Moon Rachel Y, Weese-Mayer Debra E, Silvestri Jean M
Division of General and Community Pediatrics, Children's National Medical Center, Washington, DC 20010, USA.
Pediatrics. 2003 Apr;111(4 Pt 1):795-9. doi: 10.1542/peds.111.4.795.
Millions of children in the US have parents who work alternative shifts. As a result, extended-hour and nighttime child care centers have increased in number to meet the needs of parents working nonstandard hours. Recognizing that 20% of sudden infant death syndrome (SIDS) occurs in child care settings and that child care providers may place infants prone, it is important to determine sleep position practices in nighttime child care centers.
To determine if nighttime child care centers 1) follow Back to Sleep recommendations; 2) are aware of the need for a safe sleep environment; and 3) have written policies directing proper SIDS risk reduction practices.
A descriptive, cross-sectional survey of licensed child care centers in the US offering evening and nighttime care. All nighttime centers caring for infants <6 months old were recruited for the study.
Out of 153 eligible centers, 110 centers in 27 states completed the survey. Infants were placed prone in 20% of centers, although only 1 center placed infants exclusively prone. Infants slept in cribs in 53.6% of centers, but slept in uncluttered sleep environments in only 18.2% of centers. Smoking was prohibited in 86.4% of centers. The most commonly cited reason for avoiding prone altogether was SIDS risk reduction; however, 10 centers that cited SIDS risk reduction continued to place infants prone at least some of the time, because of parental request or concerns about infant comfort. Over half (59%) of the centers had written policies; however, presence of written policy was not associated with avoidance of prone position. In over one third of centers with written policies, providers were unaware of the content of the policy.
Twenty percent of nighttime child care centers place infants prone at least some of the time. Most providers who place infants prone do so because of lack of awareness or misinformation about safe sleep environment. Although the Back to Sleep campaign has been effective in communicating the risks of sleeping prone, nonprone positioning is not universal among nighttime child care providers. Additional educational efforts toward child care providers remain necessary. In addition, parents as advocates for their own infants need to be proactive in assuring that safe sleep practices are implemented in child care settings.
美国数百万儿童的父母从事轮班工作。因此，延长营业时间的夜间托儿中心数量有所增加，以满足非标准工作时间父母的需求。鉴于20%的婴儿猝死综合征（SIDS）发生在托儿场所，且托儿服务提供者可能会让婴儿俯卧，确定夜间托儿中心的睡眠姿势习惯很重要。
确定夜间托儿中心是否：1）遵循“仰睡建议”；2）意识到需要一个安全的睡眠环境；3）制定了指导适当降低SIDS风险做法的书面政策。
对美国提供晚间和夜间护理的持牌托儿中心进行描述性横断面调查。所有照顾6个月以下婴儿的夜间中心均被纳入研究。
在153个符合条件的中心中，27个州的110个中心完成了调查。20%的中心让婴儿俯卧，不过只有1个中心只让婴儿俯卧。53.6%的中心婴儿睡在婴儿床里，但只有18.2%的中心婴儿睡在整洁的睡眠环境中。86.4%的中心禁止吸烟。完全避免俯卧最常被提及的原因是降低SIDS风险；然而，10个提及降低SIDS风险的中心由于家长要求或担心婴儿舒适度，至少在某些时候仍让婴儿俯卧。超过一半（59%）的中心有书面政策；然而，书面政策的存在与避免俯卧姿势并无关联。在超过三分之一有书面政策的中心，工作人员并不知晓政策内容。
20%的夜间托儿中心至少在某些时候让婴儿俯卧。大多数让婴儿俯卧的工作人员这样做是因为对安全睡眠环境缺乏认识或信息错误。尽管“仰睡运动”在传达俯卧睡眠风险方面很有效，但非俯卧姿势在夜间托儿服务提供者中并不普遍。仍有必要对托儿服务提供者进行更多教育。此外，作为自己婴儿倡导者的家长需要积极主动，确保在托儿场所实施安全的睡眠做法。
