Objective To independently assess compliance with safe sleeping guidelines for infants <12 months in licensed childcare services.
Design Full-day, in-situ observations of childcare practices (including sleep and non-sleep periods) conducted in 2016–2017.
Setting Australian home-based and centre-based licensed childcare services. All subject to national regulation and legislation to comply with safe sleeping guidelines.
Participants The sample was 18 licensed childcare settings (15 centre-based, 3 home-based) that had infants <12 months (n=49) attending at the time of observation. 31 educators completed self-report surveys.
Main outcomes and measures Standard observations of childcare practices, including a 20-item infant Safe Sleeping Guideline checklist. Educator characteristics, including each individual’s knowledge, beliefs and attitudes regarding safe sleeping practices.
Results 83% of childcare services were observed to be non-compliant on at least 1 of 20 target guidelines (median 2.5, max=7); 44% were observed placing infants prone/side and 67% used loose bedding, quilts, doonas/duvets, pillows, sheepskins or soft toys in cots. 71% of the childcare settings had a copy of current safe sleeping guidelines displayed either in or at entry to the infant sleep room.
Conclusion Despite 25 years of public health messaging, non-compliance with safe sleeping guidelines was observed to be high in childcare services. Understanding of the reasons underlying non-compliance, particularly in contexts were legislative mandate and access to information regarding safe sleeping is high, is critical to informing ongoing public health messaging and should be the focus of future studies.
Trial registration number ANZCTR 12618001056280—pre-results.
- safe sleeping
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Contributors SSt and KT led the research team, oversight of observational data collections, analyses and writing of the paper. Associate SSm and CP contributed to data collections and analyses and reviewed and revised the manuscript. PB, JY, AP and associate SI, contributed to analysis and reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests SSt reports grants from Queensland Government, during the conduct of the study and has been previously commissioned by the Queensland Department of Education to develop resources and professional development programmes for the childcare sector. SSm and SI report grants from Queensland Government, during the conduct of the study; KT reports grants from Department of Education, Queensland Government, during the conduct of the study; JY reports grants from Department of Child Safety, Youth and Women and fees for professional time to consult to the Queensland Child Death Review Panel outside the submitted work. CP, AP and PB have nothing to disclose.
Ethics approval Ethical approval was received for the project by the University Human Research Ethics Committee (approval number: 1500001089).
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Deidentified data are available from the corresponding author upon reasonable request and in compliance with ethical guidelines.
Patient consent for publication Not required.
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