird, MSc

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

OBJECTIVE. The goal was to evaluate, through an American Academy of Pediatrics demonstration project, the effectiveness of a curriculum and train-the-trainer model in changing child care providers' behaviors regarding safe infant sleep practices.

METHODS. Participating licensed child care centers and family child care homes were assigned randomly to intervention and control groups. Observers performed an initial unannounced visit to each site, to watch infants being placed for sleep, to inventory sleep policies, and to administer questionnaires to center staff members. Trainers then used the American Academy of Pediatrics curriculum in educational sessions at intervention sites. Three months later, observers conducted a follow-up observation at each site, and staff members completed a questionnaire about logistic barriers encountered in implementation of safe sleep recommendations.

RESULTS. A total of 264 programs and 1212 providers completed the study; the care of 1993 infants was observed. Provider awareness of the American Academy of Pediatrics infant supine sleep position recommendation increased from 59.7% (both groups) to 64.8% (control) and 80.5% (intervention). Exclusive use of the supine position in programs increased from 65.0% to 70.4% (control) and 87.8% (intervention). Observed supine placement increased from 51.0% to 57.1% (control) and 62.1% (intervention).

CONCLUSIONS. A sudden infant death syndrome risk reduction curriculum using a train-the-trainer model is effective in improving the knowledge and practices of child care providers. Perceived parental objections, provider skepticism about the benefits of supine positioning, and lack of program policies and training opportunities are important barriers to implementation of safe sleep policies. Continued education of parents, expanded training efforts, and statewide regulations, mandates, and monitoring are critical to ongoing efforts to decrease further the risk of sudden infant death syndrome in child care.

Key Words: Back to Sleep • child care providers • intervention • risk reduction • safe sleep practices • sudden infant death syndrome • sleep position • training

Abbreviations: AAP—American Academy of Pediatrics • BTS—Back to Sleep • CCC—child care center • FCCH—family child care home • SIDS—sudden infant death syndrome

Accepted Jan 15, 2008.


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