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A Child Care Provider's Guide to Safe Sleep

Did you know? 

  • About one in five sudden infant syndrome (SIDS) deaths occur while an infant is being cared for by someone other than a parent. Many of these deaths occur when infants  who are used to sleeping on their backs  at home are then placed to sleep on their  tummies by another caregiver. We call this “unaccustomed tummy sleeping.” 
  • Unaccustomed tummy sleeping increases the risk of SIDS. Babies who are used to sleeping  on their backs and placed to sleep on their tummies are 18 times more likely to die from  SIDS.  

Who is at risk for SIDS? 

  • SIDS is the leading cause of death for infants  between 1 month and 12 months of age. 
  • SIDS is most common among infants that are 2-4 months old. However, babies can die of  SIDS until they are 1 year old. 

Because we don’t know what causes SIDS, safe sleep practices should be used to reduce the risk of SIDS in every infant under the age of 1 year.

Know the truth…SIDS is Not Caused By: 

What can child care providers do? 

Follow these guidelines to help protect the infants in your care:  

Create a Safe Sleep Policy 

Create and use a written safe sleep policy. Reducing the Risk of Sudden Infant Death Syndrome, Applicable Standards from Caring  for Our Children: National Health and Safety Performance Standards; Guidelines for Out-of-Home Child Care Programs outlines safe sleep policy guidelines. Click here to download a free copy.

A Safe Sleep Policy Should Include the Following: 

  • Back to sleep for every sleep. To reduce the risks of SIDS, infants should be placed for sleep in a supine position (completely on the back) for every sleep by every caregiver until 1 year of life. Side sleeping is not safe and not advised. 
  • Consider offering a pacifier at nap time and bedtine. The pacifier should not have cords or attaching mechanisms that might be a strangulation risk.  
  • Place babies on a firm sleep surface, covered by a fitted sheet that meets current safety standards. For more information about crib safety standards, visit the Consumer Product Safety Commissions’ Web site.
  • Keep soft objects, loose bedding, bumper pads, or any objects that could increase the risk of suffocation or strangulation from the baby’s sleep area.
  • Loose bedding, such as sheets and blankets, should not be used. Sleep clothing, such as sleepers, sleep sacks, and wearable blankets, are good alternatives to blankets.
  • Sleep only 1 baby per crib.
  • Keep the room at a temperature that is comfortable for a lightly clothed adult.
  • Do not use wedges or infant positioners, since there’s no evidence that they reduce the risk of SIDS, and they may increase the risk of suffocation.
  • Never allow smoking in a room where babies sleep, as exposure to smoke is linked to an increased risk of SIDS.
  • Have supervised, daily “tummy time” for babies who are awake. This will help babies strengthen their muscles and develop normally.
  • Teach all staff, substitutes, and volunteers about safe sleep policies and practices and be sure to review these practices often.

When a new baby is coming into the program, be sure to talk to the parents about your safe sleep policy and how their baby sleeps. If the baby sleeps in a way other than on her back,  the child’s parents or guardians need a note  from the child’s physician that explains how  she should sleep, the medical reason for this position and a time frame for this position. This note should be kept on file and all staff, including  substitutes and volunteers, should be informed  of this special situation. It is also a good idea to put a sign on the baby’s crib. 

If you are not sure of how to create a safe sleep policy, work with a child care health consultant to create a policy that fits your child care center  or home.  

Safe Sleep Practices

  • Practice SIDS reduction in your program by using the Caring for Our Children standards. 
  • Always place babies to sleep on their backs during naps and at nighttime. 
  • Avoid letting the baby get too hot. The infant could be too hot if you notice sweating, damp hair, flushed cheeks, heat rash, and/or rapid breathing. Dress the baby lightly for sleep. Set the room temperature in a range that is comfortable for a lightly clothed adult. 
  • Talk with families about the importance of sleep positioning, and encourage them to follow these guidelines at home. 

Safe Sleep Environment 

  • Place babies to sleep only in a safety-approved crib with a firm mattress and a well-fitting sheet. Don’t place babies to sleep on chairs, sofas, waterbeds, or cushions. Adult beds are NOT safe places for babies to sleep. 
  • Toys and other soft bedding, including fluffy blankets, comforters, pillows, stuffed animals, and wedges should not be placed in the crib with the baby. These items can impair the infant’s ability to breathe if they cover his face. 
  • The crib should be placed in an area that is always smoke-free. 
  • Room sharing without bed-sharing is recommended. Evidence has shown this arrangement can decrease the risk of SIDS as much as 50%.

Other Recomendations 

  • Support parents who want to breastfeed or feed their children breast milk. 
  • Encourage parents to keep up with their baby's recommended immunizations, which may provide a protective effect against SIDS.
  • Talk with a child care health consultant about health and safety in child care
  • Have a plan to respond if there is an infant medical emergency
  • Be aware of bereavement/grief resources. 

Am I a Child Care Provider? 

Some child care providers are professionals with college degrees and years of experience, but other kinds of child care providers could be grandparents, babysitters, family friends, or anyone who cares for a baby. These guidelines apply to any kind of child care provider. If you ever care for a child who is less than 12 months of age, you should be aware of and follow these safe sleep practices.   

If you have questions about safe sleep practices please contact Healthy Child Care America at the American Academy of Pediatrics at or 888/227-5409. Remember, if you have a question about the health and safety of an infant in your care, ask the baby’s parents if you can talk to the baby’s doctor.

Last Updated
A Parent's Guide to Safe Sleep (Copyright © American Academy of Pediatrics, Revised 4/2012)
The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.
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