Let's tango: Practice encounters policy in North Carolina's statewide infant/toddler safe sleep and SIDS risk reduction in childcare initiative

North Carolina's Sudden Infant Death Syndrome (SIDS) rate of .8 per 1,000 live births (2005) consistently exceeds the U.S. average of .5 per 1,000 live births (2004). Each year approximately 100 infants succumb to SIDS, the state's leading cause of mortality for infants aged 1-12 months. SIDS accounted for two-thirds (N=38/61) of all North Carolina childcare deaths from 1997-2004. From 2002-2006, the North Carolina Healthy Start Foundation and the N.C. Division of Child Development implemented a statewide train-the-trainer program to tackle SIDS in licensed childcare. The Infant/Toddler Safe Sleep and SIDS Risk Reduction in Childcare Project's goals were to introduce a safe sleep standard of care; train a cadre of certified ITS-SIDS trainers; train 14,500 childcare providers and provide contact hour credits. Evidence-based research and best practices consistent with recommendations from the American Academy of Pediatrics and statewide epidemiological data formed the core curriculum. Pre-test/post-test observational and survey data, training evaluations and a trainer-tracking system were used to measure outcomes. Media events spurred passage of a N.C “Prevent” SIDS Law, development of childcare licensing rules and policy requirements, including tobacco-use restrictions, and accelerated the ITS-SIDS intervention. Exceeding expectations, 30,500 childcare providers received the ITS-SIDS training from 250 certified trainers during 2002-2005. In-depth technical assistance strengthened Safe Sleep Policy development and compliance. Pre-test/post-test data indicate fewer SIDS risks, more infants positioned on their backs for sleeping, more Safe Sleep Policies, and greater adherence to SIDS-related legal and licensing requirements in licensed childcare facilities. SIDS deaths in N.C. childcare have decreased!