SIDS, Daycares and Back to Sleep

With two thirds of children younger than 12 months old being cared for in a child care setting in the United States, it is important to be aware of what position your child is spending most of the day in.  Does he spend hours a day on his back in a bouncer, swing or car seat?  Or is he given the opportunity to move around and play in the safety of a crib or play yard?  These are the questions I encourage you to ask every day when you drop your infant off and pick him up from a secondary caregiver. 

One retrospective study done in 2000, not only gained a lot of media attention, but started its own widespread panic surrounding daycares.  Unfortunately, law suits were cast resulting in some daycares fearful of positioning infants in their care.  The study consisted of 11 states reporting with 1916 SIDS cases analyzed.  It found that 20.4% of what was diagnosed as SIDS occurred in a daycare setting citing an “unaccustomed” sleeping position as the culprit.  Rather than encourage everyone to get infants accustomed to different positions from birth, the AAP decided it was best to further discourage any position but on the back.  Of course, the AAP is referring to the sleeping baby, but what people hear most is “only place your baby on the back” translating to “never put your baby on his side or stomach”.  The whole “while sleeping” part is often left out of the equation. 

If babies are given the opportunity to explore side lying, lying on the stomach and lying on the back equally from the beginning (birth) during waking hours, there should be no “unaccustomed” position.  Unfortunately, I hear from the parents of my patients that the only position their baby is in for long hours a day is on the back, especially if he isn’t the only infant being cared for at the daycare.  One could only assume it is easier to keep all the infants contained if there are multiple babies in one room. 

If you are not the primary caregiver of your child, I encourage you to have this conversation with the one who cares for you infant during the day.   Think variety of positions.  If the caregiver needs to put your child in a contained situation to care for the other infants, ask them to place him or her in a crib or play yard so they are not confined and can easily move around an explore in an safe situation.  Cribs and play yards are so much better for development, exploration and movement because the baby is given the opportunity to use his muscles, build his skills and mature his brain.  Car seats, swings and bouncers restrict movement and discourage muscle movement and exploration.  They also encourage a favored head position and propagate flat spots on the head.  Substituting the crib or play yard is a very reasonable request that even the busiest day care worker should be able to comply with.  Even if they are not comfortable placing your child in any position but on the back, at least your child can move around during the day and explore the positions he is capable of on his own. 

Good luck out there!