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Examples
of State Licensing and Regulation for Safe Sleep Practices and SIDS The
following are standards from states that have regulations about placing babies
on their backs to sleep and other safe sleep practices to reduce the risk of SIDS
in child care. The information was taken from the National
Resource Center for Health and Safety in Child Care Web site. Please access
this site to read full state licensing and regulation for each state. Alabama: a.
In accordance with recommendations from the American Academy of Pediatrics, unless
the infant has a note from a physician specifying otherwise, each infant shall
be placed in a supine (on his/her back) position for sleeping to lower the risks
of Sudden Infant Death Syndrome (SIDS).
b. In accordance with recommendations
from the American Academy of Pediatrics, when an infant can easily turn over from
the supine (back) to the prone (front) position, he/she shall be put down to sleep
on his/her back, but allowed to adopt whatever position he/she prefers for sleep.
c. In accordance with recommendations from the American Academy of Pediatrics,
each infant (younger than twelve (12) months) shall be placed in a prone (front)
position part of the time he/she is awake and observed. "Tummy time"
helps muscle development and reduces the tendency of back positioning to flatten
the back of the infant's head.
d. In accordance with recommendations
from the American Academy of Pediatrics, unless a physician specifies the need
for a positioning device that restricts movement within the child's bed, such
devices shall not be used.
e. In accordance with recommendations from
the American Academy of Pediatrics, soft materials are prohibited in the infant's
sleeping environment.
(1) Soft materials or objects, such as pillows,
quilts, comforters, or sheepskins, shall not be placed under a sleeping infant.
(2) Soft objects, such as pillows, quilts, comforters, bumper pads, sheepskins,
stuffed toys, and other gas-trapping objects shall be kept out of the infant's
sleeping environment.
(3) No infant shall be put to sleep on a sofa,
soft mattress, or other soft surface.
Alaska: Ensure
that infants are placed on their backs to sleep, unless otherwise ordered by a
physician.
Arkansas:
Recommendation:
Care should be taken to ensure that loose bedding materials, such as pillows,
blankets, etc., are kept away from the faces of sleeping infants. Infants should
be placed on their backs to sleep unless there is a medical reason not to do so.
These precautions are intended to lessen the risk of suffocation and Sudden Infant
Death Syndrome.
Colorado: a. Individual
cribs must provide each toddler with sufficient space for the toddler's length,
size, and movement, and must meet federal Consumer Product Safety Commission standards.
Each crib must be fitted with a firm, comfortable mattress and heavy plastic sheeting
or other type of waterproof material. If individual cribs are used, they must
be separated by a sturdy divider from the area used for activities.
b.
Sleeping cots and mats must be of firm construction and in good repair.
c. In the infant nursery, soft bedding materials that could pose a suffocation
hazard are not permitted in cribs or playpens.
d. Infants who fall asleep
in a swing or infant seat must be placed in their cribs for the remainder of their
nap.
e. Infants must be placed on their backs for sleeping.
Georgia:
In order to reduce the risk of Sudden Infant Death Syndrome (SIDS), staff
shall put an infant to sleep on the infant's back unless the home has been provided
a physician's written statement authorizing another sleep position for that particular
infant. The infant shall be placed for sleeping on a firm, tight-fitting mattress
in a sturdy and safe crib. If the crib has side bars, the bars will be no more
than two and three-eighths inches (2 3/8'') apart. Any crib used for sleeping
shall have a tight-fitting bottom crib sheet with no pillows, quilts, comforters,
bumper pads, sheepskins, stuffed toys, or other soft items in the crib. If a blanket
is required for the comfort of the infant, the infant's feet shall be placed at
the foot of the crib and the infant shall be covered with the blanket only to
chest level with the blanket tucked firmly under the crib mattress. The infant's
sleeping area shall be maintained within a temperature range of sixty-five (65)
to eighty-five (85) degrees depending upon the season. When an infant can easily
turn over onto his or her stomach, staff shall continue to put the infant to sleep
initially on the infant's back but allow the infant to roll over onto his or her
stomach as the infant prefers. Positioning devices that restrict an infant's movement
in the crib shall not be used unless a physician's written statement authorizing
its use is provided for that particular infant.
Iowa:
a. Children under the age of one year shall be placed on their backs when
sleeping unless otherwise authorized by a parent or physician.
b. A crib or
crib-like furniture which has a waterproof mattress covering and sufficient bedding
to enable a child to rest comfortably and which meets the current standards or
recommendations from the Consumer Product Safety Commission or the American Society
for Testing and Materials for juvenile products shall be provided for each child
under two years of age if developmentally appropriate. Illinois:
To avoid sudden infant death syndrome, children who cannot turn over alone
shall be placed on their sides or backs when put down to sleep unless contraindicated
by a physician. Placing children on their abdomens for any reason shall be avoided,
unless specifically instructed by the child's physician to do so.
Indiana:
Licensee shall provide a separate crib, portacrib, or playpen in which each
infant or toddler can sleep. Each crib, portacrib, or playpen shall be equipped
with a firm-fitting mattress or pad made of waterproof materials. A parent or
legal guardian may provide or approve the use of a bassinet for an infant and
is responsible along with the caregiver to monitor its use closely. (Manufacturers
of bassinets indicate that a bassinet should no longer be used once an infant
begins moving and turning unassisted.)
Maine:
Infants shall be placed on their backs to sleep unless there is a documented
(written) medical reason why the infant should not sleep in this position. Sleeping
infants shall be checked at least every thirty minutes. Maryland:
From Title 07 Department of Human Resources, subtitle 04 Child Care Administration.
Chapter 01, Family Day Care. .14 Training Requirements for the Provider. F.
Sudden Infant Death Syndrome (SIDS) Training.
(1) Effective July 1, 2004,
the Office shall not approve an initial request by an applicant or a provider
to provide care for children younger than 24 months old unless the applicant or
provider presents evidence of having completed SIDS training that has been approved
by the Office.
(2) Effective January 1, 2005, a provider previously
approved to care for children younger than 24 months
old may not continue to provide that care unless the
provide has presented evidence to the Office by that
date of having completed SIDS training that has been
approved by the Office.
(3) Effective April 1, 2004 family child care providers
are required to complete a CCA-aaproved SIDS training
course if they wish to care (or continue caring) for
children under the age of 2.
Massachusetts:
The provider must notify parents of SIDS risk reduction practices, sleep
positioning policies, and arrangements for sleeping all infants on their backs. Minnesota: License
holders must ensure that before staff persons, caregivers, and helpers assist
in the care of infants, they receive training on reducing the risk of sudden infant
death syndrome. The training on reducing the risk of sudden infant death syndrome
may be provided as orientation training under Minnesota Rules, part 9503.0035,
subpart 1, as initial training under Minnesota Rules, part 9502.0385, subpart
2, as in-service training under Minnesota Rules, part 9503.0035, subpart 4, or
as ongoing training under Minnesota Rules, part 9502.0385, subpart 3. Training
required under this section must be completed at least once every five years.
Mississippi:
An infant shall not be placed
on its stomach for sleeping unless written parental authorization is in the child's
record. Nebraska: Should documentation reveal
that death is attributed to S.I.D.S. (Sudden Infant Death Syndrome), that information
will be filed. New Jersey:
10:122-4.7 Placing
infants in the appropriate sleep position is one of nine issues in health and
safety procedures, one of the three core areas required as part of the eight hour
annual requirement of staff development hours for child care center staff. 10:122-6.4
For children 18 months of age and younger, the center shall ensure that each child
is placed in a face-up sleeping position unless a different sleeping position
is indicated in writing by the child's health care provider. For children
12 months of age and younger, the center shall provide for each child a crib,
playpen or other Bureau-approved sleeping equipment that meets the following
requirements: 1)
A firm, waterproof, snugly fitting mattress;
2) A clean, snugly fitting sheet
or other covering and blanket;
3) Top rails that are at least 19 inches above
the mattress; and
4) Slats that are not more than 2 3/8 inches apart.
Sleeping equipment shall be free of pillows and soft bedding
when occupied
by a sleeping child. New York: a. Appropriate
sleep, rest and quiet periods which are responsive to individual and group needs
must be provided so that children can sit quietly, lie down to rest, or begin
or continue their night's sleep. For children unable to nap, time and space must
be provided for quiet play. Children must not be forced to rest for long periods
of time. Sleeping arrangements for infants require that the infant be placed on
his or her back to sleep, unless medical information is presented to the provider
by the parent that shows that arrangement is inappropriate for that child.
b. When a parent requests that an infant sleep on a cot or mat rather than
in a crib, the sleeping arrangement must be made in writing between the parent
and the provider. Ohio: a. Each mattress
shall be securely covered with a waterproof material which is not dangerous to
children.
b. Bumper pads shall not be used.
c. Nothing shall
be placed or be hung over the side that obstructs the provider's visibility of
the infant.
d. Infants shall not be placed in cribs, porta cribs or playpens
with bibs or any other items which could pose a strangulation or suffocation risk.
e. Infants shall be placed in their cribs or playpens for sleeping, and shall
not be allowed to sleep in bassinets, swings, car seats or other equipment. If
a medical condition exists where a child needs to sleep in equipment other than
a crib or playpen, written permission shall be obtained from a physician and shall
be on file for review.
f. Infants shall be placed on their backs or
sides to sleep unless the caretaker provides written authorization to the provider
for the child to be placed on his/her stomach to sleep, and which shall be maintained
on file for review by the CDJFS.
g. Cribs or playpens shall not be used
for storage of toys and other materials.
Oklahoma: a.
To reduce the risk of Sudden Infant Death Syndromes (SIDS), infants under 12 months
of age are placed on their back for sleeping unless there is a medical reason
why the infant should not sleep in this position as documented by a doctor. This
documentation is maintained at the facility. b. Infants who are able to
turn themselves over are placed initially on their back for sleeping but allowed
to sleep in a position they prefer. c. Each child has an appropriately-sized,
individual place to rest, such as a crib, playpen, bed, cot, sofa or mat, with
clean individual bedding. The place to rest is maintained in a clean and sanitary
condition and in good repair. Waterbeds, sofas, soft mattresses, pillows, beanbag
chairs, and other soft surfaces are prohibited as infant sleeping surfaces. Oregon:
Infants must be put to sleep on their backs. Tennessee:
Because of the risk of Sudden Infant Death Syndrome (SIDS), sleeping infants
(under 13 months) shall be checked every 30 minutes by touching them. If a child
appears not to be breathing, emergency medical assistance shall be sought immediately.
Utah:
Infants shall be placed on their
backs for sleeping, unless parents document a medical treatment requirement for
a clinical condition.
Infants less than 12 months shall not sleep on mats
or cots. Vermont:
To reduce the risk of
Sudden Infant Death Syndrome, infants shall be placed on their backs to sleep
unless there are medical orders requiring alternative positioning.
Cribs shall
have firm, well-fitting mattresses and crib sheets. Sheepskins, beanbags, waterbeds,
comforters and pillows shall not be used.
Virginia: When
an infant is placed in his crib, he shall be placed on his back (supine). When
an infant is able to easily turn over from the back (supine) to the belly (prone)
position and he is placed in his crib, he shall still be put on his back (supine)
but allowed to adopt whatever position he prefers. This applies unless otherwise
directed by the infant's physician. However, if the side position is used, caregivers
shall bring the dependent arm forward to lessen the likelihood of the infant rolling
into a belly (prone) position. Resting or sleeping infants shall be individually
checked every 30 minutes. An infant who falls asleep in a play space not his crib,
cot, mat, or bed shall be moved to his own crib, cot, mat or bed if he is uncomfortable
or unsafe. Washington:
WAC 388-295-4100 and
WAC 388-295-4110 (updated August 2003) 1) You must put infants to sleep
on their backs to reduce the risk of SIDS unless you have a written note in the
infant's file from both the infant's parent and the infant's health care provider
requesting another sleeping position. 2) Once infant's are able to turn
over, continue to place them on their back to sleep. You do not need to wake the
infants to return them to their back while sleeping. 3) Do not use crib
bumper pads, stuffed toys, quilts, lambskins, and pillows in cribs, infant beds,
bassinets or playpens. 4) You must provide a crib, infant bed, playpen
or bassinet mattress that is snug fitting and touches each side of the crib to
prevent the infant from becoming entrapped between the mattress and the crib side
rails.
If you do not see your state on this list there are no regulations
or licensing information regarding infant sleep positioning and SIDS. Educate
your policy makers on the importance of having licensing and regulation in your
state about safe sleep practices and SIDS. (click
here to hear audio-conference)
Additions or corrections to your state's licensing
and regulations for safe sleep? Contact Trisha Calabrese:
TCalabrese@aap.org.
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