ST. LOUIS — Child-care centers in Missouri soon will be required to put babies to sleep on their backs and to have a staff member trained in CPR on staff at all times, in the first revision of state child care rules in two decades.
Although, the American Academy of Pediatrics recommended 15 years ago that babies sleep on their backs to prevent sudden infant death syndrome and accidental suffocation, child-care workers in Missouri have not been required to follow that recommendation. That will change this year, with the "back-to-sleep" rule expected to go into effect by late summer and the CPR regulation by Jan. 1, The St. Louis Post-Dispatch reported.
In an interview earlier this spring, Margaret Donnelly, director of the Missouri Department of Health and Senior Services, said both rules would save lives. The department regulates child care in the state through its section for Child Care Licensing.
Many established licensed child-care providers — particularly accredited ones with independent reviewers — have been using the back-to-sleep rule for more than a decade.
"If I'm giving advice out to parents, I tell them, 'You just need to put your child to sleep on their backs,'" said Lynn Navin, director of the University Child Development Center on the campus of the University of Missouri-St. Louis, which has had such a policy for years. "Too many children are dying because of policies that could be in place that are not."
The rules will affect about 2,200 centers and 1,440 licensed home-based child care centers. From 2007 to 2009, the Missouri Child Fatality Review Program recorded two infant deaths in licensed child care facilities because of SIDS or suffocation.
The new rules do not apply to legally unlicensed home-based child-care businesses in Missouri, estimated to number well more than 5,000, nor to the 670 faith-based child-care centers that are exempted from state licensing.
But advocates of quality child care said the new rules are an important start, though they say they have been waiting for years for the state to take these steps.
"We are very pleased that child-care licensing has taken this step in the right direction," said L. Carol Scott, executive director of Child Care Aware of Missouri. "But it's been 20 years almost since we revised the licensing rules in Missouri, and we've learned a lot in 20 years. Over that time, organizations like the American Academy of Pediatrics have made strong suggestions about better protections for children. Missouri hasn't kept up with those recommendations."
The state's efforts in the past five years to update its rules have faltered because of budget cuts, changes in leadership and concerns on the part of smaller providers about costs and the scope of regulation. State licensing officials lost fundraising for consultants about two years ago. Officials said then that the state would attempt to do the revisions piece by piece.
The new back-to-sleep and CPR requirements are the first new rules to come out of that process. Another rule involving disaster plans is under review.
A study nearly a decade ago by Rachel Moon, a pediatrician and SIDS researcher with Children's National Medical Center, determined that 20 percent of all SIDS deaths occur in child care, when that rate should be about 8 percent.
The back-to-sleep practices aren't always adhered to in child care — particularly in home-based child care businesses where providers often aren't regulated and lack training. National researchers on SIDS have long said that most children are dying in home-based care, where providers put babies on their tummies for naps because that is how they raised their babies.
"This is a very important rule," said Lori Behrens, executive director of SIDS Resources of Missouri. "We're glad we have it on the books, and it gives us the lead that we need to get in with child-care providers — especially those home-care providers — to do our education on safe sleep."
Behrens notes that SIDS Resources also does not recommend crib bumpers or any other type of suffocation hazard in a crib.