AAP alters sleeping recommendation

To reduce the risk of Sudden Infant Death Syndrome (SIDS), pediatricians are warning parents against letting infants sleep on their sides or backs and cautioning parents not to share a bed with their infant.

In an updated policy statement, the AAP said it no longer recognizes side sleeping as a reasonable alternative to sleeping while fully supine (lying on back).

As the Director of Kids Path for Hospice & Palliative Care Center of Alamance-Caswell, Patti Gasparello has been working to keep local day care centers aware of the changing AAP recommendations.

“Despite major decreases in the incidence of SIDS over the past decade, the syndrome is still responsible for more infant deaths beyond the newborn period in the United States than any other cause of death during infancy,” said Gasparello.

Studies have found that the side sleep position is unstable and increases the chances of the infant rolling onto his or her stomach, according to the AAP.

“Every caregiver should use the back sleep position during every sleep period,” Gasparello said.

ITS-SIDS class at Buncombe County Child Care Center

For the price of a single meal at Subway Alice Elio teaches child care providers how to save babies from a killer of infants that medical experts cannot predict.

“The number of babies dying from sudden infant death syndrome in secondary care is appalling,” Elio said as she prepared herself for an intensive training session in a simple yet elegant room at the Buncombe County Child Care Center on 59 Woodfin Place.

Elio, now a Buncombe county health-care consultant and leader of the ITS-SIDS child care training workshop in downtown Asheville, began her career in child care at the Mamieo Stookey school for children with special needs in Illinois. She taught essential SIDS prevention techniques to child care providers in Asheville after working for Buncombe County’s disease control division.

“The prevalence of SIDS deaths in child care was the whole reason that a new law in 2003 was enacted by the Division of Child Development,” Elio said. “Looking at the statistics showing that the number of kids dying in child care was way too high they said, ‘What is going on here?’”

The 2003 Safe Seep legislation mandates N.C. child care providers complete educational programs designed to teach preventative measures for SIDS.

Elio’s classes, held in a conference room at the BCCCC, uses the American Academy of Pediatrics’ 64-page instruction manual as the foundation for teaching concepts to aspiring child care providers.

“I believe that once you have a standard and you’re aware of the standard that you should be following it as practice and if something goes wrong you have protected everyone involved,” said Kay Riddles.

A participant of Elio’s class, Riddles is the director of Candler based Hominy Baptist Child Care and has been working with children for over 25 years.

“The SIDS programs that the state has mandated are critical to learning how to properly care for infants,” said Riddles. “I will only hire individuals who have sought out and completed the training.”

One of the toughest issues ITS-SIDS seeks to remedy are antique ideas about child rearing that many parents cling to because it is the way their family has raised children for generations

“Some parents will request to have their child put to sleep on his or her tummy, or with a comfort item such as a stuffed animal,” said participant and child care worker Felisha Burke. “I have worked for Children and Friends home day care center for 19 years, and every so often I deal with a parent who insists that we bend our rules to make the child ‘transition easier’ into a new setting,” she said.

“We have to explain to them that what they’re doing is putting their child at risk and we follow state operating procedures strictly,” she said.

Despite the expressed adherence to state mandated child care laws, the SIDS rate in child care remains static at a daunting/mysterious 20 percent. This begs the question of whether or not the classes are diagnosing and seeking to eliminate the right causes of SIDS, a phenomenon that scientists do not fully understand. Still, some care workers believe that the findings concerning the SIDS rate are not accurate.

“Hominy Child Care practices what the training courses are teaching as the best preventative techniques for SIDS, though other causes of it may still be unknown,” said Riddles.

“Never once have I had a case of SIDS on my watch.”

Can taking Mucinex cause you to fail a drug test? (Answer Man)

Mucinex, an over-the-counter cough medication, may beat the snot out of congestion, and it might cause you to fail a drug screening.

“Generally, any over-the-counter medications that a person can take will not effect any of the testing,”Usha Brioughs, employee at Florida Drug Testing, said. “Unless it’s prescribed by the pharmacy, then they sometimes put additives to it that could render a positive result.”

The active ingredient in Mucinex is a drug called guaifenesin. An over-the-counter drug that assists in expectoration, which is the bringing up of phlegm from a person’s airways, guaifenesin was approved by the Food and Drug Administration in 1952 and is legal in the U.S.

“Of course, they make other products that contain gauifenisen that have other ingredients,“ CVS Pharmacist Keith Frierson said.

The manufacturer of Mucinex, Adams Respiratory Therapeutics, has an entire line of expectorant products, including a similarly named creation, Mucinex DM.

“Mucinex DM is gauifenisen, plus it has a decongestant,” Frierson said.

The DM ending stands for dextromethorphan, which is the pairing active ingredient to guaifenesin in Mucinex DM. More commonly referred to as DXM, dextromethorphan is an opioid agent used as a cough suppressant and can show up on a drug screening as opioids, opiates or heroin.

“That’s a restricted item (Mucinex DM),” Frierson said. “That’s why you have to sign for it and show valid identification.”

If you are genuinely sick, taking Mucinex DM, and are approached by your boss for random drug testing, it might feel like there’s no safe remedy.

However, the likelihood of testing positive for opioids from Mucinex DM consumption is even quite low. But, if you are lying to cover up heavy opioid or heroin abuse, you might want to think twice before blaming the failing grade on medicinal DXM use.

The 1995 study, “The dextromethorphan defense: dextromethorphan and the opioid screen” attempted to determine whether a single, oral dose of dextromethorphan produced a false positive urine opioid screen, may have discredited the dextromethorphan plea.

The randomized placebo-controlled study focused on 20 adult men who had no drugs in their systems before the test.

Each screen completed six hours after the participant had ingested a single dose of liquid medication, either dextromethorphan, codeine or placebo. Each participant ingested all three medications randomly, at least 72 hours apart.

Half of the participants ingested the standard adult dose of dextromethorphan, 20 mg, while the other half ingested double the adult dose. The amounts of codeine (30 mg) and sucrose placebo (10 mL) remained constant.

For these adults, whose calculated average age was a little over 30, all urine tests were negative for opioids and all other drugs.

Although DXM is legal, the study presents fairly conclusive evidence that it would be difficult to suggest medicinal use of DXM as an excuse for testing positive for opioids.

“I’ve never heard of Mucinex being abused,” Sarah Davis, a physician assistant at UNCA Asheville’s student health center, said.

This might prompt one to think there would be more public scrutiny about medicine residing on the shelves of any local drugstore that, on a drug screen, can pass as its cousins in the Schedule I drug classification, according to the Controlled Substances Act.

But this is where things get a little stuffy.

“DXM is not classified as a controlled substance,” Brioughs said. “It can be purchased legally in pharmacies, grocery stores and convenience stores.”

Some national pharmacies and wholesale distributors have chosen to regulate the sale of products containing DXM to only those over the age of 18. Also, limits on the quantity an individual may purchase have been instituted.

Currently, almost no stores inform customers of the betraying potentiality DXM possesses if taken before a drug screen. Although stores are not required to post such information, the cost of ignorance to a clogged up consumer can be a catch-22 of a headache.

SIDS prevention educator profiled

For the past 15 years, Alice Elio fought a killer of infants that medical experts cannot predict.

“The number of babies dying from sudden infant death syndrome in secondary care is appalling,” Elio said from her office at the Buncombe County Child Care Center where she began working 11 years ago.

Elio, now a Buncombe county health-care consultant and leader of the ITS-SIDS child care training workshop in downtown Asheville, began her career in child care at the Mamieo Stookey school for children with special needs in Illinois. She taught essential SIDS prevention techniques to child care providers in Asheville after working for Buncombe County’s disease control division.

“The prevalence of SIDS deaths in child care was the whole reason that a new law in 2003 was enacted by the Division of Child Development,” Elio said. “Looking at the statistics showing that the number of kids dying in child care was way too high they said, ‘What is going on here?’”

The 2003 Safe Seep legislation mandates N.C. child care providers complete educational programs designed to teach preventative measures for SIDS.

Elio’s classes, held in a conference room at the BCCCC, uses the American Academy of Pediatrics’ 64-page instruction manual as the foundation for teaching concepts to aspiring child care providers.

“If the class is mostly new students, then I usually give a lecture-style presentation of the material,” Elio said. “But when the majority of the folks are re-training, it’s more call-and-response or activity-based.”

One activity involves teaching students to diagnose whether an environment is lawfully compliant for a sleeping infant. The most important instruction is Elio’s demonstration on how to position the infant for sleep.

Experts believe the greatest defense to SIDS is to place the child to sleep supine, meaning flat on their backs, according to the AAP.

“Increase in back and side sleeping was a result of the American Academy of Pediatrics recommendation on sleep position published in 1992,” she said. “And the success of the Back to Sleep campaign, an initiative to encourage parents to place their infants to sleep in the supine position, begun in 1995, was very influential in reducing the risk of SIDS while the child was home.”

But the rate of SIDS in child care did not follow the same downward trend. An AAP report stated that infants in child care are 18 times more likely to die of SIDS. Furthermore, approximately 20 percent of SIDS deaths occur while the infant is in the care of a non-parental caregiver, a statistic which has remained static since 1992.

“Parents are doing it all right,” said Elio. “(When) They are taken to child care and they are placed to sleep on their tummies for the first time, which, for a developing child, can be traumatic. This is what we’re working to change.”

Her training courses appear critical to lowering the child care SIDS rate. Yet, in the 10 years she and others have been teaching SIDS prevention there has been no visible statistical reduction.

“The techniques being taught, the formula of the classes and the level of enforcement provided by state sanctioned agencies seem adequate,” said Elio. “But the lack of implementation of proper techniques when workers are not being observed may be hindering the progress.”

Compared to occupations requiring similar levels of education, child care providers wages fall short of the norm, according to Gordon Cleveland, senior lecturer of economics and division of management at the University of Toronto.

“Neither job experience nor education is adequately rewarded, so there is little incentive for licensed child-care workers to improve their abilities and stay in the sector,” he said.

Cleveland teaches courses in labor economics and industrial organization. An American Economic Association member, he has also written eight books and numerous journal articles on the subject of the benefits and costs of good child care.

“As a result of low wages and the lack of prospects for advancement, the rate of job turnover is very high, with negative implications for maintaining an acceptable quality of care,” Cleveland said.

Elio defends her course’s value and doesn’t think the lopsided SIDS rate is the result of employers cutting corners by hiring workers who simply have not received the mandated training or the fault of the DCC loosely checking provider’s qualifications.

“The training is the strongest tool we have to educate care givers and, because the training is mandatory, it is typically paid for by the facility,” she said. “Truly, the DCC does check. Providers do not want to get caught not having this documented. If nothing else, they get liability!”

However, Elio recognizes the demanding task of supervising multiple infants at once, which can lead to breakdowns in proper procedure.

“I think they do not always follow the procedure because it is difficult when you have five infants in your care and one will not sleep,” she said. “It may be that the child is not used to sleeping on its back or is used to sleeping with an adult. Then, I sometimes find infants in swings.”

Being overworked and underpaid inversely correlates to “burnout” and indifference towards one’s job, according to a study performed by the Clearinghouse on Elementary and Early Childhood Education.

“Cleveland is right on target,” said Elio. “As a state we have been very cognizant of this. Teachers need the education to be excellent caregivers. What we do find is that we do a lot of training but not a lot of retaining.”

Discontent with a position in a field without many avenues for promotion often results in workers quitting after only a few years

“Obviously, workers seek employment where they can get a higher pay grade,” said Elio.

Taking objection to the idea that overworked employees contribute to the N.C. SIDS rate, Diana Sutton defended her facility as one of the highest quality child care centers in Western North Carolina.

“Our employees do a fantastic job, and we have a low turnover rate because we pay our employees as much as possible while keeping up with the rent. We are not turning a profit,” said Sutton, co-owner of the Asheville based child care facility Regent Park Early Childhood Development Center. “We follow every single mandated procedure and have a ratio of three babies to every employee, which is better than the state mandated 5-to-1.”

Sutton recognizes the disproportionate amount of child deaths in day care as a disturbing statistic and something she hopes to never have to deal with at RPECDC.

“Our employees are very aware of the causes of SIDS and are keeping up-to-date with SIDS education mandated by the state,” said Sutton. “Having a child die in your care would be one of the worst things possible.”

Sutton says parents share part of the responsibility of placing a strain on the system. Increased enrollment has created higher child-to-caregiver ratios and more frequent worker turnover in other day cares.

“Part of the problem is the parents. Child care is very often on the low end of priorities for parents,” said Sutton. “They don’t have appreciation for staff or concern for who is taking care of their child.”

“Regardless of the arguments over the myriad causes of SIDS, continuing and expanding the courses increases the likelihood that infants will survive the first 18 months of life,” Elio said.

“The majority of SIDS deaths in child care occur on the first day, which is really scary,” she said.