10A NCAC 09 .0606         SAFE SLEEP Practices

(a)  Each center licensed to care for infants aged 12 months or younger shall develop, adopt, and comply with a written safe sleep policy that:

(1)           specifies that caregivers shall place infants aged 12 months or younger on their backs for sleeping, unless:

(A)          for an infant aged six months or less, the center receives a written waiver of this requirement from a health care professional; or

(B)          for an infant older than six months, the center receives a written waiver of this requirement from a health care professional, or a parent or a legal guardian;

(2)           specifies no pillows, wedges or other positioners, pillow-like toys, blankets, toys, bumper pads, quilts, sheepskins, loose bedding, towels and washcloths, or other objects may be placed with a sleeping infant aged 12 months or younger;

(3)           specifies that children shall not be swaddled;

(4)           specifies that nothing shall be placed over the head or face of an infant aged 12 months or younger when the infant is laid down to sleep;

(5)           specifies that the temperature in the room where infants aged 12 months or younger are sleeping does not exceed 75° F;

(6)           specifies that caregivers shall visually check, in person, sleeping infants aged 12 months or younger at least every 15 minutes;

(7)           specifies how caregivers shall document compliance with visually checking on sleeping infants aged 12 months or younger;

(8)           specifies that pacifiers that attach to infant clothing shall not be used with sleeping infants;

(9)           specifies that infants aged 12 months or younger sleep alone in a crib, bassinet, play pen, mat, or cot;

(10)         specifies that infants aged 12 months or younger are prohibited from sleeping in sitting devices, including car safety seats, strollers, swings, and infant carriers. Infants that fall asleep in sitting devices shall be moved to a crib, bassinet, play pen, mat, or cot; and

(11)         specifies any other steps the center shall take to provide a safe sleep environment for infants aged 12 months or younger.

(b)  The center shall post a copy of its safe sleep policy about infant safe sleep practices in a prominent place in the infant room where parents and caregivers are able to view daily.

(c)  A copy of the center's safe sleep policy shall be given and explained to the parents of an infant aged 12 months or younger on or before the first day the infant attends the center. The parent shall sign a statement acknowledging the receipt and explanation of the policy. The acknowledgement shall contain:

(1)           the infant's name;

(2)           the date the infant first attended the center;

(3)           the date the center's safe sleep policy was given and explained to the parent; and

(4)           the date the parent signed the acknowledgement.

The center shall retain the acknowledgement in the child's record as long as the child is enrolled at the center.

(d)  If a center amends its safe sleep policy, it shall give written notice of the amendment to the parents of all enrolled infants aged 12 months or younger at least 14 days before the amended policy is implemented. Each parent shall sign a statement acknowledging the receipt and explanation of the amendment. The center shall retain the acknowledgement in the child's record as long as the child is enrolled at the center.

(e)  A caregiver shall place a child age 12 months or younger on the child's back for sleeping, unless for a child age 6 months or younger, the operator obtains a written waiver from a health care professional; or for a child older than 6 months, the operator obtains a written waiver from a health care professional or parent. Waivers shall include the following:

(1)           the infant's name and birth date;

(2)           the signature and date of the infant's health care professional or parent;

(3)           if a wedge is needed specify why it is needed and how it is to be used; and

(4)           the infant's authorized sleep positions.

The center shall retain the waiver in the child's record as long as the child is enrolled at the center.

(f)  For each infant with a waiver on file at the center as specified in Paragraph (e) of this Rule, a notice shall be posted for quick reference near the infant's crib, bassinet, play pen, cot or mat that shall include:

(1)           the infant's name;

(2)           the infant's authorized sleep position; and

(3)           the location of the signed waiver.

No confidential medical information, including an infant's medical diagnosis, shall be shown on the notice.

(g)  Documents that verify staff member's compliance with visual checks on infants shall be maintained for a minimum of one month.

(h)  A bed, crib, or cot, equipped with a firm waterproof mattress at least four inches thick and a fitted sheet shall be provided for each child who remains in the center after midnight. The top of bunk beds shall be used by school-age children only.

(i)  A caregiver shall not place anything over the face of a child during rest time.

History Note:        Authority G.S. 110-85; 110-91(15); 143B-168.3;

Eff. May 1, 2004;

Amended Eff. July 1, 2010;

Readopted Eff. October 1, 2017;

Amended Eff. February 1, 2021.