title: Back to sleep: can we influence child care providers?
abstract: OBJECTIVE
  Despite the fact that 20% of sudden infant death syndrome (SIDS) deaths occur in child care settings, many child care providers continue to be unaware of the association of SIDS and infant sleep position and/or are misinformed as to the risks and benefits of the various sleep positions. The objective of this study was to determine whether an educational program for child care providers regarding SIDS and safe sleep environment is effective in 1) providing basic information and understanding regarding SIDS risk reduction practices, 2) changing child care provider behavior, and 3) promoting development of written sleep position policies.
  
  
  METHODS
  We designed a 60-minute educational in-service for child care providers, to be led by a trained health educator. All providers who attended the in-service were asked to complete surveys before and after the in-service. Surveys assessed provider knowledge, beliefs, and practices. A 6-month follow-up interview was conducted with child care centers that had providers participating in the in-service.
  
  
  RESULTS
  A total of 96 child care providers attended the educational in-service. Providers who were using the supine position exclusively increased from 44.8% to 78.1%. This change in behavior was sustained, with 85% of centers placing infants exclusively supine 6 months after the intervention. Awareness of the American Academy of Pediatrics recommendation of supine as the preferred position for infants increased from 47.9% to 78.1%, and 67.7% of centers continued to recognize supine as the recommended position 6 months later. The percentage of centers that reported written sleep position policies increased from 18.8% to 44.4%.
  
  
  CONCLUSIONS
  A targeted educational in-service for child care providers is effective in increasing awareness and knowledge, changing child care provider behavior, and promoting development of written sleep position policies. This change is sustained over at least a 6-month period.
authors.affiliation: Department of General Pediatrics, Children's National Medical Center, Washington, DC 20010, USA. rmoon@cnmc.org
authors.forename: Rachel Y
authors.initials: RY
authors.lastname: Moon
authors.forename: Rosalind P
authors.initials: RP
authors.lastname: Oden
mesh_terms: D000328:Adult; D017028:Caregivers / Q000523:psychology*; D002656:Child Day Care Centers / Q000592:standards; D003625:Data Collection; D004219:District of Columbia; D019983:Guideline Adherence; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007223:Infant; D007224:Infant Care / Q000379:methods* / Q000592:standards; D007231:Infant, Newborn; D007318:Inservice Training; D015397:Program Evaluation; D011640:Public Policy; D012890:Sleep; D013398:Sudden Infant Death / Q000517:prevention & control*; D016683:Supine Position