Safe Sleep Practices in Prepared by the Health Consultant Team at Child Care Aware® of North Dakota

Place all (birth up to 1 year) completely flat Do not allow infants to sleep in car seats, swings, on their backs for sleep in a crib or playpen. Rock n sleeper or bouncers. • ALWAYS place an infant on her back each time • Downward bending of the neck and head compress you lay her down for sleep. Once an infant can roll the airway, thus decreasing the amount of air the from back to front and front to back, the infant can infant is able to breathe in. be allowed to remain in the sleep position that she • Infants are not well protected from the other chooses. You do not need to return her to a back children’s activity in these devices. sleeping position. • When using restrictive equipment, safety straps • There is no safe way to elevate the head of the crib should always be used properly along with close or playpen supervision to prevent strangulation. • If a requests an alternative sleep position • Restrictive infant equipment contributes to or sleeping surface, it is required to obtain a positional skull deformities in infants. written order from a health care provider stating Do not attach anything to the crib/playpen the medical reason and the time frame to follow the order, along with written parental permission. • Mobiles, mirrors or crib toys are not allowed. You are not required to follow the order if you are • Hanging blankets or other items on the sides or uncomfortable. It is recommended to consult an over the top of the crib or playpen is not allowed. attorney to discuss the liability risk. • Breathable/mesh bumper pads are not allowed. Only allow infants to sleep in a crib or playpen Place crib/playpen in a safe location. • are not allowed. • Away from stairs, windows blinds, outlets, heaters, • If using a crib: etc. - It must be compliant with federal safety • Keep everything out of reach (ex. monitor cords, standards put into effect June 28, 2011. pictures, etc.) within 3 feet of crib/playpen. - Regularly check for loose, missing or broken • Do not hang anything heavy on the wall around the parts or slats. crib or playpen. - Do not allow more than 2 fingers width between Encourage tummy time when infant is awake and mattress and frame. supervised. - Mattress must be firm. • This strengthens neck and shoulder muscles, - Mattress should be kept in the lowest position. encourages rolling over and crawling. - Make sure model has not been recalled. Visit Remove pillows, heavy blankets, fluffy comforters, www.cpsc.gov for updates. sheepskins, bumper pads, stuffed toys, and other soft items from the crib. • If using a playpen: Only use properly fitting FITTED crib or playpen - Make sure the model has not been recalled. sheets to cover the mattress or pad. Visit www.cpsc.gov for updates. • Do not use flat sheets, blankets, or fitted sheets - Read the manufacturer’s instructions before that are the wrong size. assembly and use of playpen • Mattress/pad must maintain shape when fitted - Make sure there are no holes in the mesh sheet is used. If playpen pad cannot maintain - Frame is sturdy and locks in place shape, use it without a sheet. - Use only the pad provided by the manufacturer Blankets are not recommended - Pad should lay flat and touch all four corners of • If using a blanket, only one blanket is allowed and it frame should be thin. Place the infant’s feet to the foot of the crib/playpen and tuck the blanket in along the - Use the Velcro straps/snap straps provided by sides and foot of the mattress. The blanket should the manufacturer to secure the pad in place not come up higher than the infant’s chest. Arms - Check pad frequently to make sure wood panels should be above the blanket. aren’t broken or haven’t shifted • Written permission from the infant’s health care - inserts, mobiles, and changing pads provider is required to use more than one blanket. sold with the playpen are not allowed

Safe Infant Sleep Practices - page 1 of 2 Safe Infant Sleep Practices - page 2 of 2

Swaddling is not recommended • Visual checks are recommended every 10-15 • Ask to consider using a sleep sack instead minutes. of a blanket. If a swaddle sleep sack (with arm • Visual checks consists of the following: panels) is used, it is recommended to discontinue - Readjust clothing/blanket if needed. use once the infant reaches 2 months of age or sooner if showing signs of rolling. - Make sure head and face are uncovered - If parents request that their infant be swaddled, - Make sure infant is breathing (chest rising & only one thin blanket should be used and it falling) should not come any higher than to the infant’s - Check color of infant’s skin (Blue/grey skin shoulders; blanket needs to be loose enough indicates not enough oxygen; red skin indicates for a hand to fit between the blanket and infant is overheated.) the infant’s chest so the infant doesn’t have • Lighting in the room needs to be bright enough to trouble breathing; blanket should be kept loose see the infant’s skin color and breathing. around the infant’s hips. The AAP recommends to be discontinued when an infant • Music/sound machines must be placed at a low reaches 2 months of age or sooner if showing volume to ensure infants’ noises can be heard. signs of rolling. Licensing requires swaddling to • Video monitors do not replace visual checks. be discontinued once an infant becomes mobile. • All monitors/cords must be kept at least 3 feet - “Mobile” is defined as when an infant shows away from crib/playpen. signs of rolling. Signs of rolling: gaining more • Written orders from a health care provider are control over arms and legs; having more head required to use a monitor that requires cord(s) to control; moving from side to side etc. be attached to the infant or for a device placed in - Written permission from the infant’s health care the crib/playpen. provider is required to swaddle after an infant • Stay on same level (preferably main) as crib/ becomes mobile. playpens to make visual checks more convenient Make sure the infant’s head remains uncovered and fire evacuation safer/faster. during sleep. • Require parents to remove their infant from the car Don’t let the infant overheat during sleep. seat and outer clothing when they arrive. • Infants should not be dressed in more than one • Refuse to place infants in their car seats for extra layer than an adult. departure unless you are transporting the infant. • Signs of overheating: sweating, chest feels hot to Do not allow infants to share a crib, even if they are touch, flushed cheeks, heat rash, breathing rapidly siblings or twins. Consider offering a pacifier (with parent’s Know and practice CPR. permission) when placing an infant down for sleep. • Know what to do for an unresponsive infant. • Once infant falls asleep and it falls out, it does not have to be reinserted. Always inspect pacifier for Do not use positioning devices. cracks/tears. • Written permission from the infant’s health care • Pacifiers cannot be tied around an infant’s neck or provider is required to use them. clipped to an infant’s clothing. Encourage regular check-ups and . • Pacifiers with stuffed animals/toys attached are not Support . allowed for sleep. Set a policy on infant sleep position. Remove bibs, necklaces (including teething necklaces), hooded sweatshirts, headbands, and • Put your policy in writing and give a copy to parents as soon as possible and encourage them to follow hats before laying infant down for sleeping. guidelines at home to prepare infant for care. Make Do not let babies sleep or play in a room where sure parents sign your contract upon enrollment. smoking is allowed at any time. • Inform all staff, including substitutes and Keep infants in sight and sound when sleeping. If volunteers, of your policy on the first day of this is not possible, it is required by licensing to employment/volunteering before they are allowed use an infant monitor and conduct regular visual to care for infants. checks. • Licensing requires written parental permission to use one blanket or sleepsack, a pacifier, and a security item for sleep. Post copy out of reach of infant near the infant’s crib/playpen for providers/ Sources: staff to reference. CFOC, 4th Edition, 2019 SIDS and Other Sleep Related Infant Deaths: Updated 2016 Recommendation for a Safe Infant Sleeping Environment, AAP, , 2016 AAP news, June 2013 Revised 1/2021

Child Care Aware® of North Dakota is a program of Lutheran Social Services of North Dakota.