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Important Information about Infant Sleep

Sudden unexpected infant death (SUID) is a term used to describe the sudden and unexpected death of an infant less than 1 year of age in which the cause was not obvious before investigation. Sudden unexpected infant death includes Sudden Infant Death Syndrome (SIDS), accidental suffocation in a sleeping environment and other deaths from unknown causes. One-half of all SUID cases are Sudden Infant Death Syndrome. Sudden Infant Death Syndrome (SIDS) is defined as the sudden death of an infant less than 1 year of age that cannot be explained after a thorough investigation is conducted, including a complete autopsy, examination of the death scene, and review of the clinical history.

Sudden Infant Death is NOT:

• The same as suffocation and is not caused by suffocation
• Caused by vaccines, immunizations, or shots
• Contagious
• The result of abuse or neglect
• Caused by cribs
• Caused by vomiting or choking
• Completely preventable, but there are ways to reduce the risk

Startling Statistics about SIDS

SIDS is the leading cause of death among infants 1 month to 12 months old and is the third-leading cause overall of infant mortality in the United States.

About one in five 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. Infants who are used to sleeping on their backs and placed to sleep on their tummies are eighteen times more likely to die from SIDS, according to the American Academy of Pediatrics.

According to the National Resource Center for Health and Safety in Child Care and Early Education, a majority of SIDS-related deaths at child care facilities occur within the first day or week that an infant starts attending a child care program.

Because the causes of SIDS are unknown, safe sleep practices should be used to reduce the risk of SIDS in every infant under the age of 1 year.

Sleep for Toddlers and Preschoolers

Sleep is an important part of a healthy childhood. Naps give children time to rejuvenate, and they let active bodies rest. Young brains and muscles also do serious work during sleep. Without naps, children may become overtired. Children who are overtired often upset easily and may even have a harder time falling asleep at night (for more information, see ).

We often think of infants when we think of safe sleep practices. Although toddlers and preschoolers are not at risk for sudden infant death syndrome, rest time is not without risk. It is still your responsibility to keep all children safe during this important time.

Developmental Stages and Sleep

As children progress from infancy through the preschool years, they typically need less and less sleep during the day. While young infants often sleep many times throughout the day, older infants and young toddlers often have one morning and one afternoon nap. Typically, preschool children (ages 3 to 5) benefit from one afternoon nap. This nap usually lasts around one hour, but each child’s sleep needs are different. The amount of sleep a child needs during the day is also related to the amount of sleep a child gets at night. A child who sleeps ten to twelve hours per night may nap less than an hour during the day. A child who gets less sleep at night will likely need a longer nap during the day. Some children do not sleep during naptime, but they still benefit from a quiet period of rest. This is why it is important to discuss children’s sleep routines and patterns with their parents or guardians; family schedules may influence the sleep patterns that are best for each child in your care.

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Infants and Toddlers

Education is the key to promoting care-giving practices that ensure infants’ well-being. The American Academy of Pediatrics (AAP) provides safe sleep policy guidelines and practices.

AAP's policy guidelines say:

• Healthy babies should always sleep on their backs. A physician’s note should be required for non-back sleepers.
• Cribs must be in compliance with 2014 Consumer Public Safety Commission and ASTM International requirements.
• Use a firm mattress covered by a tight-fighting sheet designed for a safety-approved crib.
• Keep cribs free of blankets, pillows, stuffed toys, soft objects, loose bedding and bumper pads. Nothing else should be in the crib except for the baby.
• Bibs, necklaces, and garments with ties or hoods should be removed.
• Dress the baby lightly for sleep. Set the room temperature in a range that is comfortable for a lightly clothed adult.

Creating a Restful Environment for Sleep

There is a lot you can do to promote a peaceful rest time. First, each child age 5 and under who attends your program for a full day should have a cot or mat for rest time. Children should not sleep directly on the floor. Think carefully about cot arrangement as well. If children are too close together, they may distract each other and they may spread illnesses. According to the National Association for the Education of Young Children, children’s faces should be at least 3 feet apart or separated by a solid barrier, such as a shelf unit. This distance can be accomplished by staggering the direction in which children lie: head-to-toe and toe-to-head. Playing soothing music can help children fall asleep. Your interactions can also help soothe children to sleep. Patting children on the back, quietly reading a story, or comforting an upset child can create a peaceful environment for sleep.

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When children are sleeping, providers should be able to hear them. Providers should also do visual checks on infants under 8 months of age every 15 minutes (monitors are not permitted as a substitute for a visual check). Family child care providers’ own children may not sleep in their own beds (during nap) unless the bed is adjacent to or located in the child care area. Further, children under 3 years of age must be in sight and sound supervision at all times.

For Infants:

Infants should be placed on their backs to sleep. If infants roll over onto their stomachs on their own, adults do not need to reposition them onto their backs.

Infants who arrive at the facility asleep in car safety seats should be immediately removed and placed on their backs in a safe sleep environment.

Infants should not nap or sleep in a car seat, bean-bag chair, bouncy seat, infant seat, swing, jumping chair, playpen or play yard, high chair, chair, futon, or any other type of furniture or equipment that is not a safety-approved crib. If an infant is asleep in one of these, the infant should be immediately removed and be placed on their back in a safety-approved crib.

Infants should not be swaddled according to the National Health and Safety Performance Standards, 4^th Edition, Standard 3.1.2.4, which states “In child care settings, swaddling is not necessary or recommended, but rather one piece sleepers should be used.”

Balance Back Sleeping by Offering Tummy Time

As a result of being placed on their backs to sleep, infants may develop flattening of the skull. To minimize this, it is recommended that infants have supervised tummy time. Tummy time also encourages motor development, especially the upper-body muscles. During tummy time, it’s important to never leave infants unattended.

Promoting Safe Sleep with Infants

Parents, family members, teachers, and all adults who care for an infant for one nap or many should follow safe sleep practices every nap time and every sleep time. Sleeping-related preferences may be sensitive to a family’s culture or personal preferences and beliefs. Handle discussions sensitively. Provide families with A Parent’s Guide to Good Sleep (see the Explore section).

To best ensure the safe sleep of infants and toddlers, you should adhere to the following guidelines:

• Ensur your program has a safe sleep policy and you have shared it with families.
• Place infants on their backs to sleep every time.
• Provide firm, safety-approved crib mattresses.
• Keep soft objects and materials (toys, stuffed animals, quilts, blankets, comforters, sheepskins, and pillows) out of cribs or near sleep areas.
• Use sleep clothing (sleepers) or follow safe blanket procedures.
• Provide daily supervised tummy time while babies are awake.
• Teach all my backup providers and substitutes about safe sleep practices.
• Keep infants’ sleep areas free from hazards such as dangling cords, electric wires and window covering cords because they present a strangulation risk.
• If you see an unsafe sleep practice, take corrective action immediately.
• Remove bibs, pacifier clips, or any clothing with hoods or cords before laying an infant down.
• Put infants to sleep in safe places, never in bouncy seats, play gyms, or swings.

For Toddlers, Preschoolers and Older Children

If all children are resting quietly, you can take care of daily tasks like lesson planning, working on portfolios, washing toys, or reading relevant educational materials. Remember though, your first job is to keep children safe. These activities during rest time must not distract from your primary job of child supervision.

It is important to remember that each child is unique. If you know there is a child in your program with special mobility or health needs, more direct adult supervision may be necessary to help keep the child safe.

You should also make sure that children remove any dress-up or clothing items that might strangle them during sleep, such as necklaces or sweatshirts with drawstring hoodies.

Remember, as discussed in Lesson Two, if you are providing overnight or extended care, children are permitted to sleep in other rooms, but most of these safe sleep practices should still be followed. Providers should sleep on the same floor as the children for which they are caring and no children should sleep in the basement.

What about Children Who Don’t Nap?

By the age of 5, many children no longer need a daily nap. There are several things you can do to accommodate these children:

• Encourage a brief quiet time. Provide cots or mats and a collection of books or quiet toys for the children to play with for a brief period.
• Provide quiet play in a different location, perhaps in the same room away from nappers, or in an adjacent room, preferably one to which you have some visual access. In family child care, children over age 3 may be out of the provider’s line of sight for short periods of time, as long as the provider is close and listens carefully to assure safety (NAFCC, 2017). This may be something to consider for non-nappers, early risers, or school-age children.