Chapter 5: Facilities, Supplies, Equipment, and Environmental Health
5.4 Space and Equipment in Designated Areas
5.4.5 Sleep and Rest Areas
18.104.22.168: Sleeping Equipment and Supplies
Programs should have a separate crib, cot, sleeping bag, bed, mat, or pad for each child who spends more than 4 hours a day in care. No child should share a crib, bed, or bedding with another child at the same time. Each child should have clean linens once a week; more often if soiled. Regardless of age group, bed linens should not be used as rest equipment in place of cots, beds, pads, or similar approved equipment. Bed linens used under children on cots, cribs, futons, and playpens should be tight-fitting. See Standard 22.214.171.124 for crib specifications.
Store each child’s pillow, blanket, sheet, and any special sleep item separately, and label it. The sleeping surfaces of one child’s rest equipment should not touch the sleeping surfaces of another child’s rest equipment in storage.
Sleeping pads or other sleep equipment should not be placed directly on a floor that is cooler than 65°F when children are resting. Cribs, cots, beds, mats, or pads that children are sleeping in or on should be at least 3 feet apart. If the room used for sleeping is too small to have 3 feet between children, it is recommended that caregivers and teachers space children as far as possible from one another, and/or alternate children head to toe. Screens to separate sleeping children are not recommended. If empty sleep equipment is used to separate children, place the equipment so that the staff can watch and have immediate access to each child.
No child should sleep on a bare, uncovered surface. Seasonally appropriate covering, such as sheets, sleeping garments, or infant sleep sacks that are sufficient to maintain adequate warmth, should be available and used by each child below school age. Caregivers and teachers may ask parents or guardians to bring in bedding that will be washed at home at least weekly, or sooner if soiled.
Toddlers and Older Children
Canvas cots are not recommended for toddlers. If toddlers and older children use pillows, pillows should have removable cases that can be laundered, assigned to a child, and used only by that child while enrolled in the program. When pads are used, they should be enclosed in washable covers and long enough, so the child’s head or feet do not rest off the pad. Mats and cots should be:
- Lead-safe, BPA-free, phthalate-free, have no fire-retardant chemical, and meet all Consumer Products Safety Commission rules and regulations for foam cots1,2
- Made with a waterproof material that can be easily cleaned. Plastic bags or loose plastic material should never be used as a covering.
Infants should not use pillows, nursing pillows, blankets, and sleep positioners.3,4 Programs should make sure that cribs, bassinets, portable cribs, or play yards used for safe sleeping meet the current U.S. Consumer Product Safety Commission (CPSC) and American Society for Testing and Materials (ASTM) safety standards and have not been recalled by the manufacturer.5,6 Programs can read and file complaints about thousands of consumer products at https://www.saferproducts.gov/. Canvas cots are not recommended for infants.
Programs should use only sleep equipment for sleeping. Couches, futons, and armchairs are extremely dangerous for infants and should never be used for infant sleep.7 When infants wake up, remove them from their cribs and return them to the play area. Do not use sleep equipment in play, feeding, or diaper-changing areas.8 The ends of cribs are not enough to separate sleeping children.
Infant monitors with dangling cords or other electric wires should never be in the crib or sleeping equipment. Caregivers and teachers should never use strings to hang objects (mobiles, toys, diaper bags, etc.) on or near a child’s sleep area.9
Using screens to separate sleeping children is not recommended because screens can limit supervision, can interfere with immediate access to a child, and could injure children if pushed over on them. Keep each child’s sleeping and resting surfaces away from others’ to reduce the risk of spreading disease. Solid crib ends between sleeping children can be barriers if they are 3 feet from each other.
Children freely interact and can contaminate one another while awake, but reducing the risk of spreading germs during sleep will reduce the number of germs the child is exposed to overall. Because respiratory illnesses can spread through the air¾and children don’t cover their coughs and sneezes while sleeping¾keep at least 3 feet between cots, cribs, sleeping bags, beds, mats, or pads used for resting or sleeping.
Three feet between equipment will also allow staff to get to a child in an emergency. Many caregivers and teachers find that placing children in alternating positions (i.e., one child’s head is next to the other’s feet) reduces interaction, promotes settling during rest periods, and may help reduce the spread of infections.
Sometimes children drool, spit up, or spread other body fluids on their sleeping surfaces. Using cleanable, waterproof, nonabsorbent rest equipment lets the staff wash and disinfect the sleeping surfaces that have touched body fluids. Plastic bags may not be used to cover rest and sleep surfaces or equipment because they can suffocate the child if the material clings to the child’s face.
American Academy of Pediatrics
- Safe Sleep Campaign Toolkit. https://www.aap.org/en/news-room/campaigns-and-toolkits/safe-sleep/
- Virtual Early Education Center. https://veec.aap.org/index.html
TYPE OF FACILITYCenter, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home
RELATED STANDARDS126.96.36.199 Safe Sleep Practices and Sudden Unexpected Infant Death (SUID)/SIDS Risk Reduction
188.8.131.52 Cleaning Individual Bedding
184.108.40.206 Strangulation Hazards
220.127.116.11 Emergency and Evacuation Drills Policy
Ford A, Moore E, Stebbins J. Chemicals and all: the health risks posed by crib mattresses. National Center for Health Research. November 22, 2013. https://www.center4research.org/rock-bye-baby-chemicals-health-risks-posed-crib-mattresses/. Accessed September 19, 2022
Consumer Product Safety Commission. Standard for the flammability (open flame) of mattress sets; final rule. March 15, 2006. https://www.cpsc.gov/s3fs-public/pdfs/blk_media_mattsets.pdf. Accessed September 19, 2022
Consumer Product Safety Commission. CPSC warns parents not to use nursing pillows for sleep; agency is investigating infant deaths that may be associated with pillow-like products. October 7, 2020. CPSC.gov Web site. https://www.cpsc.gov/Newsroom/News-Releases/2021/CPSC-Warns-Parents-Not-to-Use-Nursing-Pillows-for-Sleep-Agency-Is-Investigating-Infant-Deaths-that-May-Be-Associated-with-Pillow-Like-Products. Accessed May 25, 2022
U.S. Food and Drug Administration. Do not use infant sleep positioners due to the risk of suffocation. FDA.gov Web site. https://www.fda.gov/consumers/consumer-updates/do-not-use-infant-sleep-positioners-due-risk-suffocation. Updated April 18, 2019. Accessed May 25, 2022
Federal Register. Safety standard for infant sleep products. FederalRegister.gov Web site. https://www.federalregister.gov/documents/2021/06/23/2021-12723/safety-standard-for-infant-sleep-products
Consumer Product Safety Commission. CPSC approves major new federal safety standard for infant sleep products. June 2, 2021. CPSC.gov Web site. https://www.cpsc.gov/Newsroom/News-Releases/2021/CPSC-Approves-Major-New-Federal-Safety-Standard-for-Infant-Sleep-Products. Accessed May 20, 2022
American Academy of Pediatrics. Tips for keeping infants safe during sleep from the American Academy of Pediatrics. February 2022. AAP.org Web site. https://www.aap.org/en/news-room/news-releases/aap/2020/tips-for-keeping-infants-safe-during-sleep-from-the-american-academy-of-pediatrics/. Accessed August 2, 2022
National Institute of Food and Agriculture. USDA. Cooperative Extension. Creating safe and appropriate napping areas in child care. August 15, 2019. https://childcare.extension.org/creating-safe-and-appropriate-napping-areas-in-child-care/. Accessed May 25, 2022
Moon RY, Carlin RF, Hand I, The Task Force on Sudden Infant Death Syndrome and the Committee on Fetus and Newborn. Sleep-related infant deaths: updated 2022 recommendations for reducing infant deaths in the sleep environment. Pediatrics. 2022; e2022057990. 10.1542/peds.2022-057990
Content in the STANDARD was modified on 3/31/2017 and 1/31/2023.