ITS-SIDS For Childcare Providers Questions and answers

Q: Can I let the baby sleep with his favorite stuffed animal?
A: North Carolina childcare licensing rules let providers decide if they are going to allow objects in the crib while babies sleep. If providers decide to permit objects in the crib with sleeping infants, they must spell this out in their "Safe Sleep Policy" and indicate what objects and how many are allowed.

Remember, it is a best practice and a national safe sleep standard not to allow objects like toys, stuffed animals, pillows and excess bedding in the cribs while infants sleep, but the decision is the providers' to make.

Q: Can babies use pacifiers while they sleep?
A: If a provider's "Safe Sleep Policy" states that pacifiers are allowed then the baby may sleep with a pacifier. Research suggests that pacifiers may be protective against SIDS.

Q: What about mobiles - can they be attached to the crib?
A: When it comes to using mobiles, let safety be your guide. If providers choose to use mobiles, specify this in the "Safe Sleep Policy."

Take care to position the mobile up and outside of the crib. Keep it out of baby's reach and attach it securely. Mobiles should not interfere with the providers' ability to easily access the child in the event of an emergency.

Check mobiles often to make sure no parts are loose or broken and that it is attached securely to the top of the crib in order to prevent choking or strangulation.

Q: How often should I check on the babies while they are sleeping?
A: Licensing rules specify that providers visually check sleeping infants but they do not specify how often. A reasonable schedule is to check every 15 to 20 minutes. For providers with NAECY (National Association for the Education of Young Children) certification, the requirement is to check sleeping infants every five minutes.

Be sure to indicate who will do the checking, how they will check and how often in your "Safe Sleep Policy" (view a Safe Sleep Policy template,). Remember that you must document, in writing, that the sleeping babies have been checked and you must save this record for 30 days. Click here to view and download a sample Sleep Chart.

Q: We've had a request for a physician waiver to allow twins to sleep together because that is how they sleep at home. How should I handle this?
A: The physician waiver (Alternative Sleep Position - Physician Request Form) should only be used if there is a medical reason why infants should sleep in a position other than on their backs. Research shows that twins are at a greater risk for SIDS, not because they are twins, but because most twins are born preterm or low birthweight. Allowing twins to sleep together is a violation of N.C. licensing and sanitation rules.

Providers faced with this situation should use this as a teachable moment for the parents and the doctor. Revisit the "Safe Sleep Policy" with the parents and stress to them that the standards that prohibit co-sleeping are important because they lower the risk of SIDS and help prevent the spread of disease.

Regulatory Questions

Q: Are all childcare providers required to take the ITS-SIDS training?
A: All North Carolina childcare providers licensed to care for infants 12 months of age or younger are required to take the Infant/Toddler Safe Sleep and SIDS Risk Reduction in Child Care (ITS-SIDS) training. This includes lead infant teachers, owners, operators, directors, volunteers and substitutes counted in the child-to-staff ratio.

Q: How often do I need to take the ITS-SIDS training?
A: Providers must be re-certified in ITS-SIDS every three years.

Q: How soon after staff are hired do they need to take the ITS-SIDS training?
A: New hires must take the ITS-SIDS training within four months of being hired if they are not already certified. In the meantime, directors should orient new staff to their "Safe Sleep Policy" and ensure that staff follow their policy's infant sleep safety requirements.

Q: I am a provider licensed to care for infants but I don't have any infants enrolled right now and I don't plan on taking care of infants any longer. Do I still need to take the ITS-SIDS training?
A: YES. If you are licensed to care for infants, even though none are currently in your care, you are required to complete the training and be ITS-SIDS certified. If you no longer intend to care for infants, talk with your licensing consultant and make arrangements to change your license to accurately reflect the ages of the children in your care.

Q: Where can I find out about the next ITS-SIDS training in my county?
A: Contact the ITS-SIDS Trainer for your county or area. You can also call your Infant/Toddler Specialist, a Child Care Health Consultant, the local Smart Start agency or local Cooperative Extension Service office for information.

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Last updated: November 2011