In the U.S., there are more kids in childcare than ever before. In recent years, a number of infants have died at the hands of daycare providers who used over-the-counter medicines to quiet cranky babies without their parents' permission.
New York pediatrician Dr. Laura Popper tells The Early Show infants should never be given medication to make them sleep.
She says, "The only person who should be administering anything should be in an operating room and it should be an anesthesiologist. There are no sleep medications for babies."
The golden rule for over-the-counter medication: "Don't give it unless you've talked to your healthcare provider." Also, you should not give a baby medication that's meant for an older child.
Dr. Popper says to find safe, quality care, do your homework. On a personal level, get references, and evaluations. "The bottom line is, know who's taking care of your children. It's very important that day care, be the state or the city or whatever your locality, is licensed."
So how do you make sure your child is not given medication without your knowledge?
She says parents should have a conversation with the provider, home or not at home, that they want nothing to be given to their child without their knowledge.
Dr. Popper says there are ways to tell if the child has been given a sedative. They last in the system a long time, so if your child is sleeping too much and not eating a lot, these could be signs that there are medications in his or her system. Dr. Popper notes, "If you come upon day care at a time that they didn't expect you, you may check to see if the baby is difficult to arouse or the baby is not eating. But I think it probably would be unusual that you would see anything."
Paula Burcham ran the kind of day care working mothers dream about.
Her house was immaculate, the children's meals were home cooked. Kids would line up to get a hug from "Mama Paula."
But the families who trusted Burcham didn't know she was giving over-the-counter medicines to their children without their permission. Some now suspect she was using the drugs to sedate cranky little ones.
On Aug. 15, Burcham was sentenced to eight years in prison for giving a 3½-month-old girl a lethal dose of Benadryl. And since Grace Olivia Fields' death in December 2001, her parents have found they are not alone in their loss.
In the last three years, at least 10 other cases of day care workers allegedly sedating children with cold medicines and cough syrups have been investigated nationwide. Four babies died in those cases. At least four people were charged, with one acquittal, and some cases are still pending.
Grace's mother, Tracy Fields, and other parents are now pushing for new laws that would make it a felony for day care workers to give a child medicine without written permission from a parent or a doctor's order. One state has already passed such a law.
"I don't want any other parents to go through this," Fields said. "It didn't take a whole lot for this beautiful little baby to die from an over-the-counter medicine."
There is also a growing movement among medical examiners for greater awareness of the practice, as some pathologists fear babies who died after being drugged were written off as sudden infant death syndrome cases.
Burcham had poured about a tablespoon of children's Benadryl into a four-ounce bottle of breast milk before feeding it to Grace. The dose was three times more than what would be needed to sedate an adult.
Burcham admitted giving the baby the drug, but denied it was to control behavior. Her critics aren't swayed.
"She found a way to make those kids sleep half the day," Fields said, adding her 2½-year-old daughter told her she was given "bubble gum" flavored medicine before nap time at Burcham's.
Drug makers are adamant that their medicines aren't intended for infants and put warnings on containers that doctors should be consulted for use in any child younger than age 6.
Dr. William Sears, a pediatrician and author of books on infant sleep, said it is an "old school" practice to use cold and allergy medications to sedate babies, but even using a small amount of drugs is dangerous.
"Categorically, sedative medications have no place in day care," he said.
Young babies need to awake easily to protect themselves from dangers like choking when they spit up. The sedative interferes with that natural waking mechanism, Sears said.
Sharon Dabrow, associate professor of pediatrics at the University of South Florida, said some pediatricians do advise parents to use appropriate doses of Benadryl to sedate children who are at least 12 months old. Dabrow doesn't recommend it.
"Our society is so wrapped up around medications being a fix for anything," she said. "To be using it (Benadryl) on a 3-month-old is just horrible."
In Mobile, Ala., Robert and Mary Hernandez's 2-month-old son, Douglas, died last year at day care after being given a combination of drugs found in allergy and cold medicines.
A toxicology test turned up the drugs. A grand jury is expected to hear the case later this year.
The Hernandezes have sought a state lawmaker's help to introduce legislation that would make it a felony for a day care provider to give a child medication without their parents' permission or the consent of a doctor.
Parents whose children died in Ohio and North Carolina have waged similar campaigns.
Last month, North Carolina made it a felony to give children medicine without permission. That law was named for 5-month-old Kaitlyn Shevlin, who died in 2001 after being given the generic form of Benadryl. Her caretaker, Josephine Burke, served four months in prison on misdemeanor charges of child abuse and neglect.
Ohio communities have begun adopting ordinances prohibiting the unauthorized use of medicines in day cares following the 2000 death of Allison Kuczmarski. Baby sitter Karen Zemba pleaded guilty to reckless homicide for giving the baby Benadryl, but was sentenced to just 250 hours of community service.
The cases of five otherwise healthy infants who died from overdoses of diphenhydramine, one of the ingredients in Benadryl, were detailed in an article published earlier this year in the Journal of Forensic Science.
The research began after high levels of the drug were found in a baby who died in Virginia in 2001. Everyone who had access to the child has denied giving him the medicine; the case remains under investigation.
In all five cases examined in the project "the medication was not used for the benefit of the infant, but for the benefit of the person administering it," said Andrew Baker, the assistant chief medical examiner in Minneapolis who led the research project. "We aren't talking about runny noses or allergies here."
Baker said he hopes the article will persuade pathologists to conduct toxicology tests on babies who die from seemingly no cause. He also warned parents to be wary of day care providers who give medicines without permission, even appropriate doses of needed ones.
"I believe things like this are probably very rare," Baker said. "But the reality is unless you are testing for this, you are never going to know."