Care Providers Consider Rejecting Some Infants

By LYNNE TUOHY
The Hartford Courant
February 01, 2001

The Connecticut Sudden Infant Death Syndrome Center emphasizes that "no one is at fault'' when an otherwise healthy baby dies of this syndrome.

But a Connecticut jury's verdict, holding a Bolton day-care provider liable for $800,000 in one infant's death, prompted many caregivers Wednesday to reassess their own liability and the ages of babies they'll accept in the future.

"I've already gotten calls from providers who are going to make changes in the ages of the infants they'll accept,'' said Lynn Behrmann, president of the Manchester Family Care Providers Association. "Some are looking at [age] 6 months and up. There are a few who said a year. A few who have babies that are supposed to start in February are seriously considering not taking them.''

Tuesday's rare verdict also began stoking the perennial debate about whether training beyond the basics of first aid and cardiopulmonary resuscitation should be mandated for Connecticut child-care providers.

A Rockville Superior Court jury found Barbara Horne of Bolton negligent in the death of 2-month-old Shelby LePage of Coventry, who died of SIDS during her second day in Horne's care.

Although Shelby's mother, Mary LePage, instructed Horne to let Shelby sleep only in her portable car seat or in a baby swing Horne had at her home, the baby was laid in a crib and died while asleep on her stomach. Shelby's older brother, in Horne's care for two years, was with Horne when she discovered that Shelby had died.

The cause of SIDS is unknown, but its incidence in the United States has been reduced 42 percent since the American Academy of Pediatrics recommended in 1992 that babies sleep on their backs.

A national campaign began two years later with the slogan "Back to Sleep.''

"The campaign has truly made a difference in keeping probably 2,000 or more babies alive,'' said Judy Jacobson, executive vice president of the national Sudden Infant Death Syndrome Alliance, based in Baltimore. "It's not a guarantee. But it certainly has become the standard of care and it should be followed. If a caregiver is not following the standard of care, they will be subject to litigation. That's the society we live in.''

SIDS is the leading cause of death for babies under the age of 1, with most incidents occurring in the age range of 2 to 4 months. Shelby's case also fits with a recently detected phenomenon of babies dying of SIDS within the first day or two of being placed with a care provider.

Dr. Henry Krous, director of pathology at Children's Hospital in San Diego, has researched SIDS for two decades, and also serves on the county's infant death review board. He said babies who are accustomed to sleeping on their backs are at "substantially higher risk to die of SIDS the first couple of times they are placed [on their stomachs].''

"We have seen a number of babies placed on their stomach by the day-care provider and the baby died shortly thereafter, in the first day or two they were in the care of the day-care provider,'' Krous said. "This phenomenon is definitely recognized.''

Jacobson agreed. "We emphasize to families they need to communicate with anyone watching their baby - whether it's a day-care provider or the grandmother taking the baby for the weekend - everyone needs to be aware of this. Those babies who are used to sleeping on their backs and all of a sudden find themselves that first or second time on their stomachs really are at the highest risk.''

Krous' comments dovetail with a study published last August in Pediatrics magazine that revealed a disproportionate number of SIDS deaths are occurring in child care, with 60 percent of those occurring in family child-care settings -homes as opposed to commercial care centers.

Dr. Rachel Moon of the Children's National Medical Center in Washington, D.C., said she expected to learn that 7 percent of SIDS cases were occurring in child-care settings, based on Census Bureau and other data. Instead, based on a study of 1,916 SIDS deaths, she determined the percentage to be 20.4.

"It's truly a public health embarrassment, the extent to which day-care providers are not aware of the well-documented relationship between sleep positions and SIDS,'' said attorney Gerald S. Sack, who represents the LePage family.

But, Sack said, Horne did not fit into that category of caregivers.

"This is not a care provider who should have known,'' he said. "This is a case where she did know and didn't act. She knew the relationship between SIDS and sleep position. She saw [Shelby] on her stomach and chose not to roll her over. She didn't want to wake her up.''

Horne could not be reached for comment Wednesday.

Although SIDS also is known as "crib death,'' Sheila Coutant, director of the Connecticut SIDS Center, stressed that SIDS can occur under many other circumstances. The center is the official link between the office of the chief state medical examiner and families who have lost an infant to SIDS

"I've had them die breast-feeding or on the father's shoulder,'' Coutant said of cases she personally has come in contact with. "I have them in strollers, car seats, sitting up, lying down. I had a grandmother who was bottle-feeding a baby when it died.''

Coutant and others who train and work in the day-care field, said they fear the chilling effects of the LePage verdict could lead to a dearth of licensed child-care placements for infants, particularly those under 6 months old, and an increase in unlicensed care providers. "Because they're licensed, they're liable,'' Coutant said.