- Describe why safe sleep habits are important for young children.
- Identify your role in keeping young children safe while sleeping.
- Define SIDS and the “back to sleep” campaign.
- List ways to help create a restful environment and support non-nappers.
Important Information about Infant Sleep
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.
Startling Statistics about SIDS
SIDS is the leading cause of death among infants 1 month to 12 months old.
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 in the first day or first 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 http://kidshealth.org/parent/growth/sleep/naps.html).
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.
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 2012 Consumer Public Safety Commission requirements.
- Keep cribs free of extra bedding.
- 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.
In general, 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.
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.
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).
If you are prepared to ensure the safe sleep of infants and toddlers, you should be able to make the following statement.
When it comes to promoting safe sleep practices:
- My program has a safe sleep policy and I have shared it with families.
- I place infants on their backs to sleep every time.
- I provide firm, safety-approved crib mattresses.
- I keep soft objects and materials (toys, stuffed animals, quilts, blankets, comforters, sheepskins, and pillows) out of cribs or near sleep areas.
- I use sleep clothing (sleepers) or I follow safe blanket procedures.
- I provide daily supervised tummy time while babies are awake.
- I teach all my backup providers and substitutes about safe sleep practices.
- I keep infants’ sleep areas free from hazards such as dangling cords, electric wires and window covering cords because they present a strangulation risk.
- If I see an unsafe sleep practice, I do something about it.
- I remove bibs, pacifier clips, or any clothing with hoods or cords before laying an infant down.
- I put infants to sleep in safe places; infants never sleep 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—e.g., 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, 2013). This may be something to consider for non-nappers, early risers, or school-age children.
As stated in Caring for Our Children: National Health and Safety Performance Standards; Guidelines for Early Care and Education Settings, infants who are cared for by adults other than a parent, guardian, or primary caregiver are at increased risk of dying from SIDS.
Much can be gained from learning why these risks remain. Study the pamphlets provided here. Respond to the questions in the study guide and share your responses with your trainer, coach or family child care administrator.
Do you have children who don’t nap? The risk for injury increases when children are bored. Here are quiet ideas to keep them engaged during a brief quiet time on their mats or at tables or in another quiet area of the room. Review the ideas on the “I’m Not Sleepy...” Activity Cards and keep them in an envelope in your family child care home. Let children don’t nap choose one each day.
|Aspiration||The inhalation of food, liquid, or a foreign body into a person’s airway which results in choking or respiratory distress|
|Sudden infant death syndrome||Known as SIDS, the sudden, unexplained death of an infant under 1 year old; deaths typically occur while the infant is sleeping|
|Supine||Lying on the back|
American Academy of Pediatrics. (2018). Healthy Child Care. Retrieved from https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/healthy-child-care/Pages/default.aspx and https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/healthy-child-care/Pages/default.aspx
American Academy of Pediatrics, American Public Health Association, National Resource Center for Health and Safety in Child Care and Early Education (2018). Safe Sleep Practices and SIDS/Suffocation Risk Reduction. Retrieved from http://cfoc.nrckids.org/StandardView/SpcCol/Safe_sleep
American Academy of Pediatrics, American Public Health Association, National Resource Center for Health and Safety in Child Care and Early Education. (2011). Caring for Our Children: National health and safety performance standards; Guidelines for early care and education programs. 3rd edition. Elk Grove Village, IL: American Academy of Pediatrics; Washington, DC: American Public Health Association. Also available at http://nrckids.org/CFOC3/PDFVersion/PDF_Color/CFOC3_ch6.pdf
Centers for Disease Control and Prevention. (2018). Sudden Unexpected Infant Death and Sudden Infant Death Syndrome. Retrieved from https://www.cdc.gov/SIDS/index.htm and https://www.cdc.gov/sids/Parents-Caregivers.htm
National Association for Family Childcare. (2013). Quality Standards for NAFCC Accreditation.
National Association for the Education of Young Children. (2007). NAEYC Early Childhood Program Standards and Accreditation Criteria: The mark of quality in early childhood programs. Washington, DC: National Association for the Education of Young Children.
National Institutes of Health. (n.d.) About SIDS and Safe Infant Sleep. Retrieved from https://www1.nichd.nih.gov/sts/about/Pages/default.aspx
National Institutes of Health. (2017). Sudden Infant Death Syndrome (SIDS). Retrieved from https://www.nichd.nih.gov/health/topics/sids
Nemours Foundation (2011). Kids Health for Educators, Parents, Kids, and Teens. Available at http://kidshealth.org/en/parents/nemours.html