20 CAR § 1025-1103 – Infant and toddler sleeping requirements

(a) Sleeping infants and toddlers shall be:
1. (1) Visually monitored at all times; and
2. (2) Physically checked regularly for breathing.
(b)
1. (1) Infants and toddlers shall be placed in age-appropriate cribs, cots, or mats meeting Consumer Product Safety Commission standards for when they fall asleep.
2. (2) Note. Also, any items used in the crib must be used according to manufacturer guidelines, regardless if the child is sleeping or not, in accordance with 20 CAR § 1025-1101(a).
(c)
1. (1) Infants (children twelve (12) months of age and below) shall be placed flat on their backs to sleep, in accordance with American Academy of Pediatrics guidelines, to lessen the risk of suffocation and sudden infant death syndrome.
2. (2) If a child rolls over on his or her own, the facility is not required to reposition the child.
3. (3) If there is a medical reason a child cannot sleep on his or her back, then a signed statement from the child’s physician must be in the file stating the:
  1. (A) Reason;
  2. (B) Sleep position indicated; and
  3. (C) Time frame this is required.
(d)
1. (1) Infants’ sleep space (e.g., crib) shall be free of loose bedding.
2. (2) If a light blanket is necessary, it should be kept at or below the mid-chest area of the child.
3. (3) Staff shall not cover the faces of infants.
(e) Swaddling infants is not recommended and shall require a note from the child’s physician if continued past the age of three (3) months.
(f) Pillows, including nursing or Boppy pillows, bumpers and bumper pads, and stuffed animals shall not be placed in cribs.
(g) Bibs, necklaces, and garments with ties or hoods shall be removed from infants prior to rest and naptime to reduce the risk of entanglement and strangulation while the child is sleeping.
(h) Any cribs or playpens that have been identified as unsafe or have been subject to recall, as defined by the Consumer Product Safety Commission guidelines or law, shall be removed or repaired as indicated.
(i)
1. (1) An individually labeled crib or safe playpen with a waterproof mattress shall be provided for each child less than twelve (12) months of age.
2. (2) A bassinet shall not be used.
3. (3) Please note that the Consumer Product Safety Commission does not recommend the use of playpens in licensed child care.
(j) The following guidelines shall be required for cribs:
1. (1) Slats shall be no greater than two and three-eighths inches (2 3/8") apart;
2. (2) Cribs that have end panels with decorative cutout areas shall not be used;
3. (3) Mattresses shall:
  1. (A) Fit snugly in the crib;
  2. (B) Be waterproof; and
  3. (C) Be in good repair;
4. (4) The space between crib and mattress shall measure no more than one inch (1");
5. (5) Corner posts shall be the same height as end panels; and
6. (6) End panels shall extend below mattress at the lowest position of the mattress.
(k) Crib bedding shall be changed daily or more frequently when wet or soiled.