bereaved families

When SIDS Occurs in Child Care Settings

SIDS is the leading cause of death in the United States in infants from one month to one year of age. While the majority of deaths occur in the home, some of these deaths take place while the infant is in the care of someone other that the parents. The loss of an infant to SIDS while in childcare is an especially traumatic event for all concerned.

It is difficult to find exact figures on the number of SIDS deaths in child care settings because there are no uniform reporting procedures on infant deaths that occur in day care. Labor Force Participation rates for women 15 to 44 years old with newborn children reached the 53 percent level in 1990, up from 38 percent in 1980 and 31 percent in 1976, 1976 being the first year the Census Bureau recorded these statistics (Fertility of American Women: June 1990.) These figures have major implications for child care providers. It follows that as more mothers return to work and place their infants in day care, the shift in location of some infant deaths is bound to change. Child care providers need to be aware of this change.

The death of an infant in a day care setting powerfully affects the family but also stuns the child care providers. A SIDS death intimately impacts on the providers and their families as well as on the other children in their care and the parents of these children. Such a crisis situation presents special problems and concerns for all involved and necessitates a variety of interventions.

"As family day care providers, we are a special group, and we form bonds with other people's children."
Jackie Slade, "A Provider's Greatest Fear: SIDS"

With more mothers working outside the home, more infants are being placed with child care providers and therefore more SIDS deaths can be expected while the child is under someone else's care. Such a death is an overwhelming tragedy. This death is a blow to the parents and child care provider. The loss directly impacts the baby's parents and family, the provider, and provider's family. The other children in the facility, their parents, and the community also are affected. The provider's business may be disrupted for a while.

The staff of any family child care facility or child care center should be trained for emergencies. Information about SIDS should be included. Emergency procedures on what to do if an infant is found not breathing and unresponsive should be posted in a prominent location.

General emergency procedures should include the following:

Dial 911 or the emergency telephone number for your area.

Begin CPR (if you are alone, begin CPR FIRST, and call after a minute or so).

Notify the baby's parents of the crisis

Contact an emergency child care backup person to care for the other children.

Do not disturb the scene of death.

Prepare to talk with law enforcement officers, a coroner or medical examiner, and licensing and insurance agencies.

Document the entire sequence of events.

Obtain and complete necessary forms, including medical forms, as soon as possible.

State laws and jurisdictional regulations vary in the ways investigations of certain types of deaths are carried out. In most cases, a coroner or medical examiner and law enforcement officers will conduct the inquiry. This process will include collecting detailed information about the baby's health history, behavior and events prior to the death, the location o the death, and the position of the infant.

The investigator may take pictures and collect items at the scene of the death. The provider and other adults in the facility will be interviewed, sometimes in great detail, about the baby and what happened. The state and local child care licensing agencies also will gather facts for their own inquiries.

In addition, the parents will probably question the provider repeatedly about the last hours of their baby's life. This is a time of intense grief for the child care provider, parents, and family members.

"It is important to communicate your feelings…your pain, your fears, your sense of helplessness to your family members.
Judith Henslee "The Daycare Worker: Sharing the Pain of Loss"

A Provider's Emotional Response

Bonding occurs between the baby and the child care provider, therefore a SIDS death can cause feelings of grief much like those felt by the parents. Because providers essentially are an extension of the baby's family, the death is a wrenching and emotional event for them as well.

Feelings of anger, loneliness, sadness, guilt, and loss of confidence are common, frequent, and at times unbearable. Other grief reactions include shock, denial, flashbacks, periods of physical pain or illness, self-doubt, fear of caring for other infants, and depression. Both providers and parents often are dismayed and exhausted by the depth of these emotions. These feelings are normal, but it is important to note that if they last for an unusual length of time or are extremely severe, professional help may be needed. Some Providers and parents describe feeling numb and as if they were dreaming. Some interpersonal relationships may strengthen and others may weaken.

The impact of a SIDS loss on the provider's family also can be tremendous. Family members may not be able to understand the depth of suffering because, in most cases, the childcare provider is the only family member who was close to the baby and the parents. In the case where the provider's own children were present at the time of the death, the event becomes even more upsetting.

The Impact of SIDS on the Provider, the Family, the Community

"When a child dies of SIDS while in daycare, the impact can be devastating. Daycare workers involved with the infant may experience an intense grief reaction. For weeks following the death, the care provider may experience an intense loneliness or sadness whenever anything triggers the memory of the infant."

Judith Henslee, "The Daycare Worker: Sharing the Pain of Loss"

The provider may have difficulty talking to the baby's parents. Often, the provider was the last person to see the baby alive. The provider had to call the parents and explain that something was terribly wrong with their child. The provider is usually the one who hands over the baby's belongings to the grieving parents.

The parents' emotions will vary. They may blame the provider for the baby's death but they also could feel guilty and sorry for the provider. Until the results of the completed investigation identify SIDS as the cause of the death, the parents and the provider spend hours questioning each detail about the baby's death.

When the diagnosis if SIDS is made, the parents and provider should try to accept that no one is to blame and that the death could not have been predicted or prevented. However, the questioning does not end with the diagnosis of SIDS. The wondering and grieving will continue.

Explaining SIDS to Children

One of the hardest tasks following a SIDS tragedy is talking to other children about the death. Explaining death, especially a SIDS death, is difficult. As with any sensitive subject, there is a balance between being very open and overwhelming the children with information they cannot understand and providing no information at all or even untruthful explanations. Because many adults have problems dealing with death, they assume that children cannot understand or cope with it. Trying to protect children by not discussing the death can leave them feeling anxious, confused and alone.

In the case of a SIDS death, the problem may be greater because other children probably witnessed the dismay of the staff and the panic and disruption created by the presence of police and emergence personnel. The children could tell something was wrong because of the chaos and confusion.

Both the child care provider and the parents of the other children at the facility will try to explain what happened. This will take time. Parents of the other children also may want information and assistance in explaining the death. Help from a professional such as a nurse, community health specialist, or SIDS counselor can make this task easier. Parents, providers, and other professionals must work together to obtain the best support for each other and for the children.

Two factors influence children's concepts of death: their developmental stages and experiences in life, including their environment, ethnic background, and religion.

Preschool children usually consider death to be reversible, temporary, and impersonal. Children ages five to nine begin to realize that death is final and that living things die, but they still do not consider death to be personal. As they grow older and reach each developmental stage, they may go over the experience again, seeking more advanced information. Children ages nine or ten through the teenage years begin to realize that death someday is irreversible, that all living things die, and that they will die someday.

Children may not show their feelings and may appear unaffected because they are so overwhelmed. It is more common for them to express their reactions through behavior and play. Regardless of whether they can express themselves openly, children of all ages do grieve, often very deeply. Experts have determined that, much like adults, children feel afraid, angry, guilty, and sad.

It is very important that people are honest when helping children work through their feelings about death. They should also be able to talk with children who see adults crying and sad, even when there are no clear explanations. Children often ask questions at the most unexpected times. Answer their questions using works that they can understand. Children need to feel that talking about the death is an open subject and that they can express their thoughts and questions as they arise. Children should not be told that the baby "went to sleep forever," or "went on a long trip and will not be back," or other such unfounded explanations. Such simple but dishonest answers only serve to increase the fear and uncertainty that the child is feeling. Children tend to be very literal and may think that they, too, will die when they go to sleep or on a trip.

In helping children to understand and cope with death, remember four key concepts:

Be Loving

Be Accepting

Be Truthful

Be Consistent

Talking to the Parents of the Other Children

Parents of the other children need to be reassured and informed about SIDS. They should be told about the death as soon as possible following the event. SIDS raises fear in other parents, especially if they also have infants. The other parents should be provided with educational materials and, if desired, the opportunity to speak with health care professionals. Information and counseling after a SIDS death in a child care setting are needed for everyone.

How Providers Cope after a SIDS Death

"I could not help but feel that I had somehow failed in caring for the child who had been entrusted to me. I began to question my natural childrearing instincts. I lost trust in my ability to care for babies. For a while I would not even take care of infants."

Sharon Russell, "SIDS and Its Effect on Caregivers"

The death of a baby in child care could leave providers hesitant to subject themselves to the possibility of such intense pain in the future. Despite reassurances from the family, counselors, and healthcare or other professionals, self-esteem and self-confidence may be so low for a while that caring for infants is a problem. Sometimes a child care provider will feel so overwhelmed with grief that he or she will leave the profession or prefer to care for older children exclusively for a period of time.

Being informed about SIDS before it happens and receiving support after the death lessens the chances that a provider will leave the child care profession permanently. Child care providers who had cared for a baby when a SIDS death occurred say that accurate information and peer support helped strengthen their resolve to continue in the profession and to feel confident in caring for other infants.

Even with adequate information about SIDS, it is difficult to accept the fact that no one is to blame. It takes time for the emotions to accept what the mind knows is the truth, that SIDS is not currently preventable. Support from the parents of the baby who died, as well as from the parents of other children at the facility, is very important. Their support helps to reaffirm that the provider was not negligent or responsible for the baby, parents of other children in their care, and others may not know how to talk about the death or how to offer support. The parents and others feel just as helpless and inadequate in the face of such a tragedy as the provider feels.

Support for Child Care Providers

Both parents and providers need support for their grief. Both will experience a wide range of emotions and some traumatic days, weeks, and even months following a SIDS death. Support is apt to focus on the baby's parents and family, leaving the child care provider feeling abandoned at a time when help is most needed.

Sharing experiences and feelings with others is healing. Such experiences may be shared with individuals such as the baby's parents (if they seem open to this), public health nurses, physicians, social workers, ministers, directors of the licensing agency, or the local SIDS parent organization. Attending a bereavement support group may also be helpful. Talking with other child care providers who have experienced a SIDS loss and are part of a self-help network may help with the unique problems of a provider.

Regaining confidence in the ability to provide excellent child care is a basic concept for [providers to remember. It is vitally important to understand and believe that no one was at fault. Education about SIDS is critical to this understanding.

When a baby dies of SIDS, all of the people involved are faced with a crisis. There is no warning, no preparation. The structure of daily life is changed. Such a tragedy is impossible to understand and difficult to accept. All who are grieving need help.

"You will never again be exactly the same person you were prior to the tragedy, but you will have an increased appreciation for the miracle of an infant's life and an increased awareness of your own inner resources and strengths."

Judith Henslee, "The Daycare Worker: Sharing the Pain of Loss"

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