Chapter 5: Facilities, Supplies, Equipment, and Environmental Health
5.4 Space and Equipment in Designated Areas
5.4.5 Sleep and Rest Areas
220.127.116.11: Sleeping Equipment and Supplies
Facilities should have an individual crib, cot, sleeping bag, bed, mat, or pad for each child who spends more than four hours a day at the facility. No child should simultaneously share a crib, bed, or bedding with another child. Facilities should ensure that furniture and surfaces for sleeping are in compliance with the current U.S. Consumer Product Safety Commission (CPSC) and ASTM safety standards and have not been recalled by the manufacturer (1).
Clean linens should be provided for each child. Beds and bedding should be washed between uses if used by different children. 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. Sheets for an adult bed should not be used on a crib mattress because they could become loose and entangle an infant (2). See Standard 18.104.22.168 for crib specifications.
When pads are used, they should be enclosed in washable covers and should be long enough so the child’s head or feet do not rest off the pad. Mats and cots should be made with a waterproof material that can be easily washed and sanitized. Plastic bags or loose plastic material should never be used as a covering.
No child should sleep on a bare, uncovered surface. Seasonally appropriate covering, such as sheets, sleep garments, or blankets that are sufficient to maintain adequate warmth, should be available and should be used by each child below school-age. Pillows, blankets, and sleep positioners should not be used with infants (2). If pillows are used by toddlers and older children, pillows should have removable cases that can be laundered, be assigned to a child, and used by that child only while s/he is enrolled in the facility. (Pillows are not required for older children.) Each child’s pillow, blanket, sheet, and any special sleep item should be stored separately from those of other children.
Pads and sleeping bags should not be placed directly on any floor that is cooler than 65°F when children are resting. Cribs, cots, sleeping bags, beds, mats, or pads in/on which children are sleeping should be placed at least three feet apart (3). If the room used for sleeping cannot accommodate three feet of spacing between children, it is recommended for caregivers/teachers to space children as far as possible from one another and/or alternate children head to feet. Screens used to separate sleeping children are not recommended because screens can affect supervision, interfere with immediate access to a child, and could potentially injure a child if pushed over on a child. If unoccupied sleep equipment is used to separate sleeping children, the arrangement of such equipment should permit the staff to observe and have immediate access to each child. The ends of cribs do not suffice as screens to separate sleeping children.
The sleeping surfaces of one child’s rest equipment should not come in contact with the sleeping surfaces of another child’s rest equipment during storage.
Caregivers/teachers should never use strings to hang any object, such as a mobile, or a toy or a diaper bag, on or near the crib where a child could become caught in it and strangle (2).
Infant monitors and their cords and other electrical cords should never be placed in the crib or sleeping equipment.
Crib mattresses should fit snugly and be made specifically for the size crib in which they are placed. Infants should not be placed on an inflatable mattress due to potential of entrapment or suffocation (2).
RATIONALESeparate sleeping and resting, even for siblings, reduces the spread of disease from one child to another.
Droplet transmission occurs when droplets containing microorganisms generated from an infected person, primarily during coughing, sneezing, or talking are propelled a short distance (three feet) and deposited on the eyes, nose, or mouth (3).
Because respiratory infections are transmitted by large droplets of respiratory secretions, a minimum distance of three feet should be maintained between cots, cribs, sleeping bags, beds, mats, or pads used for resting or sleeping (3). A space of three feet between cribs, cots, sleeping bags, beds, mats, or pads will also provide access by the staff to a child in case of emergency. If the facility uses screens to separate the children, their use must not hinder observation of children by staff or access to children in an emergency.
Scabies and ringworm are diseases transmitted by direct person-to-person contact. For example, ringworm is transmitted by the sharing of personal articles such as combs, brushes, towels, clothing, and bedding. Prohibiting the sharing of personal articles helps prevent the spread of diseases.
Head lice is not commonly transmitted through the sharing of personal articles, though sharing hats, headgear, towels, and bedding is discouraged. Head lice transmission occurs with direct head-to-head contact with infested hair (4).
From time to time, children drool, spit up, or spread other body fluids on their sleeping surfaces. Using cleanable, waterproof, nonabsorbent rest equipment enables the staff to wash and sanitize the sleeping surfaces. Plastic bags may not be used to cover rest and sleep surfaces/equipment because they contribute to suffocation if the material clings to the child’s face.
Canvas cots are not recommended for infants and toddlers. The end caps require constant replacement and the cots are a cutting/pinching hazard when end caps are not in place. A variety of cots are made with washable sleeping surfaces that are designed to be safe for children.
COMMENTSAlthough children freely interact and can contaminate each other while awake, reducing the transmission of infectious disease agents on large airborne droplets during sleep periods will reduce the dose of such agents to which the child is exposed overall. In small family child care homes, the caregiver/teacher should consider the home to be a business during child care hours and is expected to abide by regulatory expectations that may not apply outside of child care hours. Therefore, child siblings related to the caregiver/teacher sleeping in the same bed during the hours of operation is discouraged.
Caregivers/teachers may ask parents/guardians to provide bedding that will be sent home for washing at least weekly or sooner if soiled.
Many caregivers/teachers find that placing children in alternate positions so that one child’s head is across from the other’s feet reduces interaction and promotes settling during rest periods. This positioning may be beneficial in reducing transmission of infectious agents as well.
The use of solid crib ends between sleeping children can serve as a barrier if they are three feet away from each other (3).
TYPE OF FACILITYCenter, Large Family Child Care Home, Small Family Child Care Home
RELATED STANDARDS22.214.171.124 Safe Sleep Practices and Sudden Unexpected Infant Death (SUID)/SIDS Risk Reduction
126.96.36.199 Cleaning Individual Bedding
188.8.131.52 Strangulation Hazards
184.108.40.206 Emergency and Evacuation Drills/Exercises Policy
U.S. Consumer Product Safety Commission (CPSC). 2011. CPSC approves new mandatory standard for toddler beds. https://www.cpsc.gov/newsroom/news-releases/2011/cpsc-approves-new-mandatory-standard-for-toddler-beds.
American Academy of Pediatrics Task Force on Sudden Infant Death Syndrome. SIDS and other sleep-related infant deaths: Updated 2016 recommendations for a safe infant sleeping environment. Pediatrics. 2016;138(6):e20162938. http://pediatrics.aappublications.org/content/early/2016/10/20/peds.2016-2938.
Kimberlin, D.W., Brady, M.T., Jackson, M.A., Long, S.S., eds. 2015. Recommendations for care of children in special circumstances. In: Red Book: 2015 Report to the Committee of Infectious Diseases. 30th Ed. Elk Grove Village, IL: American Academy of Pediatrics.
Aronson, S. S., T. R. Shope, eds. 2017. Managing infectious diseases in child care and schools: A quick reference guide, 4th Edition.Elk Grove Village, IL: American Academy of Pediatrics.
Content in the STANDARD was modified on 3/31/2017.