Daycare Workers Must Check Baby’s Sleep Position EVERY 15 MINUTES!

Hi Readers: In our quest to make childrearing ever more worry-and-labor intensive, I submit the newest wrinkle. – L.
.
Dear Free-Range Kids: My children go to a wonderful daycare center that is part of a franchise.  While the center is owned by a local couple, they are part of a greater organization and subject to their rules.
.
Earlier this week, we received a notice that the infants would no longer be allowed any type of blanket (previously, lightweight receiving blankets were allowed), and they would not at all be allowed to sleep in any kind of bouncy seat or swing.  These changes were to better meet the AAP’s guidelines for safe sleep and prevention of SIDS.  They seemed reasonable to me.
.
Today, when I dropped off my daughter, I noticed several clipboards with charts on them.  I looked a little more closely, and saw 15-minute time increments down the side, and columns listing “back,” “side” and “tummy.”  I asked the teachers about the form, and it’s just what you think it is.  Every fifteen minutes while the babies are asleep, the teachers are mandated to put a check mark next to the baby’s sleep position.  EVERY FIFTEEN MINUTES.
.
There are so many things about this that are absurd to me.  Primarily, what are the chances my child will die of SIDS while napping at daycare in a crib with no bumper and no blanket?  I’d venture a guess that they are certainly smaller than the chance that I could go buy a winning lottery ticket.  What are the chances that my child will benefit developmentally and physically from more attention from her teacher while a few of her classmates nap?  Certainly way higher than the risk of SIDS.
.
I can’t imagine the pain in the butt this is going to be for the teachers, given the sleep schedules of children under age 1 (after that, they age out of the charts).  I almost think the center is going to have to hire someone to walk around the room and be the sleep monitor. To me, this certainly falls into the range of being ridiculously overcautious about sleeping babies. — Caring-but-Not-Crazy Mom
.
Lenore here: This kind of obsessiveness serves one purpose only — “proving” to someone (a worried parent, lurking lawyer, out-for-blood inspector) that the center is doing “all that it can” — as opposed to the sensible “all that is necessary.” More is always better when it comes to overprotection! 

Let's hope one of them is filling out a chart!

144 Responses

  1. “Primarily, what are the chances my child will die of SIDS while napping at daycare in a crib with no bumper and no blanket? I’d venture a guess that they are certainly smaller than the chance that I could go buy a winning lottery ticket. ”

    Ten seconds of thinking about this and you would realize that your guess is wrong by a factor of at least thousands.

  2. This kind of stuff draws interesting comparisons to adult safety in the workplace. Under Bill C-45 in Canada, you can’t be found liable if you can prove you did your due diligence – “reasonable steps” taken to prevent accident or injury. REASONABLE is the word here.

    For example, my department at the mine I work at provides workers with respirators when they need them. To get a respirator, you have to take a respiratory protection training course, have a medical consultation with a qualified nurse or doctor to make sure you are medically fit to use a respirator, and then we perform a respirator fit test to make sure the worker is using a mask that actually provides protection for their face shape. This is much more than most companies actually do.

    However, after all this happens, we can’t stop the person from wearing a respirator with a beard, for example, which would impede the seal and potentially let contaminants in, or if someone who isn’t medically fit somehow gets their hands on a respirator and wears it anyway, that’s beyond our responsibility.

    Technically we COULD have “respirator police” wandering around site getting everyone they see wearing a respirator to show their fit test cards or make sure they are clean shaven, but the majority of people would consider this to be unnecessary and a big waste of time and money, because we’ve already taken many reasonable steps, already above and beyond what most companies do to ensure that people are using respirators safely and we’re confident we wouldn’t be found liable.

    Sadly, when kids are involved, it doesn’t seem like any kind of due diligence is ever enough.

  3. I try not to be paranoid, although these days God knows it’s difficult, but sometimes it seems there’s a conspiracy going to make having children as exhausting, tedious, and unpleasant as possible.

  4. Unfortunately, this is policy is a direct effect of daycare centers being sued every 5 minutes when a SIDS death occurs. New parents can’t accept the fact that their infant died so they sue anyone and everyone they can. Daycare centers have started doing this in response to the lawsuits (although not sure that there has been any benefit other than staff being VERY attentive) which may be a good thing.

  5. Oh, you did NOT just get me started on sleep position and SIDS!

    At least they are not required to turn the babies onto their backs (I hope)!

    I’ve read a fair amount about SIDS and it really has nothing to do with blankies or tummy sleeping by a normal, healthy child. But forcing a baby/child to sleep on his back makes it harder for him to get enough healthy sleep, which can lead to learning and behavior issues. It also interferes with kids outgrowing primitive reflexes, which again can have significant effects on development. I do not think it’s a coincidence that every other kid is ADHD or ASD or SPD, etc., since this back-to-sleep trend started.

  6. Just how many bona fide SIDS deaths have occurred in licensed, inspected, rule-abiding daycares?

  7. At our daycare, they are required to turn my baby over until she is 9 months old. She sleeps much better on her tummy, but can only get cat naps (1/2 hr) when forced to sleep on her back. Counting the days until she is 9 months (8 more days), then she will magically be out some sort of danger zone.

  8. For that I can only say : only on America🙂
    But if we put the craziness that has to do with
    SIDS, it’s nice to know thar there is awareness that babies suppose to sleep on their tummy as well. In my country the over-worrying about SIDS cause parents to let their babies sleep only on their back, which is problematic developmntaly wise.

  9. Let’s be real here. This isn’t really about child safety. It’s about liabilities the day cares don’t want to deal with. So they are covering their asses…I mean their bases. That in the remote chance – yes delurking…REMOTE. It’s less than 1% of all babies born in the US every year. 5x more children die from car collisions every year, and 4x more than a child being abducted by a stranger which is remote in itself -, your baby should succumb to SIDS or other injuries while sleeping, they can say “we were doing all we could to prevent it”, and they have their clipboards to prove it. I bet you can ask anyone in that day care why they are doing this, the first thing they will say is for the precaution and safety of the children. But the first thing they will be THINKING is because they don’t want to be sued for negligence. Alas, apart from the exaggerations from the media that has put many on edge, our society has also become a litigious one, compounding even more fear.

  10. I’m with SKL on this one. Life became so much more pleasant at my house when I threw out the baby sleep rule book and let my daughter sleep on her tummy, in her swing and just about anywhere she would actually sleep (which was just about nowhere). Sleep, for both baby and mom, is far more important than the very small risk of SIDS.

    I can’t speak for all daycares but I can say that there has never been a SIDS death at the daycare my child attended in the 13 years of its existence. I’ve never heard of a baby dying from SIDS at any daycare in my city. Babies are not dying of SIDS in daycares at such alarming rates that we need sleep charting every 15 minutes (I also never cared to be told what each diaper contained when my kid was on daycare and didn’t think that needed yo be charted either).

  11. I feel bad for those workers who have to get a baby to sleep without blankets (brrr) on there backs and check on them every 15 minutes. I don’t think my baby would have gotten any sleep at all and would have been screaming the whole time.

    I Swaddled all my babies in order to get them to sleep and keep them that way, then I left and shut the door. If I went in to check on them the woke up- no matter how quiet I was trying to be.

    Not that I didn’t worry about SIDS, my oldest was on a monitor for 6 months because of sleep apnea, I worried plenty. But common, I had to be realistic, I had 6 babies and thankfully they all are now healthy, loud, kids who are still with me. But as painful as it is some babies are not going to make it. We do what we can, but no one gets to live forever.

  12. I’m going to agree with a poster above who said at least they aren’t turning them onto their backs (yet). My twins were preemies and spent 10 days in NICU. The NICU nurses always put them to sleep on the bellies and by the time we brought them home that is what they were used to. I tried to put them to sleep on their backs and it just wasn’t happening. Flopped them onto their bellies and they were good to go. They are 7 years old now and are still tummy/side sleepers.🙂

  13. One of our biggest concerns when picking out a daycare for a newborn was the kind of attention our little snowflake would be receiving. The little infants spend so much time sleeping and we wanted to know there was more than just a cursory glance in their direction. Would the kid be fine otherwise? Sure, but here we are paying someone to do something one of us would rather be doing so they should at least attempt to be better/more attentive that I would possibly imagine. Unnecessary? Sure, but that’s what I pay for: unnecessary, over the top monitoring and the (false) peice of mind beleiving that my little snowflake is being cared for.

    It’s hard dropping your kid off at daycare, it really is. So maybe it’s ok here maybe it helps a little knowing that if the kid wakes up it will be noticed. I don’t think it is possible to pay too close of attention to newborns – they benefit a lot from human contact and while it dosen’t have to be at every second this is not the worst thing a daycare could be doing…

  14. @SKL would you mind posting some links/websites from what you’ve read? I would love to put my twins to sleep on their tummies but personally knowing someone whose baby dies of SIDS (over twenty years ago, mind you) I’m still hesitant. Reading some good info about it would put me at ease.

  15. Good thing I stayed home with my two. The oldest would only sleep in a swing or belly to belly with me until he was 6 months old. The youngest couldn’t sleep if there was the slightest movement within 6 feet of her.

  16. Its probably excessive – however, the required provider:infant ratio is generally very small, ranging from 1:6 down to 1:3. I doubt that doing a quick check and making a mark in a box is going to take enough of the provider’s time to get worked up about it.

  17. Little infants spend so much tine sleeping? Really? Because my little infant didn’t sleep at all. My little infant refused to sleep all day and then screamed non-stop from 2 to 8 every night. Little infants differ greatly in their sleep habits. Daycare workers need to be able to deal with all. They need to be free to deal with a non-sleeping baby instead of spending time charting perfectly happy, sleeping babies. If my child had gone to daycare as an infant, I’d have been livid if she had been left to scream while sleep positions were charted.

    And this isn’t human contact. This is chart contact. The worker simply glances in the crib. The only contact is with the chart.

  18. Eric, the fraction of infants that suffer SIDS is less than 0.1% of the kids born every year. Still, that is not a REMOTE chance, it is quite significant. It is in fact thousands of times greater than your odds of buying a winning a lottery ticket (even corrected for sleep at day-care centers only).

    SIDS deaths are more common than auto deaths for children birth-11 months by a factor of ~20 for 2009. See National Vital Statistics Reports, Vol 59, No. 4, March 16, 2011. You seem to be comparing infants to all children with your 5x number. This is illogical. SIDS is in fact the most significant cause of infant death for infants without abnormal symptoms or laboratory findings. For 2009, there were 2168 SIDS deaths and 1620 deaths by all external causes of mortality combined (cars, falls, firearms, drownings, poisoning, airway obstruction, etc.).

    Stranger abductions are far rarer than you quote. The NCMEC lists 279 infant (birth – 6 months) stranger abductions between 1983 and 2011. That really is a remote chance. Only 7 of those were not recovered unharmed.

    The funny thing about this blog (not the commenters) is that one of its ostensible goals is to point out when people are worrying about tiny risks and neglecting large ones, but it often gets the risks grossly wrong.

  19. My understanding is that babies should be placed on their backs to sleep. If they are capable of moving to their tummy themselves, they are safe. People aren’t expected to check on sleeping babies at home. It’s been a while, but isn’t this correct?

  20. As a previous daycare worker in an infant room, I can say that we were only one step away from this anyways. I remember the tedious charts, having to write down what time the baby ate, how much, when the fell asleep, when they woke up, every diaper change, and what was inside said diaper. Most of the parents would either forget to take the paper or would glance at it and throw it away in the room’s trashcan. It was frustrating to have to do it, but the daycare admin stayed on top of it and made sure we were not slacking off with the paperwork. I agree, it is not about child’s safety or well being as much as it is about liability.

    I can say, however, that this is just one more piece of paperwork that the teachers have to handle. Honestly, it seems like a lot and that it would be hard to do, but daycare workers are pros at paperwork.

    Random tidbit: One of the things I hated most about the liability/stupid rules of daycare was the amount of diaper changes we had. In the 6 wks-9 months class, we had to change diapers every hour, no matter how dry they were. In the 9-18 months class, we had to check diapers every hour and change whoever needed to be changed, and change everyone every 2 hours, no matter how dry. It was humiliating to constantly have to explain this to parents when they asked why they were going through diapers so quickly.

  21. Next, the government will require all parents to log their infant sleep to prove that we are good parents.

  22. Of the 2168 SIDS deaths in 2009 in the US, how many of those babies were sleeping on their backs?

    Or is it just taken as an assumption that the only way babies die during sleep is if they are on their stomachs?

    Is it possible to determine via autopsy whether a child was purposely suffocated with a pillow or died of SIDS?

    Just wanting a bit more information so I can understand the issue better.

  23. I don’t know. I was a nurse and 15 minute checks aren’t that big a deal. For children under the age of 1 at a well staffed day care this doesn’t seem too onerous to me. I’m sure it has to do with current guidelines and liability. But again quick checks shouldn’t be an issue. More than anything it makes a care provider keep ‘eyes on’ babies while they are sleeping. I’m pretty ok with this.

  24. Effectively, they’re saying you’re bad parents for allowing your kid to have a blanket. I’ll hazard a guess there’s a lot bigger chance they get either sleepless, stressed or simply cold.

    Preventing SIDS is a worthwhile cause, but since there is no definitive cause linked to the whole thing, this doesn’t seem necessary.

  25. My mother, who had 10 children, gave me the best advise:
    1) Never wake a sleeping baby
    2) Don’t try to make a happy child happier.

    The paper pushing among child care workers is insane. Do we want box checkers or kind, nurturing teachers? Coupled with the low pay, I understand why there is so much turnover in this field.

  26. Delurking- Just to challenge you a bit on your stats, but what the original post asked was “Primarily, what are the chances my child will die of SIDS while napping at daycare in a crib with no bumper and no blanket?”

    According to researcher Rachel Wood, about 20% of SIDS deaths are at daycare with 60% of those happening at home daycares. So only 8% of SIDS deaths are happening in the type of center described by this post.

    My point is that while the difference between placing baby prone on inappropriate surfaces with bumpers and blankets and placing baby on the back on an appropriate surface without bumpers in blankets has merit based on years of research, the added benefit of checking every 15 mins to determine sleep position likely does not.

  27. mollie,

    There is an investigation of every infant death by local health officials, so the data exist. They are not in the NVSR, but summaries are in the medical literature, as is all of the reasoning that lead to the AAP guidelines on infant sleep positioning (though you will have to do a lot of reading if you want to start from primary sources). It is not assumed that babies who died during sleep were on their stomachs.

    I do not know what the diagnostic power of autopsies is in your hypothetical case.

    What issue are you trying to understand better?

  28. I do have to question: If the day care workers aren’t changing the babies’ sleep position what is the purpose does logging it serve? If a caregiver was going to lie about checking the babies on a regular schedule wouldn’t they also lie about the babies’ positions? If the purpose is to follow the back-to-sleep and other AAP guidelines wouldn’t that require intervention if a baby sleeps on their stomach or side? If the purpose is to limit liability wouldn’t knowing, and charting, that a baby was not sleeping according to guidelines make them look worse in court?

  29. Kels, and the odds of winning a lottery are typically between about 18 million and 120 million to one. Still a factor of thousands difference.

    I’d say that by having someone look at a baby closely enough to notice sleep position and mark it down, they will likely notice if the baby is in an unusual position or turning blue. While there is likely not epidemiological data studying the practice, the cost of the practice when you have a bunch of babies sleeping in one place is very low. Therefore, it is unwarranted to characterize the practice as not-sensible and unwarranted overprotection.

  30. @Donna Little infants spend so much tine sleeping? Really?

    Call me a lucker and hate me, but mine did. There are kids like that. You do not hear about them that often, because their parents have nothing to complain about.

    “Because my little infant didn’t sleep at all. My little infant refused to sleep all day and then screamed non-stop from 2 to 8 every night. ”

    That sounds like a very difficult baby.

  31. “Primarily, what are the chances my child will die of SIDS while napping at daycare in a crib with no bumper and no blanket?”

    Just a little bit higher than with bumper and a blanket. There is a difference, but it is not very high.

    “I’d venture a guess that they are certainly smaller than the chance that I could go buy a winning lottery ticket.”

    Depends how often you buy lottery tickets. It is smaller if you buy them often and higher if you buy them rarely.

    “What are the chances that my child will benefit developmentally and physically from more attention from her teacher while a few of her classmates nap?”

    Assuming that he is not neglected, that chance is zero. Additional 2 minutes of attention per day will make no difference.

  32. Mollie, this refers to shaken baby syndrome (another one of those, oh, the child died, someone must be at fault,) http://www.npr.org/2011/06/29/137471992/rethinking-shaken-baby-syndrome

    The thing that I got out of hearing this on the radio is that an expert is needed to do an autopsy on a baby. Those experts are generally not available (even a doctor to an autopsy is not available for adults in many areas of the country.) People tend to rush to conclusions without considering all the facts. (Like, was the baby ill prior to the death.)

    The questions you ask are good ones.

    I am just glad that 1) I did not need to put my kids in daycare and 2) that nothing happened to them, because like in the link above, someone would probably have been charged with murder because of the “some one must pay for this” mentality.

  33. @Miriam – SKL’s comments got me curious as well. I don’t know what they were referring to specifically, but a quick google search led me to this site which presented a lot of info in ways that I had not previously considered.
    http://www.heracliteanriver.com/?p=97

  34. I love this blog, but I might go a little rougue here. I put two infants in FT care at 8-10 weeks. I liked knowing when they ate last (bottles), how long they slept, and if they pooped. Unfortunately, the person with your baby for most of the day is not always the one who is there when you pick the baby up. If you’re trying to keep an eye on something, like the baby hasn’t eaten or slept well in the last 3 days, those sheets really come in handy.

    That being said the best thing is to establish a good relationship with the staff. They know you, know your baby and can be a great resource.

    Most licensed daycares don’t use bumpers or these days blankets, but my daughters infant room was kept reasonably warm, so getting chilly wasn’t an issue.

    Checking every 15 minutes was usually nothing more than a pass by, and a light touch to ensure everything was OK. It’s really not that time consuming. Plus our state has a 1:5 ratio at that age, and there were usually two teachers per room.

    Now some centers (5 star) go completely overboard on paperwork and detailing your child’s activity during the day. They have to in order to keep their 5-star rating.

    I think daycare centers are concerned about liability, but the good ones? the ones you want your child to be in? They are more concerned with parents being comfortable and confident with the center and the care.

    First-time mothers of newborns can be pretty intense. Even ones, like me, who grow into much more free-range parents.🙂

  35. I do home daycare for the Navy (Child Development Home Program) and we’re required to visually check on sleeping children (ALL ages) every 5 minutes.

    Thank God they don’t make us keep logs for this yet, but sadly with how much paperwork we already have to do, we probably will have to in the future.

  36. Part of me likes the idea of documenting enough to keep a good track on the babies (and I guess I get the legal thing) but that often seems a tad unnessary. I do think it’s a good idea to note when Baby seems out of normal.

    My parents recently revealed to me they would sometimes leave me in my baby swing at night when I was just too collicky to tolerate anything else. Somehow I survived to be reasonaly well-adjusted.

  37. @ delurking. Compared to the number of children born every year, that stat is remote. Less than one percent is remote. Not saying it’s not tragic, but not something that is an epidemic that requires a constant and vigilant watch over infants. Every 15 min checkup? That’s pretty excessive, unnecessary, and in some ways pointless. Above all, it’s more about litigation than anything else. IF, big if, a baby gets SIDS in this daycare, are the care givers knowledgeable and qualified to save their lives? And what if the child has SIDS between the the last checkup and the next? That’s 15 min of not being watched. 15 min of not breathing. That’s death right there. So then that means checkups should be ever minute…30 seconds? Or maybe all infants at day cares should be hooked up to heart and respiratory monitoring devices. Do you see, how this is sounding pretty ridiculous? That’s like the mentality of parents who are afraid to let their children out of their site, because they are afraid something might happen to them.

    There is nothing wrong in wanting to keep children/infants safe. But when it is becomes more about not wanting to get sued, over actual common sense thinking and taking care of infants, that becomes the issue. It’s a drain on resources, and a cost that is taken on by the parents who choose to send their infants to day care. And some have mentioned already, most SIDS cases have happened at home. Not in day cares. As well, there are many SIDS cases that have found the child to have had some other health issues prior. So when you look at stats of fully healthy infants dying of SIDS in a day care facility, that 1% drops even more. This is basically another “worse case thinking” and “we don’t want to get sued” scenario.

  38. “I do not know what the diagnostic power of autopsies is in your hypothetical case.

    What issue are you trying to understand better?”

    Delurking, I want to understand if the strategy of checking (or correcting) a baby’s sleep position is actually preventing an otherwise unexplainable death from lack of oxygen.

    From Wikipedia: “Sudden infant death syndrome (SIDS) is marked by the sudden death of an infant that is unexpected by medical history, and remains unexplained after a thorough forensic autopsy and a detailed death scene investigation.”

    So I ask again: How can an autopsy differentiate between SIDS and intentional suffocation?

    It may be one of those taboo subjects, but infanticide does happen. Perhaps, like sexual molestation once was, this is one of those things people never believe could happen in their own family, and hence, deny that possibility with vehemence. I don’t at all intend to suggest that all cases of SIDS are infanticide, just a portion could be, based on lack of identification of exact cause of death.

    “An infant is at the highest risk for SIDS during sleep, which is why it is sometimes referred to by the terms cot death or crib death.”

    “Crib death” doesn’t necessarily mean death while asleep. It means the baby died in the crib. Just like “I went to bed with her” doesn’t alway mean sleeping, it just identifies the place the action happens.

    “The cause of SIDS is unknown, but some characteristics associated with the syndrome have been identified.”

    If the cause is unknown, it’s unknown. Period. It means there is no quantitative, empirical evidence revealing a specific precipitating factor, so that’s why I ask if it is a.) preventable and b.) prevented by strategies such as the one delineated in Lenore’s post above. Suffocation is preventable (some physical outside force acted on the infant to deny it adequate oxygen, so if someone or something is “suffocating” the baby, removing that would be prevention). However, SIDS is still cause “unknown” and “unexplained,” so that doesn’t give us a concrete prevention strategy, at least in my understanding.

    “There are many risk factors and medical causal relationships proposed for SIDS.”

    Proposed, not proven. It is also proposed that most commercial shampoos, deodorants, and other cosmetics contain chemicals that might be linked to the development of certain cancers. Does that mean it is proven that using xyz shampoo causes cancer? Why not pull all carcinogenic cosmetics from the shelves? Would that strategy be effective? Some might say yes, in fact, that strategy would be more serving of life than denying sleeping infants a blanket and checking them at regular intervals and perhaps repositioning them to be on their backs.

    “Infanticide and child abuse cases may be misdiagnosed as SIDS due to lack of evidence. Accidental suffocations are sometimes misdiagnosed as SIDS.”

    So. With all of these variables in place, taking the “unexplained” and insisting that all parents and caregivers must do x, y and z with babies seems, at best, more like superstition than preventive care.

    I think we have become very superstitious as a society. We do not accept the death of any infant or child as “natural.” We want it all to be preventable. We think it is “wrong” that any baby would die, and so we have come up with “suggestions” to “prevent” SIDS, an unexplained cause of death. None of these suggestions seem to have been proven empirically to do more to keep your child alive than would throwing salt over your shoulder and praying really hard.

    I like the idea of parents, especially, choosing to do what, given their unique circumstances, is “optimal” for their specific kid. These blanked “musts” are like so many “musts” these days: children must be supervised at all times, they must not walk alone, parents and institutions must not accept even the most minimal risk for any injury or highly unlikely criminal scenario.

    I disagree, because I think that on the altar of “safety,” we sacrifice our own integrity, the integration of all that we require to thrive: rest, ease, comfort, well-being, learning, growth, development, joy, play, connection, community… you name it.

    In my heart, there is more to life than a narrow definition of “safety.”

  39. I have 2 kids whom I adopted around a year old. One was a back sleeper, the other a belly sleeper. The back sleeper was having a very rough time with visual learning, and this was traced to retained primitive reflexes. She needed therapy to fix this. Many kids will have the same problem, but their parents won’t realize the potential source and they will have significant learning problems in school.

    I think it’s pretty unbelievable that the medical profession thinks it’s OK for millions of kids to sleep poorly and develop unnaturally, to improve the chances for a few kids who happen to have other fairly clear risk factors. More direct risk factors include having a lung infection, nasty old mattress, smoking parents, prematurity, etc. These don’t apply to most kids. I also suspect that a fair number of SIDS cases are actually due to parents using age-inappropriate meds to get sick kids to sleep. Only recently has this risk been highlighted.

    I’m a huge proponent of sleep and natural human development. I feel the risk of millions of kids developing learning/behavior problems should not be minimized. I’d rather hear parents being told that they need to watch their babies more closely when they have a respiratory illness, have a clean mattress (inside and out), and keep smoke outside of the baby’s environment, for starters.

  40. EricS,
    Sorry, something of order 0.1%, or even 0.01% is not remote in everyday language. Your personal definition of “remote” is the outlier.

    Infant sleep deaths are not typically caused by a sudden cessation of breathing. It is typically a confluence of multiple factors including external stressors like sleep position and immature cardiorespiratory development and arousal response that leads to an insufficient response. So, due to some stressor (like bad sleep position) the infant begins breathing less well. The infant does not shift position or wake up because of its immaturity and lack of strength, which leads to further oxygen deprivation (see, e.g., Pediatrics 128, e1341, 2011 and Biol. Neonate. 65, 194, 1994). This takes long enough that 15 minutes intervals are reasonable for checks.

    So, yes, if an average caregiver notices an infant in an unusual position or with bluish skin, they will know what to do. They will move the baby just to check on it and that will be enough to save its life.

    There are no quantitative absolutes, there are costs and benefits to every safety measure. If there are a bunch of infants sleeping in a room, in a day care room where there are typically three or fewer infants per staff member, the cost of looking at the infants every 15 minutes is low enough that this is not a ridiculous measure. It is much more reasonable than what day-care centers typically do to prevent stranger abductions.

  41. @SKL- I do believe Sudden Cardiac Arrest (SCA) accounts for 30% of SIDS cases. It’s a heart defect (either physical or electric) that isn’t detectable without an electrocardiogram, which is a test many hospitals do not routinely do at birth.

    I have no idea how charting daycare babies like they were a science project would prevent these deaths.

  42. I don’t see anything wrong with “looking at” the infants every 15 minutes. Marking the sleep position on the chart is much more than looking. You can “look at” multiple babies in a couple of seconds while holding another child.

    If this were the only paperwork requirement, that would be a different matter.

    Frankly, I don’t have a problem with my baby being “looked at” frequently as long as nobody disturbs her normal, healthy sleep by rolling her onto her back. Daycare workers are paid, after all. As someone noted, having an unfamiliar caregiver changing the baby’s normal sleep routine can be a risk factor.

  43. mollie,
    You wrote:
    “I think we have become very superstitious as a society. We do not accept the death of any infant or child as “natural.” We want it all to be preventable. We think it is “wrong” that any baby would die, and so we have come up with “suggestions” to “prevent” SIDS, an unexplained cause of death. None of these suggestions seem to have been proven empirically to do more to keep your child alive than would throwing salt over your shoulder and praying really hard.”

    1. I think human life is worth saving. There are many illnesses that are “natural”, and we still do all we can to prevent them from taking peoples’ lives. All medical research is based on this philosophy.
    2. The rate of SIDS, the number-1 killer of infants birth-11 months aside from diagnosable disease, was cut in half between 1991 and 2001. Are you seriously arguing that throwing salt over your shoulder and praying really hard would have been as good? The fact that the causal chain is not fully understood does not mean that the discovery of correlations is worthless. Certain actions have been demonstrated to a high degree of confidence to save infants’ lives. The fact that we don’t understand exactly why they work does not invalidate the conclusion.

  44. As much as I hate to say it, some babies are going to die. The idea that this is 100% preventable is leading people to make ridiculous decisions and policies. The cause of SIDS is by definition unknown. Someone picked tummy sleeping as the culprit, but the % of SIDS cases involving back sleepers is too high to let that sit. Correlation does not equal causation. If there is an identifiable cause, let’s find it and save the babies that back-to-sleep isn’t saving, without harming the babies back-to-sleep is harming.

  45. Based on this policy, I am/was a bad mother, when I sleep when my children sleep. Especially back when they were small, when they ignored the fact, that night-time is a good time to sleep? I should have learned before to live with 10 min power-naps until they are …. how old or 18?

  46. Honestly, I think some of this is also to get as much work out of these low-paid workers as possible. My mom owns a daycare and when people pay for daycare, they don’t want the provider to have a second of rest or down time. They make absurd requests of providers so they can get the most for their money. The lower paid a worker is, the more likely they are to have to do things like this. It’s a lack of respect, and it’s an aspect of control that parents can have since they can’t be there with their kids. Plus, like I said before, childcare is a major expense so they want to feel like they are getting their money’s worth. Most stuff like this arises from parental complaints of some kind. Someone raises a stink, so something like this gets implemented. Or, they will have a freak SIDS death and parents want someone to blame, so they blame the daycare. Never mind that children have died of SIDS in their parent’s arms.

  47. Annnnnnd, reading Matt’s response proved my point.

  48. Delurking:

    It sounds like you really care about survival, and supporting the thriving of people. I share that with you.

    Crimes against children have dropped precipitously in the same timeframe. Does this mean that the current logic of keeping children supervised at all times is “working”? What accounts for the drop in crimes against kids? This entire “Free Range Kids” movement has its foundation in challenging the idea that “because what we’re doing is ‘working’ to keep kids safe, we have to keep it up, nay, do it ever more to the extreme, to save that ONE EXTRA CHILD who could have come to harm if we hadn’t been so vigilant…”

    So if you breastfeed or don’t breastfeed, put the baby to sleep sunny side up or over-easy, check on her every three hours or every five minutes, use J&J Baby Shampoo or something you concocted from organic herbs and oils, put the baby in the car and drive it to the playground instead of walking there with the stroller… stuff still happens. And we don’t always know why. So why act as though we control it all? We make our best guesses and go with it.

    In the name of “health,” the medical profession has brought us myriad “solutions” and “cures” that have, ironically, led to a state of ever more compromised well-being.

    I hear how important life is to you, and I value life too. I don’t necessarily think of living with the primary directive of preventing injury or death as living.

  49. So, what are they going to do when an infant drowses off in the swing or bouncy seat? wake them up and take them out of it? geez!

  50. I’m so glad I never had to have my kids in day care. A few of them would have hated it and never slept based on some of these rules.

    Kid #2 had colic, reflux and was easily overstimulated. he slept in his carseat the first 3 or 4 months of his life because if he laid flat the reflux would get him and he would just scream and scream and scream. It was 2 weeks before I figured out the carseat thing (he hated the swing and bouncy seat).

    Kid #3 HAD to have a blanket over her face to sleep. From the time she could coordinate her arms to pull it up over her face that’s how she slept. That was around 2 months old. The blanket I gave her was a threadbare receiving blanket I had when I was little. She slept like that every nap and all night all the time. She’s 9 1/2 now and still sleeps with a blanket over her head.

    And the whole flipping baby over thing…I would have been ticked if that had been policy (as someone above stated). My kids all learned to roll pretty early and once they could roll all five of them preferred to sleep on their tummies. I always put them to bed on their backs but they’d flip themselves either before they fully fell asleep or sometime in the night. Turning them back over would just wake them up and make them cry and for what? They’d just turn right back onto their stomachs as soon as they could. I can’t imagine the sleep lost trying to force a rolling baby to stay on its back. (the earliest my kids were rolling was 3 months on the dot, latest was 5 months).

  51. “It is in fact thousands of times greater than your odds of buying a winning a lottery ticket (even corrected for sleep at day-care centers only).”

    Aren’t there at least 44 lottery ticket winners (one for every state that runs a lottery plus D.C.), 5 days a week, year round? So over 200 a day or 50,000. Isn’t that a lot more than the number of SIDS deaths?

    Let’s see: 4 million live births per year, .01% is 4000/year, which is less than 11 per day.

    And that’s only counting the “daily number” type lotteries, not all the other ways there are to win.

    And actually the American SIDS Institute lists the annual rate as 2500.

    http://www.sids.org/

  52. Sorry, I typed .01% above but I was figuring it at .1%. The 4000 out of 4 million number is correct math, but American SIDS Institute puts the rate lower than that.

  53. Thanks, Jessica, for the Heraclitean River link. It’s a good one.

  54. mollie,
    “Crimes against children have dropped precipitously in the same timeframe. Does this mean that the current logic of keeping children supervised at all times is “working”? ”

    No, and few credible people make that claim. The most convincing piece of evidence is that crimes against everyone have fallen without similar safety measures being taken for adults. Medical research is more carefully controlled than that, certainly in the case of SIDS.

    “In the name of “health,” the medical profession has brought us myriad “solutions” and “cures” that have, ironically, led to a state of ever more compromised well-being. ”

    This is quite an accusation. You have evidence that our well-being is lowered as a result of medical research? It looks like the opposite to me. Certainly the numbers for things that are measurable are on my side. If you are simply claiming that in an alternate universe where there was less medical advance you would be happier despite the extra suffering and death, there is nothing I can say.

    “I don’t necessarily think of living with the primary directive of preventing injury or death as living.”

    Neither do I. I compare costs to benefits. The problem with this web site as a promoter of the free range kids movement is that in its criticism it often fails to distinguish between cheap efforts that have the potential to save 1 in 10,000 and expensive efforts that might save 1 in 10,000,000.

  55. There are some research going on that found the correlation between SIDS and vaccinations. Be cautious about giving vaccations to babies…way too much toxic, mercury in little bodies.

  56. Speaking of correlation, how’s this logic:

    1) Doctors and baby health “experts” advise back sleeping.

    2) Those who get good prenatal care and go to well visits and those who read up on baby health are the ones most likely to hear back sleeping recommendation and consider following it.

    3) Those who get good prenatal care and go to well visits and those who read up on baby health are also those most likely to do other things that are good for baby, such as keep cigarette smoke away from them, make sure they have a reasonably new mattress,

    follow recommended doses on meds, observe baby’s individual indications of health issues, check in on baby periodically, hold baby more, breastfeed, hire responsible caregivers, be sober while caring for baby, have the means to check into potential health concerns, not prop bottle with dish towels around baby’s neck (yes I know of someone who did this), not secretly abuse baby, have baby full-term and healthy, and probably 50 other risk factors for infant death.

    4) Back sleeping is likely to be correlated with lower SIDS rates.

    Does not prove that back sleeping is best for anyone who does not have existing health issues.

  57. SKL,
    1. Health recommendations are researched before doctors and medical organizations like the AAP issue guidelines. Then, after guidelines are issued, more research is done
    2. There are well-established techniques for controlling for socioeconomic factors and other behaviors that you mention.

  58. Delurking, no, I don’t think they can effectively control for those factors because there is such a small sample of people who are educated, health-conscious, have financial means, AND refuse to follow the back-to-sleep recommendation. I also do not think they have really tried to do so after putting the recommendation out.

    I am sure they did research, but research can lead to false conclusions, as has been proven many times.

    Also, I believe that with more kids back-sleeping, they should have more data on the problems caused by the resulting loss of sleep and other developmental issues. Though again, stats may be skewed since tummy sleeping is now so rare among many groups. Maybe they are comparing results of educated back-sleeper families with those of economically disadvantaged tummy-sleepers and finding no issue due to skewed stats, but the issue is very clear to me. They should be informing parents about these potential problems so parents can make an informed decision.

    Should it not be up to parents to decide whether they want to risk a tiny and undefined chance of breathing problems (which they could deal with in multiple ways if they thought the risk concerning), versus the fairly high likelihood that sleep deprivation is going to lead to developmental issues?

  59. delurking, quality research on SIDS isn’t as conclusive as you seem to be making it out to be. Also you fail to address the fact that back sleeping babies die of SIDS too, so while position does correlate to a moderate increase in risk it does not play the great role the recommendations lead people to believe it does. Since you asked Mollie “You have evidence that our well-being is lowered as a result of medical research?” I’d like to point out she addressed “cures” and “solutions”. Off the top of my head transfats and thalidomide come to mind as cures and solutions that actually did more harm than good.

    All of this is a moot point because, as I pointed out earlier, checking a box on a piece of paper isn’t actually going to make the babies safer. If a daycare worker wasn’t already checking on the babies there is nothing to stop them from falsifying the paperwork. And since checking a box doesn’t physically prevent SIDS the whole thing is a false sense of security. That make the cost/benefit ratio tilt toward stupid.

  60. @eathomelive – Yep in Chicago we could spend more on daycare for an infant than we pay to rent a 3 bed apt in a decent neighborhood. I want to be certain we would be getting our money’s worth and I do have a high level of respect for what the people in the daycares we checked out do. In a comment above someone mentioned that they like the data poops/feeds etc – the things you would see if you were home and just naturally around – the charts are a huge help in shift changes.

    It is not absurd to want to know the ins and outs of things that happen during the day. For example, my wife and I have readily given long updates ad nauseum to pediatricians and nurses to help pinpoint problems. So konwing the baby’s rhythm and if there were interruptions has proven valuable.

  61. delurking. Actually part of the reason this is being done (outside of preventing sue-happy everybody) is that
    “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. ”
    http://pediatrics.aappublications.org/content/106/2/295.abstract

    What studies are showing that babies who only know how to sleep on their backs are dying from SIDS, when placed on their belly by a care giver (daycare, grandma etc) This is part of the reason. I actually think NAEYC might be behind some of the changes on how sleep is monitored. My child care center went through a new SIDS training last spring.

  62. The fact that back sleeping makes kids less able to survive sleeping on their stomachs should give us pause. What other capabilities is back sleeping suppressing / destroying?

    SIDS was still very rare even when almost every baby slept on his/her tummy. Tummy sleeping does not kill healthy babies.

  63. A few people have posted things with a message similar to Heather G:
    “All of this is a moot point because, as I pointed out earlier, checking a box on a piece of paper isn’t actually going to make the babies safer. If a daycare worker wasn’t already checking on the babies there is nothing to stop them from falsifying the paperwork.”

    Checklists help a lot in many fields. A book on the topic is “The Checklist Manifesto” by Atul Gawande if you don’t want to dig up operations research journals.

  64. Sounds like suicide watch at the nuthouse or the county jail. Maybe we’re teaching babies for their potential futures?

  65. My stepsister’s baby has reflux, and for her first 6 months she slept in her carseat or swing as a previous poster shared above. She now sleeps with a wedge and not totally flat. What would the daycare be told about that? If I had a child like my niece, and was told she could not sleep in her carseat, bouncy chair, or swing I’d be looking for another daycare, particularly since it was a medical issue.

  66. I’m a parent of two, and a former childcare worker. I cannot for the life of me understand what purpose being served by this kind of bureaucratic micro-management of healthy, sleeping babies.

    If infant humans were so at risk of dying in their sleep that they simply have to be checked on every fifteen minutes, we would be extinct as a species by now.

  67. @SKL “What other capabilities is back sleeping suppressing / destroying?”

    Please, do not go there. This used to be non-fear-mongering forum.

  68. “shanada, on March 9, 2012 at 05:59 said:
    There are some research going on that found the correlation between SIDS and vaccinations. Be cautious about giving vaccations to babies…way too much toxic, mercury in little bodies.”

    Please stop spreading dangerous lies.

    Here is some information from a source that has actually bothered to check their facts. It took me ten seconds on Google to find this.

    http://www.youngausskeptics.com/2009/05/vaccines-mercury-and-you/

  69. “a small sample of people who are educated, health-conscious, have financial means, AND refuse to follow the back-to-sleep recommendation.”

    As one of this small sample, I’d be interested in seeing if there are any SIDS deaths in this group. Because as an educated, health-conscious person, I actually made a thoughtful, conscious decision to allow my child to sleep on her tummy. I researched the risk factors for SIDS and evaluated my daughter’s particular risk before making the move.

  70. @ delurking – What does this particular checklist tell you that is remotely helpful? As stupid as I think they are personally, the pee/poop chart at least provides information that could be medically helpful (i.e. My kid hasn’t pooped in 3 days. What can I do?). What information does knowing your child slept on her back at 11:15am and was still sleeping on her back at 11:30 am tell you that would be remotely useful as a parent/physician? I was a SAHM for the first year of my child’s life and I didn’t know this information since I didn’t check on my child every 15 minutes. The chart may, and that’s a HUGE may, be useful in an autopsy, but I don’t think that daycare centers need to do paperwork in a remote possibility that it will be helpful post-mortem.

  71. @SKL “What other capabilities is back sleeping suppressing / destroying?” Please, do not go there. This used to be non-fear-mongering forum.

    It is not fear-mongering to ask that question, but the beginning of a healthy risk-benefit analysis. It is always important to understand the potentially negative consequences of what is put forth as a positive action.

  72. There’s two wrinkles in this, one is that children are much more likely to die of SIDS in daycare. Especially in the first week, the risk skyrockets.

    However, every 15 minutes would not be enough to prevent this anyway. It takes less than 15 minutes to die.

  73. Donna, the only thing that this might tell me that I might have missed if my baby were in daycare for 9 hours a day is when my baby learns to turn over. Which I do recall doctor asking me. (One of mine managed that at 3 days.) Really, I don’t need someone documenting that for me, hopefully I would notice the same within a day or so at home.

  74. Hmmm, has anyone checked the increase in childhood learning issues, autism, and other stuff to see if it corresponds with the back to sleep campaign? Someone upthread mentioned something, but it would be interesting to see.

    I let my oldest sleep on her stomach the most, mostly on my tummy. She also was the early turner. My second and third slept mostly on back. They are the ones with more issues with learning, muscle development, vision stuff.

  75. Willing to bet most of the data on those charts will be faked.

  76. SIDS gives me nightmares. I’ll explain why at the end (Trigger Warning for those who have experienced an infant loss)

    But let me answer a couple of things:

    1)shanada: there is no “toxic mercury” in infant vaccines. Please join the rest of us in 2012 since thimerosol was removed from vaccines 10+ years ago and only existed in multi-dose vaccines, never in single dose vaccines (i.e. vaccines that came from 1 vial for 1 person, not 1 vial for multiple persons).

    2)the AAP guidelines now are “Back to Sleep, Tummy to Play” or something like that, because parents were NEVER putting a child on their tummy and developmental delays were noted. So now the recommendations at least say put the kid on his/her tummy for periods during the day

    3)SIDS is rare. It generally occurs between 3-9 months but the honest range is birth to about 2. Yes, autopsies can often rule out other causes of death (suffocation leaves visible signs to the trained eye) but SIDS is often what we call a “diagnosis of exclusion” meaning that every other cause they checked wasn’t there so SIDS is the only one left.

    4)The incidence of SIDS deaths has dropped since the back to sleep campaign. However, it still occurs even now.

    5)The AAP also says once a child can roll over easily, you don’t need to keep adjusting the sleeping position.

    I don’t get the “no blankets” thing at the daycare. My kids, too, required swaddling for sleep. My younger one slept in an infant tummy crouch (you older mothers will remember that position) until she was about 12 and too big to sleep that way. She had a terrible time learning a new sleeping position.

    Lastly: the only case of SIDS I ever saw was in a 2 day old infant. Due to go home from the hospital that day, baby X had a blood test drawn at 5 am. When I went to pick up baby X to feed xe (as the nurse in the room, I fed all the “in” babies – awake, crying babies were fed before waking the sleepers ), xe was dead and cold. Sometime in that 20 minutes, the baby had died. Would 15 minute checks have saved that baby? Maybe – but doubtful. The baby was awake, vigorous and crying at 5 am, and dead 20 minutes later. Lying on xe’s side, as most hospital babies were then (25 years ago), warmly swaddled and dead.

    SIDS IS *Sudden* infant death. You can’t really prevent if from never happening.

  77. My daughter’s daycare does 15 min charting as well. As it was explained to me it isn’t a 15 min on the dot deal just a walk by check in the course of other duties. At times there would be 12 infants and 3 or 4 caregivers in one room. So the room could get to be a bit noisy. I have seen caregivers look at the chart to see if anyone did a sweep of the sleep room recently. I have also seen the room loud enough that even I didn’t hear my daughter start crying when she woke up. She was discovered when someone looked at the chart and saw there was a sleeping baby in the room they hadn’t looked for. When they went to make the check (5 min after I last looked) they found her sitting up and softly crying.

    So I’ve sort of taken the chart as a reminder for the staff of who is in the sleep room and insurance that she doesn’t spent too long awake and unnoticed.

  78. @shanada

    You clearly need to see some real data. For example: http://www.fda.gov/BiologicsBloodVaccines/SafetyAvailability/VaccineSafety/UCM096228 which clearly shows that mercury in vaccines is no longer an issue…it it ever was. You’ve been reading too much of Andrew Wakefield’s fraudulent garbage.

  79. sorry as a pediatric nurse I agree with this one, in my area there have been (3) SIDS deaths in good daycare centers in the past 2 years.

  80. Seems the questions is always how much is too much. My SIL sporadically works in daycare/ childcare and when she watched my son last summer, she always gave me those sheets trackign everything related to care, which honestly seemed like overkill to me. Some of it because she made sure to record what he ate even though I packed his meals. Some of it because I don’t really need to know when exactly he was changed… if there’s something unusual, then note it. By why note the routine? Then again, I’d hope that any child care provider kinda knows the kids they work with (I teach alternative high school, and if I can get to know the daily habits of my 50 different students, then I should think a classroom of a much smaller ratio could also get a general feel for daily habits as I give a lot of credit to people who work with children for wanting to get to know them.)

    @SKL– I’d love to talk more with you about the importance of sleep in children! (Totally serious.) With our son, we learned just how important sleep is (and not just to him.) When my toddler is shorted even a mere hour of sleep– which wouldn’t seem like anything to most parents– he’s a completely different baby. And not in a good way. He acts like a typical toddler with no impulse control, lots of melt downs, and is extra clingy. But catch him up on sleep, and he’s almost the exact opposite. My journey through our joint sleep deprivation and back into health (plus all the reading I have done on sleep) have really made me reconsider the importance of sleep.

  81. I am a Neonatal Nurse. Even WE don’t keep records of sleep positions every 15 min. Granted, our babies are on monitors, but COME ON! This is over the top!! All this does is make new parents even more paranoid and sleepless!

  82. I would also be very interested in the data on SIDS occurrence in people who fit SKL’s list of factors, as I fall into the category of people who meet all of those criteria and choose to ignore the back-to-sleep recommendation after much research while pregnant and sleeplessness after discovering that my kids refuse to sleep on their backs. During my 3-year-old’s first five months, she napped sitting in a swing, but the only way she slept longer than an hour was belly to belly, in bed with me. She still usually sleeps on her belly. As I type this, my 3 week old is laying on his belly on my belly, If I attempt to lay him down on his back, the screams will wake the neighborhood. He’ll nap for 45 min or less in a swing or bouncy seat. but for the 3-ish hours between feedings, it’s mom’s belly/ chest or nothing. I have never been happier than when we brought him home from the hospital, as that was the longest sleepless 3 days ever, with seems like dozens of nurses who had no problem waking us from sleep by insisting I not drowse off holding him or ever let him sleep on his belly.

  83. I recently came across an interesting article looking into the risks of stomach sleeping: http://www.heracliteanriver.com/?p=97

  84. What in the world is wrong with all of you who are arguing about the statistics on SIDS???
    Have you no heart?
    The way you talk sounds so much more bizarre than the idea of checking a sleeping child every few minutes.

  85. The data On SIDS ? The stats on The likelihood of SIDS ? Are you all autistic?

  86. @Susan may I know what exactly do you complain about?

  87. I haven’t read all the comments yet and I’m not quite sure what to think of the original post yet either. It sounds over the top and like it could potentially fuel the anxiety of parents who are already overwhelmed by all the safety advice. On the other hand I don’t think it’s such a big deal and I think I agree that daycare center staff should be more vigilant because all parents worry about leaving their child in the care of someone who doesn’t have a strong bond with them, whether they are or become free-range parents or not.

    As a first-time parent I did struggle with all the SIDS advice. It made me feel quite paranoid and after all the trouble to get my baby to sleep, I often couldn’t really relax while she was asleep either. The first time she slept through the night I hardly slept a wink. Kept getting up to check if she was still breathing. And the SIDS warnings and advice that seem to come with every baby product you buy had me constantly worry about whether I was following all the rules correctly. I did always put my baby to sleep on her back, but then I wondered why for decades the advice had been to put them on their tummies, because I never found out why that changed from one day to another. And I never even found out if my baby would have slept better on her tummy.

    Here in Australia they don’t go as far as telling you not to use a blanket though. You just have to make sure the baby and blanket are at the foot end of the crib so there’s only just enough blanket to cover the baby’s body and the chances of them tunneling under it and suffocating are minimal. Though baby sleeping bags are way more practical anyway…

  88. Ok, having read some more comments now… I totally get where delurking is coming from. If with some simple precautions – eg. making sure your baby doesn’t overheat, which can be done by using the right weight sleeping bag – lives can be saved, it is totally worth it.

    Also, checklists are used to make sure that staff do what they say/are told to do. If they simply had a policy that said they would check every 15 or however many minutes, how many would just not do it because no one would ever find out? Admittedly, they also could just put fake data on the list. But the checklist could be a prompt for some at least.

    And this is not a direct response to the post itself, but some people here seem to sometimes confuse free-range parenting with “natural parenting”. I am all for allowing my child enough freedom to enable her to explore the world at her own pace, find her own solutions to problems and learn to be self-reliant. But I didn’t think more than 5 seconds about having her vaccinated because I know my history and it isn’t that long ago in the scheme of things that parents felt lucky if their child made it to 5 without dying of some horrible illness. But the only link that has to free-range parenting is that the anti-vaccination brigade is just another group of people who try to make parents worry and feel guilty about doing what they think is best for their kids for logical reasons.

  89. @Jen – My belly sleeper still sleeps that way at 6.

    @Lin – The problem is that there is absolutely nothing in checking a baby every 15 minutes and charting sleep positions that makes a baby even remotely safer. SIDS deaths generally involve a baby alive and healthy one minute and dead the next. There are no symptoms of distress before the baby dies. No precursors. There is nothing you will learn from looking at a sleeping baby that tells you that that baby will die of SIDS in 2 minutes – long before your next scheduled check. I suppose, if you were fortutious enough to check the very instant the baby stops breathing, you might be able to do something (since we have no idea what causes SIDS, we have no way of knowing if this is true). But the baby is more likely to stop breathing in one of the 15 intervening minutes than she is in the 5 seconds that you are checking her. This is simple action. It simply isn’t a precaution for anything.

    And what is the price? I don’t know any sane parents who check their sleeping baby every 15 minutes. Will they now think this is required? If the professionals believe it is necessary, will some scared first time parent think it’s required, thus missing out on important sleep? Will this make parents more fearful? More worried about the remote possibility of SIDS?

  90. Pat, what would charting the sleeping positions at a particular interval going to do to actually save a child from dying of SIDS (please see MI Dawn’s comment, hers is not the only story like that I’ve heard.)? If, somehow, it really *is* going to save a child’s life then parents should be doing it at home since a larger percentage of SIDS deaths occur at home than at daycare?

  91. I don’t think all this obsession is even good for babies and kids. It just makes them neurotic.

  92. In Guatemala, where my kids are from, they keep babies heads covered pretty much all the time when they are out. Even when it was 90 degrees F out, babies’ heads were always covered by light blankets. My eldest could not sleep without something covering his head. So I gave him an afghan with lots of holes in it and called it done. He was 6 months old when he came home, and I put him in the crib with (gasp!) grib bumpers and his afghan, and let him sleep however he wanted to. If he fell asleep in the backpack/stroller I had, I would take it off and plop it in the middle of his room and let him sleep, even if it looked hugely uncomfortable to me. He somehow survived my terrible parenting.

    When we went back to Guatemala to get son #2, who was 5 months old at the time, one of the first things his foster mom said was, “This kid will not sleep on his back.” She was right. He still doesn’t. And again, he is still alive.

    We need to stop deciding that fragile babies and healthy babies all should be treated equally.

  93. Plus, medical advice is always changing, and doctors don’t always know best. Thalidomide was referenced earlier, but it applies to lifestyle questions, too….

    Forty years ago doctors went to the Canadian Arctic, where all the women breastfed. They told the women it was safer and better for babies to be bottlefed. Everyone wants to do what is best for their children. So these women, semi-nomadic and living off the land, started to bottlefeed and ran straight into a variety of problems: money for bottles, money for formula, heating bottles/not-heating bottles, sterilization of nipples (in a tent out on the land, this is a challenge). Not to mention that the translations weren’t very good, so some women fed their babies carnation milk or powdered milk, or even soda pop.

    This resulted in a legacy of dental caries, rickets, and other health problems. It also resulted in women having less money to buy food for the rest of the family, so that people went hungry.

    And after all that, now the doctors say that breastfeeding is better (if you are able to do it) anyway…

  94. Does anyone know about SIDS rates in other countries? Is the US the only place where “back to sleep” is recommended? Do other countries track SIDS, or has anyone else found correlation between sleep position and SIDS?

  95. The definition of SIDS is “unexpected, sudden death of a child under age 1 in which an autopsy does not show an explainable cause of death.” So if an autopsy can say it was suffocated with a pillow, it wouldn’t be SIDS. If they can’t tell, or don’t bother to do an autopsy (which, depending on the state, they often don’t), the death is marked as SIDS. This is often done in an attempt to make parents of babies that died think “there wasn’t anything you could do” rather than “you didn’t prevent suffocation well enough” (not that I’m saying that doing a reasonable amount of suffocation prevention and still having a baby that suffocates = didn’t prevent suffocation well enough, just that it is what people will feel).

    Many of the SIDS prevention tips are actually suffocation prevention tips. And since we don’t trust Americans to regulate themselves, the tips are “don’t do x AT ALL” when telling parents how to do things CORRECTLY would be better for babies.

    Checking a baby every 15 minutes will NOT prevent SIDS. It may help prevent the small chance of suffocation death, as long as the baby happens to begin to suffocate a minute or 2 before it is checked again (rather than a minute or 2 after it was last checked). But studies have shown that even monitoring a baby CONSTANTLY while it sleeps via breathing monitors, movement monitors, etc. does not prevent SIDS. SIDS is SUDDEN Infant Death Syndrome. There is no possible way to save a baby from SIDS. You aren’t going to give a SIDS baby CPR or an epipen and save its life – because preventing the oncoming death would mean knowing the cause, and that would by definition make it NOT SIDS.

    Now I’m not saying daycares shouldn’t try to prevent suffocation. But this checking every 15 minutes thing is a small part of a huge problem. Daycares have become hands-off child-watching factories. Babies need hands-on, caring, very un-factory-like care to thrive. At many daycares, diaper changing is done on a schedule. So if the child dirties their diaper off the schedule (which most do), they just sit in it until the scheduled changing time. It makes sense that if you have 6 babies to take care of, you can’t, for example, forgo Baby5’s 15-minute-sleep-check because Baby1 and Baby 6 need an extra diaper change and it’ll take you 15 minutes just to get that done. I suppose that is the reason that people only naturally have 1, 2, or – in extremely rare cases – 3 babies at a time. But personally, I’d feel I was “getting my money worth” much more if the daycare workers were changing, playing with, holding/cuddling, etc. another baby, based on the baby’s current needs rather than a schedule, within earshot of my baby, than I would if they were making a checklist of my baby every 15 minutes. Because that means instead of making a checklist about the other baby, they are going to be changing/playing with/cuddling/etc. my baby. And maybe 11 minutes past what would have been check time, instead of being at the other end of the room checking Baby6, they are hearing that my baby started suffocating.

    A day care worker checking my baby every 15 minutes may seem worth it, but in effect it is bad for the other babies; which means that while other babies are being checked, it is bad for my baby. So feel free to drive yourself insane by making 15 minute sleep position charts at home, but keep them out of daycares, and be aware that it isn’t going to prevent SIDS.

  96. I echo Donna’s question — just because the concept of a checklist isn’t useless where it isn’t useless, doesn’t mean this particular checklist does a dime’s worth of good in this particular situation. So we can repeat the question: how does this checklist process prevent SIDS?

  97. Susan, the issue isn’t whether it bothers us when babies die of SIDS. OF COURSE IT DOES. You need to improve your general view of humanity if you think that that needs to be said in every conversation about whether a policy is useful or stupid, in order to know whether the people talking about the policy think that it’s horrible when babies die.

    The issue is that this probably does nothing to prevent that and creates other negative issues.

    We’re not talking right now about the tragic death of a particular baby. If we were, no doubt we’d all (or at least most of us, with some exceptions if there are really odd people around here, though I’ve no reason to think that) be expressing appropriate sympathy. We’re talking about a policy that is intended to prevent SIDS deaths, that wastes time, costs money, probably decreases the ability of the daycare workers to care properly for the non-sleeping kids, and probably also does nothing to prevent a single SIDS death.

    What it does, is make some policy creator somewhere feel good that they’re “doing something.” Which, if the world really is all about emotionalism and nothing about what works, would be the way to go.

  98. That’s one of those things that really gets my goat. If I say “I don’t agree with your overly paranoid opinion” there is a proportion of the population that seems to hear that as me saying “I want my children/your children to die horribly.” No, I don’t want my children, or anyone’s children to die. I want them to live. Which they cannot do if they are bubble wrapped and velcroed to my side and monitored every second of every day.

  99. The diaper changing thing – maybe I’m out there on this one, but I would not want my kid to sit in a dirty diaper for a long time period just because it wasn’t “time” to change her yet. No, I don’t want her checked every second or changed if her diaper is dry, but unless everyone in the facility has a very bad head cold, it’s not difficult to know when a kid has pooped.

    My kids were trained before they went to daycare, but one thing that always bugged me (and they go to a “nice” place where pay is relatively high) is the fact that there always seems to be someone sloshing around in a poopy diaper. You see them going into that “posture” and if I know they’ve done it, their caregiver knows it –
    yet they continue about their business until the schedule says to give the crusty little tot some relief. Gross. Once it was almost closing time and the caregiver noticed a 2yo had peed through her diaper. “Should I change her?” she asked her colleague. No, just let her sit in it and get it all over her dad and her car seat.

  100. I’m in the process of moving my son from one day care to another — not my choice but he qualifies for special services but can only get them if I can get him situated for 2 hours a day in our tiny home town, far from where I work, and the school will only bus in our tiny town. *grr*

    Some day cares have huge sheets of what they do/check; some just have rules; some are laissez-faire. One day care we interviewed has pages and pages of curriculum and has web camera service where you can log in and see your kid (or kid’s classroom) online. (Which sounds like a nice cheer-up for mom or dad, but a huge source of paranoia for the staff! It also has a daunting progress chart for each toddler for each day.)

    I know there was an informal rule of when sleeping babies were checked in his daycare, and when diapers were checked… having the charts come home helped me know whether he was drinking enough, peeing enough, pooping enough. The only way to do that was with charting. If there are a lot of kids/caretakers (more than state mimimums, for instance) in a room, or someone has to call for backup while they hit the bathroom themselves, it would make sense to have a chart of what’s been checked.

    If you don’t like a standardized approach with charts and things, you do have the option of trying a different daycare.

  101. But Jenne, every fifteen minutes for every individual baby, not just checking the sleeping room to make sure no one’s fussing? And not just checked, but a box checked off?

    This isn’t just about making sure someone’s paying attention to the babies’ needs. You’re right, a checklist can help with this. But writing down every fifteen minutes how each individual baby is sleeping doesn’t, at least as far as I can see, create any real benefit for anyone.

  102. Is there a documented case of someone intervening with a sleeping infant and preventing a death that would otherwise have been categorized as “SIDS”?

    If babies lying on their backs, hooked up to monitors, surrounded by medical care, still die of “SIDS,” what, exactly, does “prevention” look like?

    “SIDS” rates had dropped 25% between 1982 – 1992, the decade before the “back to sleep” campaign began. Up until that time, decision-making about sleep position for infants was based on tradition, ease and comfort more than safety. So why was the rate dropping?

    A catch-all for every infant death that cannot otherwise be explained: “SIDS.”

    Nearly impossible to differentiate from infanticide: “SIDS.”

    Far more prevalent in populations where health, economic and social circumstances are compromised: “SIDS.”

    Something rare and tragic for worried, educated, middle-class parents to obsess about: “SIDS.”

    And if we don’t toe the line, place baby on her back, question policies that “monitor” and “chart” babies at proscribed intervals or insist on certain positions for sleep, we are labelled “careless.”

    “So you want babies to die?” Um, no. No, I don’t. And I also don’t want to pretend that this particular protocol mentioned above, which fails to meet needs for efficiency, rest, ease, comfort, or sustainability, is a strategy that meets needs even for safety or well-being.

  103. I do understand that the “back to sleep” campaign has significantly reduced the incidence of SIDS in the US, but it seems like it has led to a bit of a reasonableness-lacking fervor. I’m pretty sure my whole family would have died of exhaustion if we hadn’t put our reflux-y baby upright in a bouncer (labeled “not for sleeping”) to sleep, for the first seven months. And just yesterday, as I was washing my now-toddler’s crib blanket, the one that he uses to soothe himself to sleep, I noticed that it is purportedly, “not suitable for sleep.” It’s a blanket. For what was it actually intended? It’s a little small for building a fort.

  104. Now there’s a funny for you – “this blanket is not suitable for sleep.” I would have woken my kid with the guffaws of laughter over that one.

  105. See that’s the problem. If something helps for some percentage of kids, people take it to mean ALL KIDS WILL DIE unless I do x.

    Glasses help my 4th grader with astigmatism see better. But putting glasses on the 5th grader with 20/20 vision won’t make him see even better. Kids with poor impulse control due to autism issues need to be closely supervised. That doesn’t mean all kids need to be closely supervised all the time. Some at risk babies might benefit from intense monitoring. With the rest, it probably won’t make a difference one way or the other.

  106. Just today a website put up something about a guy losing his baby due to putting an adult pillow in the crib. Claims he put the pillow on the baby’s legs and somehow the baby ended up covering his face with it.

    I don’t know. I am sure freak accidents happen, but so does infanticide.

    Someone above noted that some states won’t autopsy a baby to find out the cause of death, but rather use the catch-all SIDS without first ruling out every other cause. (Not surprising at all.) So it seems clear that the SIDS statistics are still over-stated. I really think that if there was enough of an inquiry into each “SIDS” death, we would find that the vast majority of babies have almost zero avoidable risk whether they sleep on their tummies or not – and those who do could find out their child has a specific risk. However, since SIDS is rare and it would cost a lot to do that level of inquiry on every case, this is not likely to happen.

    Now if I had given birth to my children and raised them through infancy, knowing what I now know, if I were the worrying type, I might have inquired into whether testing was available for certain risk factors. I would rather pay for a test to give me peace of mind than make my child sleep on her back and place upon her a significant risk of developmental issues. I paid thousands for vision therapy which was caused by the fact that my daughter didn’t spend enough time on her tummy as an infant. She also had other issues which she has been working through over the years. In hindsight, I would rather have paid for a test or monitor and let her sleep on her tummy, if I had that option. (More likely, I just would have one “tummy sleeping” without the test, as it worked for almost every child in history. But if the Back-to-Sleep campaign were giving me nightmares, I might need more comfort.)

  107. @Kaetlyn Wilcox “I do understand that the “back to sleep” campaign has significantly reduced the incidence of SIDS in the US, but it seems like it has led to a bit of a reasonableness-lacking fervor. ”

    That is what campaigns do, the campaign is not something that is supposed to be balanced. They exaggerate and use emotions to drive the point home.

    The world would be better with rational discussion instead of campaigns. But then, what would we be outraged about?

  108. I didn’t have the time to do research into risks and stats on SIDS when I had my baby. I was too busy being a mum. So all I had was the overload of advice… In hindsight, I’m pretty sure that the main messages were about ways to reduce suffocation – so not really SIDS as such but obviously important advice – and apart from some common sense things like the smoking and some pre-existing risk factors some babies may have, I remember the only genuine risk factor I learnt about was the overheating. I contacted the SIDS prevention organisation once to inquire about sleeping bags with sleeves for winter and they advised against it for that reason.

    Sorry nothing to do with the daycare centre, but it would be so much better if the advice on preventing infant deaths would be more common sense and backed up with scientific data instead of treating every new parent like an idiot who needs to be scared into making sure they don’t smother their child.

  109. Lin – The problem is that there is absolutely no known scientific cause for SIDS. It simply happens. There are some possible risk factors for SIDS, but tens of thousands of babies are exposed to those exact same risk factors every year and don’t die. There are also some babies who have none of the risk factors and still die. There are babies who sleep on their tummies who don’t die and babies who sleep on their back who do. There are babies who overheat and don’t die and babies who never overheat and die. There are parents who follow every idiotic “rule” to a T and check on their babies every 5 minutes while sleeping who still lose babies to SIDS while others are downright negligent and yet their babies live to old age.

    SIDS appears to be largely a matter of fate (God …). You can’t scientifically tell people how to prevent something controlled by fate.

    That is why most of these “rules” actually address issues other than SIDS. Because telling you how to keep your baby from suffocating is not preventing SIDS, it’s preventing death by suffocation. Telling you how to keep your child from dying by overheating is not preventing SIDS, it’s preventing death by overheating. And so on …

  110. All of this makes me wonder whether it even make much sense to talk about SIDS as a “thing” that can be prevented, as though it’s really just the way of saying “unexplainable infant deaths.” How do you prevent something for which the cause is, by our current understanding, unknowable? It sounds a bit like calling “I don’t know” an “answer” to something, as though “I don’t know” actually identified something, as opposed to being a way of saying that the thing is not identified. KWIM?

  111. I do think SIDS is really just a catch-all term for any unexplained infant death. If the infant doesn’t appear to have died traumatically (murder or injury) and there are know known or obvious health problems, it is ruled SIDS. There could be as many actual causes as there are deaths.

    I think that we can work to prevent some of the causes of death that are often lumped into SIDS (suffocation, overheating), but ultimately will never eradicate SIDS completely because it is just a way of saying “unexplained infant deaths” and there will always be unexplained infant deaths.

  112. I don’t believe in fate. But if science had an answer for everything already, there’d be no need for scientists anymore. Or in other words, I believe there is an explanation for all infant deaths, we just haven’t been able to find the causes yet.

    Which is what parents and carers should be told instead of being made paranoid. Pseudo-science does more harm than complete ignorance sometimes and our media is full of it.

    Anywho, I had to conclude that I clearly don’t know enough about this topic to make an informed opinion on whether or not that childcare rule is over the top. Though other commenters do seem to know more about it and it sounds like it is just another result of the fear of liability that lots of institutions have to deal with nowadays.

  113. Donna said: “There will always be unexplained infant deaths,” and from what I can conclude, the SIDS research offers precious little in the way of direct causation of something that is defined as “unexplained.”

    So checking a sleeping baby at a daycare every 15 minutes and noting its “sleep position” seems like a pretty flawed strategy to ensure health and safety.

    I’m standing by my earlier “superstition” comment and really would love for all parents to be free to address their own and their children’s needs in the best way they can in each moment. Sometimes that’s tummy sleeping: so that the baby and the parent get sustained hours of sleep, meaning better health (and, yes, safety, since being sleep-deprived is a major contributing factor in all kinds of accidents) for both parent and child.

    To suggest that parents or caregivers who do not eradicate every single thing “researched as a possible contributing factor” —to something still entirely unexplained— are somehow uncaring, negligent, lazy, or unconcerned with human life is… well, let’s say that I feel really exasperated, wanting some sense of shared reality and respect.

    As Lenore has noted before, so much hysteria over “safety and protection” directs resources toward those who profit from such hysteria, and away from families, whether in the form of “must-have” products or higher costs in supervision, often mandated by law.

    Don’t accept strategies that don’t work for you. Be aware of your own needs and how you would like to meet them. Find solutions that work for everyone; they are out there…

  114. I worked in a daycare/preschool back in 89, the infant room, there was a grandmotherly older lady that watched the babies, and if there were more than 3 they’d get in an assistant. They’d look at the disposable diaper & decide if it needed changing – and if pooped, changed right away. I worked with the ones that were walking up to 2 years old – and our only schedule was snacktime and then naptime right afterwards. One worker would sit in the dimmed room with the kids sleeping on mats (in all sorts of positions) with a light blanket over them.

    Our first didn’t sleep more than 3 hours at at time for the first 18 months, and for the first 4 months, slept on the floor with me on a comforter, as put her in her crib, she’d scream bloody murder.

    Both my girls slept on their sides/stomachs. *laugh* i guess a cat hopping into the crib is right out. When they’d cry, the cat would hop in and go sniff them.

  115. Oh par for the freaking course. I worked in the infant room at a very respected daycare. We were not allowed to let the babies sleep in a swing or bouncy seat way back then years ago. The thing is we had 4 infants to 1 adult ratio. So if I was busying feeding one infant and another infant starts nodding off in a swing, I have to either stop feeding the infant and move the other infant to their crib or move the sleeping infant to their crib once I finish feeding the baby I currently have in my arms. Both results will end up with at least one pissed off baby. If I move the sleeping infant it will wake them up and piss them off. If I stop feeding the infant I piss that one off.

    This is why I am very anti daycare. It is these stupid rules that really lower the babies quality of life while in the daycare. Also another mindless task we have to perform like checking off the sleep patterns when we could be actually loving and interacting with the kids.

  116. Mollie,
    You beat me to it. Untill there is a definition of what constitutes SIDS, all of these studies and statistics are worthless. As far as “Shaken Baby Syndrome” is concerned, it needs to be defined as well. In my opinion both of these are a result of media hype and hystaria. A friend of mine was convicted of murdering his daughter, by shaking her, in 1985. No autopsy was done. The Medical Examiner stated that it was obvious how the baby died. My friend couldn’t find an independant ME to do an autopsy. One stated that if the cause of death was not SBS, he would be accused of helping a child abuser get off the hook.

  117. Wow, Jim, that’s sad for me to read that your friend was convicted without an autopsy… not sure how a grand jury could consider evidence in a case like that without some very clear observations of brain trauma.

    Then again, in the 1980s, there were some very tragic cases that turned less on objective observations and more on “he-said, she-said,” and adults were convicted of all kinds of crimes against kids.

    It’s almost like when we woke up as a society to the fact that there were dangers to kids when they were in the care of trusted adults (sexual abuse, and even physical abuse, had been taboo subjects until the 1970s or so, from what I’ve gathered), suddenly there were overreactions and everywhere you looked, people were suspect.

    Too bad we can’t have open dialogue about things that do occasionally happen without assuming the worst about everyone, especially men!

  118. Years ago, it was considered dangerous to put a baby to sleep on its back. In fact, my parents’ neighbor’s infant died just a few years ago when he vomited while on his back and choked to death.

  119. Arabella, that’s what I remember my mom telling me when my younger siblings were babies. They could spit up and choke, whereas on their tummies, the spitup would not stay in their mouths. I guess choking on vomit would not be considered SIDS, so it wouldn’t mess up the SIDS back-to-sleep statistics.

    I really wonder why, with all that’s being discussed here, there isn’t a serious revisit of the back-to-sleep campaign.

    Another article just came out yesterday saying that babies who snore (which happens with back sleeping) are more likely to get ADHD, with the explanation being lack of good sleep. They fail to connect the snoring / ADHD to the back-to-sleep campaign, at least in the summary I read.

  120. I know that my baby snores when he’s on his back, but then he is 50 years old…(giggle)

    As a long time insommniac, I believe that sleep is one of those things that should be damn near sacred. If my kid was asleep, the only reason I would wake him is if he was in physical danger. So when he got really tired after a missed nap at age 1 and face planted into his dinner, I picked him up and put him to bed (after getting incriminating pictures, of course). Otherwise, I didn’t care what conveyance he was sleeping in. He was asleep. Hallelujah.

  121. Yes, I heard a report on NPR a few months back about how quick the authorities are to chalk up any unexplained infant death involving brain trauma to SBS. Jim’s friend isn’t the only one to whom it’s happened.

    I mean, there are surely many clear cases in which the extent and nature of the injuries clearly indicates abuse. But there also have been others where there has been a quick leap from “internal cerebral bleeding” to “SBS with guilty parents.” We’re so paranoid of crimes against children and so unwilling to accept innocent tragedy that innocent people do sometimes get caught up in it.

    Diane S., do you know that there used to be a myth that cats “stole breath” from sleeping babies so they suffocated? People were deathly afraid to let cats anywhere near babies. (Come to think of it, that seems like it was probably the folk explanation for SIDS or other undiagnosed infant deaths.) Now I guess we just have more scientific names for our superstitions.😉

  122. Donna, Pentamom,

    Most people are honest. If it is part of their job to look at the sleeping babies every 15 minutes, they will try to look at the babies every 15 minutes. If it is part of their job to mark the babies’ sleeping positions on a chart, they will do that. That fact is that there is much research across many fields showing that the simple act of having someone record a task results in their performing the task better. It is highly unlikely that there is research about this particular checklist, but there is enough about other checklists in general to make a simple checklist worth the effort.

    Your concerns about unscrupulous employees dishonestly filling out checklists are out of left field. Are you OK with checking on babies every fifteen minutes but not OK with the checklist because there might be an employee who walks to each crib and picks up the checklist hanging from it and marks it without actually looking at the baby? The checklist is an irrelevancy in the general debate about the 15 minute checks, but it is highly likely to be of significant added benefit if the checks are performed.

    As to there being non know scientific cause for SIDS: what is your threshold for action? Pediatricians studying the issue did a whole lot of research and determined that if everyone put infants to sleep on their backs, the death rate would likely decrease. The recommendation was adopted after many studies by the AAP, a large group of pediatricians. The death rate was cut in half. Why did that happen? No one knows all of the causal details, but the correlation is well-enough established. Do you demand to know all of the causal details before any medical intervention is tried? There are lots of medical interventions that work without detailed knowledge of the causal details. Look at headaches and suggested treatments. Do you suggest no one try to treat headaches until the details are understood?

    And as for some of you positing that the medical community is foisting these things on us for their benefit, WTF? Seriously, WTF are you people thinking? How does it matter to a pediatrician’s personal benefit if an infant sleeps on its back or stomach?

  123. @delurking –

    I note that you haven’t pointed out a single useful purpose in knowing a baby’s sleep position every 15 minutes. You simply argue that other checklists have been found useful so this one must be too. That is the worst logic ever. The fact that research shows that checklists that contain useful information are helpful (something I don’t dispute) does not automatically make a checklist that contains completely worthless information valuable. The value in ANY checklist is solely in the information contained therein. The information contained doesn’t suddenly become valuable simply because it is put into a checklist as you seem to want us to believe.

    I agree with you on the fact that the teachers will probably check the babies every 15 minutes and mark the checklist correctly and neither Pentamom nor I ever said otherwise, although some did. I think it’s a complete waste of time and takes time away from more important tasks but people will do what they are told to do.

    Nobody is saying that parents should not place babies on their back to sleep. Parents should be given CORRECT information. Back-to-sleep may lessen the incidence of SIDS, but it is not some magic pill because we still have no idea of causation or correlation and, frankly, babies still die. It should not be treated as a magic pill for which parents are terrified into doing anything else. There are also a number of other risk factors that correlate with SIDS to consider. There is also information that babies sleep less soundly on their back and that sleep deprivation causes behavioral issues, learning issues, developmental issues, obesity and a whole host of other problems. Sleep deprivation in children leads to sleep deprivation in parents which leads to car accidents, work accidents, and even shaken baby syndrome and other infanticide in extreme cases.

    If a baby sleeps fine on his back, great. That is probably how he should sleep to be on the safe side. If a baby is not sleeping well on his back, parents should not be terrified not considering other options on the remote chance that (a) their particular baby will die of SIDS and (b) sleep position will ultimately determine that eventuality.

    But none of this needs to be charted every 15 minutes regardless.

  124. Donna, I note that you didn’t read my post on March 9 at 4:44 where I explain why checking on the baby every 15 minutes is reasonable, and give references to both a review paper in Pediatrics and one of the early research papers on how SIDS deaths occur. I realize it is a long thread, but you can search within this page for posts with “delurking” in them by using CTRL-F on windows machines or CMD-F on Macs.

    The point about checklists is not that they contain useful information. There is much research that shows that when people record something about a task during the performance of a task, they perform the task better. It is reasonable, given previous similar research in many fields, to think that the caregiver will be more likely to actually notice if something is wrong with the baby if they pick up a piece of paper and record something about the baby on it when they look into the crib. I note that I wrote this same thing in my previous post.

    The “back-to-sleep” recommendation seems to have cut the incidence of SIDS, the number-one non-disease killer of infants (more than all accidental and criminal causes, combined), dramatically. The fact that the death rate was not dropped to zero because of it is a pretty weak criticism.

  125. im sorry guys but seriously, isnt the whole point of this site that we need to just let people be? if you are scared to put your kid to sleep on their back/stomach/hanging from the ceiling by their ankle, then, by all means, dont do it. but why argue about it to death then find NEW things to argue about? check boxes are good for grocery lists. they do not cure cancer. is it really worth getting upset, or even debating?

    i think i feel a verse of kum-ba-yah coming on. everyone hold hands!

  126. The thing is, does this affect the baby? They’re sleeping anyway. It may result in less interaction with other babies maybe, but with better planning and organisation that can be improved.

    I understand it fuels the idea that you should never let your kids out of your sight but it’s for parents to work out what they do at home. It really isn’t making any difference to the child’s development if the carers check them every 15 minutes.

  127. Delurking, it has been strongly questioned whether back-to-sleep itself has saved lives, and extremely unlikely that all of the decrease in SIDS can be attributed to back-sleeping. Many arguments have been made above along those lines, and you just don’t want to give them any weight. That’s your choice. But I think it’s irresponsible for the medical community to treat this like a closed case when it is not. Infant sleep problems are contributing significantly to individual and national health issues. The medical community must stop looking at SIDS in a vacuum.

  128. SKL,
    I give more weight to arguments that have more research support. The medical community is not treating this like a closed case, there is plenty of research ongoing. The weight of the evidence is dramatically in favor of the back-to-sleep campaign as a net benefit. If there are further or other refinements that can produce further benefits, great, when the weight of the evidence becomes enough that the consensus among experts is that there should be a recommendation on them, it will be issued.

    Furthermore, this is only tangentially related to the post and my response to it, which is related to the utility of checking on infants while they are asleep, regardless of their sleeping position. I am arguing that this is not a ridiculous thing to do in a day-care center. You keep diverting the discussion, starting with your very first line: “Oh, you did NOT just get me started on sleep position and SIDS!”. If you have evidence that recommending to the entire nation that they put their kids to sleep in some other position would be a bigger benefit, go ahead and publish it, and the medical community will take a look. If it has been published but isn’t getting traction, it is probably because it has been evaluated and found wanting.

  129. delurking –

    Are you a parent? Do/did you check on your infant every 15 minutes during sleep for the first year of life? Because if it is reasonable for a daycare worker to do so then it must also be reasonable for a parent to do so.

    Further, I don’t see any evidence that checking a baby every 15 minutes saves lives, particularly if all other things that could kill a baby while asleep are remedied. There is no evidence that checking a baby every 15 minutes stops SIDS. There is no evidence that a death by SIDS is even able to be remedied if caught within seconds. Frankly, checking babies every 15 minutes has not existed since the dawn of time and we are now 7 billion people strong. I’m not seeing a single convincing argument that somehow all 7 billion of us currently alive survived despite the horrible neglect of not checking on us every 15 minutes.

    “The “back-to-sleep” recommendation seems to have cut the incidence of SIDS”

    Possibly. SIDS = any unexplained infant death. It isn’t a diagnosis of anything, but is instead a complete lack of diagnosis. During the same time forensic science improved making it possible to more precisely determine cause of death so that fewer deaths are unexplained. During the same time, medical science improved such that medical problems can be better diagnosed and treated even in utero so fewer unexplained infant deaths are occurring. In addition, during the same time period, substantial lifestyle changes have occurred. People have taken items out of cribs that could suffocate babies. People have gotten away from the notion that babies need to be kept bundled up at all times. People have stopped smoking around their infants. You can’t correct for all these variables — all of which, including back sleeping, could determine outcome in any one particular case leading to an overall decrease in the number of unexplained infant deaths, only a small portion of which are actually tied to back sleeping.

    “the number-one non-disease killer of infants (more than all accidental and criminal causes, combined), dramatically”

    Except that SIDS is often the default cause of death put on the death certificate of infants unless the death was obviously something else. Much like many adults die of “cardiac failure” according to their death certificate but the cause of the cardiac failure is undetermined or unspecified. My father’s death certificate lists his cause of death as “cardiac failure.” He died after a bout with a virulent strain of cancer. My grandfather’s death certificate lists his cause of death as “cardiac failure” although he died of an infection.

    “The weight of the evidence is dramatically in favor of the back-to-sleep campaign as a net benefit.”

    Except that the campaign, like everything in science, looks at the issue in a vacuum. It looks solely at the number of infants who die when kids sleep on their back compared to those who die when sleeping in other positions. It doesn’t consider a single other implication of back sleeping because that is not their goal or hypothesis.

    That is one of the major flaws in science. Each researcher works to prove his own hypothesis but doesn’t incorporate the findings of other research on different topics. So you have one set of researchers looking at SIDS and determining that back is better. You have another group of researchers looking at sleep and finding that sleep deprivation contributes to a whole host of things. The back-to-sleep people push their results. The sleep deprivation people push their results. Nobody actually considers the big picture.

  130. Donna,
    Yes, I have two children. No, I did not check on them every 15 minutes during the night. It is absurd that you suggest that a parent waking up every 15 minutes to check on an infant has the same cost as a day-care worker checking on children every 15 minutes during the day.

    Your middle paragraphs are a mishmash of misunderstandings. The fact that you again assert that there is no evidence that a death by SIDS is able to be prevented if caught withing seconds implies that you simply refused to read what I wrote or look at the cited review paper. Your vague statement of hypotheticals following this is backed by no evidence whatsoever. Your histrionic “horrible neglect” is inapposite, no one has argued that not checking is neglect, only that checking in a day-care center is reasonable.

    Your final paragraph demonstrates a complete misunderstanding of how scientific consensus evolves and how the recommendations are developed. The idea that nobody considers the big pictures is absurd, and a smear against the researchers who developed the guidelines. Researchers do incorporate findings of other research on different topics.

    To clarify your thinking:

    You (and SKL) claim that the “back-to-sleep” campaign has not saved as many lives as claimed. OK, how many fewer lives have actually been saved, and what is the confidence level of that number? You claim that sleep deprivation caused by back-sleeping in the few months before an infant is strong enough to roll over contributes to “a whole host of things”. OK, how many people are affected and to what degree? What is are the confidence levels of those numbers. Presumably you have some measure of these supposed ills that we can compare to the (overestimated by some amount that you know) number of infants lives’ that have been saved by the back-to-sleep campaign? I assume you will explain how you balance the infant lives lost due to sleep death vs. the claimed behavioral issues, learning issues, developmental issues, obesity, and sleep deprivation in parents which leads to car accidents, work accidents, and even shaken baby syndrome and other infanticide in extreme cases.

    Your assertion that researchers and the recommendation committees do not consider these things is simply false. The reason back sleeping is recommended is because the evidence that it is a net benefit is strong.

  131. Delurking, I have never seen the back-to-sleep discussions include any consideration of the effects of loss of sleep. Also, since before the campaign most babies slept on their tummies, there was not sufficient information about that. However, over the years, evidence is mounting that there are many bad things about making a baby sleep on its back when s/he would sleep better on his/her tummy. You say that the researchers take all this into consideration – well then, show me an article where this has been discussed comprehensively (or even mentioned) by the folks who make the recommendations. Show me where a study has been done demonstrating both the pros and the cons and weighing them and concluding that the pros outweigh the cons.

  132. SKL, how many more infant deaths you would be willing to accept in order to eliminate the problems you believe are caused by the back-to-sleep campaign? Just give me a ballpark number. Or, are you claiming that zero more deaths would result if the recommendation were reversed?

    Were you at the AAP task force on SIDS meetings? The pediatrics paper I cited has references to at least twenty-eight papers dealing with reservations about babies sleeping on their backs. If the particular bad things you are worried about are not cited in the task force report, it is because they aren’t credible enough to be worth citing. How about you post the references where this mounting evidence is found. Then I will do a citation analysis and quickly quantify how credible the rest of the scientific community finds it. My guess is “not very”. I mean, seriously, you managed to find a someone somewhere that says that a baby sleeping on its back until it is strong enough to roll into whatever position it feels like (typically 4-6 months) results in obesity later in life. Donna’s assertions are even more ludicrous. Yeah, back-sleep leads to car wrecks, work accidents and infanticide. Let’s see some numbers on that.

  133. Suddenly you are less certain that these are being taken into account.

  134. delurking –

    I didn’t say that a daycare worker checking on an infant every 15 minutes has the same cost as you doing so at home. I said that it is not necessary anymore than it is necessary for you to do so at home. Just because something has a low cost does not mean that it has any validity. And I have yet to see any convincing evidence that checking a sleeping infant every 15 minutes has any validity in saving infant lives.

    Disagreeing with you does not mean that I didn’t read what you wrote. You seem to view SIDS as disease, such as AIDS, cancer, the flu. It simply is not that and I am not going to treat it as it is. SIDS is defined solely as “the unexpected, sudden death of a child under age 1 in which an autopsy does not show an explainable cause of death.” It has no known cause(s). No symptoms. SIDS is nothing more than a cause of death put on a death certificate when all known causes of death are ruled out or no autopsy was performed. It has no validity beyond that. It is not an entity of it’s own.

    The idea that “we have no idea what caused this child to die” is a leading cause of death is fairly devoid of meaning. It simply means that an autopsy was not done or nothing could be determined in a number of childhood deaths, not that all the deaths were actually caused by the same thing. SIDS could be one major blight on childhood or many, many small blights. We don’t know.

    And you have a very naive belief of researchers, not SKL and I. The fact is that researchers solely research what they are funded to research. The SIDS prevention organizations get funding that is 100% dedicated to preventing SIDS. They are absolutely not researching the entire well being of the baby. Their goal is simply to reduce SIDS. And back-to-sleep may, in fact, be the best that we have to attempt to reduce SIDS at this time. That does not automatically mean that it is the best thing for every child in every situation.

  135. I didn’t say that back-sleep caused car wrecks. I said that tiredness contributes to car wrecks. Are you seriously going to deny such a thing?

    Studies show that babies who sleep on their backs sleep less than babies who sleep on their tummies – kinda the entire foundation of the back-to-sleep campaign in fact. If babies are sleeping less, mommies and daddies are sleeping less as well. Are you seriously going to deny that as well?

    Life is not black and white delurking. Everything thing has a cost that may not be direct. Sorry if you can’t see that.

  136. Delurking, we understand that this is a very important issue to you.

    What hasn’t been explained, however, (at least I don’t think it has) is how an every-15-minute checking and documenting of baby’s sleep position prevents death, or anything else. We aren’t talking about *changing* the sleep position; we’re talking about looking and then checking a box. So a baby sleeping on his/her tummy will continue sleeping on his/her tummy, right?

  137. SKL,
    I am just as certain that these things are being taken into account by the scientific community. If you want me to be more specific, you have to be more specific about what you think is not being discussed.

    Donna,
    Re – post 11:17
    The cost/benefit ratio of the daycare worker checking is far lower than the cost/benefit ratio of the parent checking at night. The benefit is the same and the cost is lower. You are arguing that the benefit is zero.

    You are incorrect that I view SIDS as a disease. It is irrelevant. If you go through the task force report, you will see that the semantics are not the core and that mostly the task force is worried about infants dying while sleeping. I do not understand why the semantics are so important to you. And as for this: “SIDS could be one major blight on childhood or many, many small blights. We don’t know.” No, this is addressed in the task force report. It is not one major blight, it is more than one, but there is a predominant one.

    How do you think research funding is allocated? It is incorrect and a smear on dedicated people to suggest they do not consider all of the consequences of their recommendations.

    Re – post 11:25
    Donna, you didn’t say back-to-sleep causes car wrecks, you said it leads to car wrecks. Please don’t attribute to me nonsensical things I didn’t say in order to try to make me look foolish. I deny that the back-to-sleep campaign has contributed in any significant way to car wrecks, and I deny that even if it has contributed to car wrecks, that damage outweighs the infant deaths that would have occurred without it. Do you have evidence to the contrary?

    As to your second paragraph, this issue is addressed in the task force report I cited. Show my the studies you refer to, because the task force cites studies on both sides.

    You are the one who seems to see everything in black and white. In 11:17, you seem to insist that the benefit of checking on a baby is zero. This is so obviously false. Need I remind you of these sentences: “Frankly, checking babies every 15 minutes has not existed since the dawn of time and we are now 7 billion people strong. I’m not seeing a single convincing argument that somehow all 7 billion of us currently alive survived despite the horrible neglect of not checking on us every 15 minutes. ”
    I’m not worried about SIDS causing the extinction of the human race, but a few thousand dead infants a year in the US is worth working to prevent.

    About your last paragraph: In my previous posts I have argued that the indirect costs are far less than the benefits. You have refused to even try to make a comparison. Making comparisons between costs and benefits is pretty much the opposite of seeing everything as black and white.

    Buffy: I have explained that. In my post on March 9 at 4:44 where I explain why checking on the baby every 15 minutes is reasonable, and give references to both a review paper in Pediatrics and one of the early research papers on how SIDS deaths occur. I realize it is a long thread, but you can search within this page for posts with “delurking” in them by using CTRL-F on windows machines or CMD-F on Macs. This is the third time I am posting this in this thread.

    In multiple posts I have explained the value of checklists. SKL introduced the issue of the back-to-sleep campaign into the thread and I have also been responding to that.

  138. […] What was once common sense, such as peeking in on a sleeping baby every now and then, has become a regulation: check infants’ sleeping position every 15 minutes to prevent SIDS. Common sense says wipe […]

  139. “Most people are honest. If it is part of their job to look at the sleeping babies every 15 minutes, they will try to look at the babies every 15 minutes. If it is part of their job to mark the babies’ sleeping positions on a chart, they will do that. That fact is that there is much research across many fields showing that the simple act of having someone record a task results in their performing the task better. It is highly unlikely that there is research about this particular checklist, but there is enough about other checklists in general to make a simple checklist worth the effort.”

    None of that really addresses my point, though — is there any evidence that really, genuinely, truly, honestly looking at a baby every fifteen minutes does anything to reduce SIDS?

    Merely asserting the usefulness of the check sheet to verify that the checking up is done begs the question. Is checking up every 15 minutes on a schedule doing any good to prevent something that happens in “seconds” at unpredictable mom
    .”
    “but there is enough about other checklists in general to make a simple checklist worth the effort.”

    That doesn’t make any sense. That “checklists in general” are useful for verifying that effective strategies are implemented tells us nothing about whether a strategy that someone decides to put on a checklist, is effective, as opposed to a complete waste of time that could better be spent promoting health and safety in other ways.

    That’s about like saying, “It’s a known fact that babies are changed more regularly when the workers have to check off when they check their diapers, so therefore checking a box that indicates that you said ‘my Aunt Tilly’ every 25 minutes to them will prevent chickenpox.” It’s not whether checking the box makes the workers more likely to do the action (which is intuitively reasonable and is conceded), it’s whether the action is demonstrably helpful to the intended outcome.

  140. Sorry, 3rd paragraph should read:

    Merely asserting the usefulness of the check sheet to verify that the checking up is done begs the question. Is checking up every 15 minutes on a schedule doing any good to prevent something that happens in “seconds” at unpredictable moments?

  141. Yes, checklists are valuable……for multi-step/multi-task activities, such as 1) preheat oven 2) assemble dry ingredients. 3) Combine flour, sugar, baking soda, and salt, etc.

    The above is not a checklist. It is a list of times and list of sleeping positions.

  142. Oh, good grief. Here’s why I’ve largely abandoned this site, all the bickering…

    So there are studies that show babies sleep less on their backs? All of them? And these babies who sleep less are of course headed for developmental disaster due to sleep deprivation? Because we know exactly and for sure how much sleep babies need and when, and they are of course all the same. Not.

    The latest thinking about SIDS is that it has to do with buildup of exhaled CO2 around the baby’s face, which has the effect of suppressing respiratory drive. An immature system may not be able to compensate for that, so where you or I would resume normal breathing as our O2 levels dropped and our CO2 rose, a baby might not, and therefore die. The back position simply allows most airflow around the face. The other recommendations about blankets and bumpers etc are in aid of the same thing. There is even research that having a fan in the room reduces the incidence.

    Regardless, every 15 minute checks is not preventative. However, I believe daycares should be checking on kids more than I might at home. In ours, there is always one staff member in the nap room (no charting unless something unusual happens, though), and they don’t even take babies. Is it absolutely necessary? Probably not, but I feel a darn sight better knowing there is an adult in that room should something — a napmare.? Someone throws up? Heaven forbid an evacuation? — go wrong.

    SKL — I would like to know what study designs you cite that are able to pinpoint back sleeping as a cause of the developmental issues you describe. So many confounding factors…

  143. “If your infant is in daycare, it’s important to know that about 20 percent of SIDS deaths happen in childcare settings, according to a study published in the journal Pediatrics in 2000.”
    http://www.babycenter.com/baby-sleep-safety

  144. I know that this is an old post but the topic drew my attention. As a foster parent who had to take shaken baby syndrome and SIDS classes to take placement of children 0-3, this doesn’t surprise me. What would surprise me would be if they found an infant on its side or tummy and didn’t move it back to its back.

    During our foster parent training we were told that we weren’t allowed to put extra blankets, bumpers, etc. in the crib because the child might roll onto it or smother itself and not be able to get that item away from their mouth. If you have to put a blanket on them then you are supposed to tuck it under the mattress and have it be no higher than the nipple line.

    It seems like a pain to me but because of lawsuits and parents we have to follow the rules. So having a day care worker check on an infant every 15 minutes doesn’t seem to unreasonable to me, especially if the ratio is 1:3. Wouldn’t they be watching them anyway? It’s not like they are an exhausted parent trying to get some sleep in the middle of the night.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

%d bloggers like this: