Nighttime child care: inadequate sudden infant death syndrome risk factor knowledge, practice, and policies.

BACKGROUND: 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. OBJECTIVE: 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. DESIGN: 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. RESULTS: 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. CONCLUSIONS: 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.

[Radiologic performance in night and emergency care]. / Radiologische Leistungen im Nacht- und Bereitschaftsdienst.

This report deals with radiologic examinations outside official working hours in a German university hospital and the influence of new government regulations. A total of 65,113 radiologic examinations were requested and performed outside official working hours between 1 July 1990 and 30 Juni 1994. The data were analyzed according to the age and sex of this patient population compared with the entire population studied within this 4-year period. Further analysis included the time of the study, the organ systems investigated, and the radiologic technique. About one-third of requests occurred between 16.00 and 20.00 hours on normal working days and, thus, could be taken care of by late shifts. Another third covers the time between 20.00 and 08.00 hours in the morning, which requires inhouse staff (medical and technical). The remainder of the requests occurred during holidays and weekends in the daytime. The most common request in this analysis was for portable chest examination. About 50% of all portable chest examinations were performed outside regular working hours. In all, 17.2% of all requests involved CT and MRT studies. Government regulation did not change the number, technique, and frequency of radiologic examinations outside official working hours.