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Sleep Position: What are the Licensing Requirements?
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<Baby>

  • Infants must be placed on their backs on a flat surface for sleeping (crib, portable crib, bassinet or playpen, only).
  • If an infant falls asleep in a place other than their crib, portable crib, bassinet or playpen, the provider must immediately move the infant to an appropriate sleep surface.
  • Car seats are to be used for transportation only. Children who are asleep in a car seat must be removed upon arrival and placed on an appropriate sleep surface.

Rationale:

  • Research studies suggest that stomach sleeping may increase SIDS risks through a variety of mechanisms, including increasing the probability that the infant re-breathes their own exhaled breath, leading to carbon dioxide buildup and low oxygen levels.

<Baby nose>

  • The sheets can pool around the infant’s mouth and nose and contribute to breathing their own exhaled breath.
  • When the infant sleeps on their tummy, they sleep more deeply and it is harder for them to wake up. This is especially true if they have breathed in too much carbon dioxide because carbon dioxide poisoning causes the brain to malfunction. If the infant doesn’t wake up enough to be able to move, or has not yet developed the skill to roll over so that they can breathe fresh oxygen, SIDS can occur. [i]
  • Infants need to be completely on their back while sleeping. Sleep surfaces other than those required will likely have the child in incline or other positons that are not allowed in child care settings. Other places that an infant could fall asleep on could increase the risk of injury from suffocations, entrapment, and strangulation.

 Additional Guidance:

  • If a child arrives asleep in a car seat, ask the parents to place the infant in the sleep area that you have prepared for the child.
  • If a child begins to fall asleep while in other infant equipment (ie. infant seat), move the infant into the appropriate sleep area that you have prepared for the child.

[i] Kinney, H. C., & Thach, B. T. (2009). The Sudden Infant Death Syndrome. N Engl J Med,361(8), 795-805. Retrieved August 1, 2018, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3268262/.

Moon, R. Y. (2016). SIDS and Other Sleep-Related Infant Deaths: Updated 2016 Recommendations for a Safe Infant Sleeping Environment. Pediatrics,138(5). doi:10.1542/peds.2016-2938