Despite the concerns of parents, infants are not at increased risk for choking if placed on their back.  Some infants may require being positioned on their stomachs due to a birth defect; a chronic problem of spitting up following eating; or a heart, lung or breathing problem. In this case, the child’s physician should provide instructions on the child’s physical examination report or provide a specific written order.

Should a parent request that a child not be placed on their back for health considerations, you should have the parent sign a statement indicating their preference. If the request is due to due to a physician’s order, you should place a copy of the order in the child’s file. If such a request or order is made, you may

want to place a note or "alert" over the crib used by the child, so that all staff are aware of the exception.

Another SIDS prevention step that you can do is to make sure the crib mattress is firm. Cribs should not be equipped with "fluffy" comforters or blankets, nor should an infant be allowed to sleep on a pillow, sheepskin, or other soft material. Soft stuffed toys or pillows should not be placed in the crib, as some infants have smothered with these items. You can also ensure the infant is not overheated while sleeping.

Contact the child care health consultant if you have further questions or would like additional training onSIDS prevention.

The Consumer Product Safety Commission has had crib safety standards since 1974. These were developed in part because of the high incidence of infant strangulation. Many children have strangled because their shoulders or necks became caught in crib openings, their heads became wedged between the mattress and the crib side, or their clothing became entangled on corner posts.

Therefore, slats or any other opening on a crib should not be more than 2 3/8 inches apart. Mattresses should fit snugly in the crib and allow for no more than two fingers to fit between the mattress and the crib side. The top of the mattress to the top of the crib rail should be at least 36 inches. Cribs should

have no corner post that exceeds 1/16 of an inch, and the headboard should have no cutouts. While many manufactures have ceased to make cribs with corner posts, you may have older cribs still in use.

Cribs should be sturdy and have secure latching devices. Cribs on wheels are helpful in the event of a fire or tornado or other need for immediate evacuation. Cribs should have sufficient spacing between them, recommended by NHSPS to be at least three feet. A divider may be used to separate the cribs, as

long as it does not obstruct staff’s view of the infant.

Cribs should not be placed end to end, as this still allows for children to reach over the "wall" into another child’s space, risking the likelihood of the transmission of illness. If the child care consultant approve the placement of cribs end to end for exceptional spacing considerations, the cribs should be used only for infants who are not yet able to pull themselves to a standing position. Staff must still have full access to a child located anywhere in the crib.

You must provide a crib and bedding for each child under two. The rule requires a crib or crib-like furniture for all children under two, if developmentally appropriate. If the child nearing age two is developmentally ready, you may substitute a cot or mat for the crib.

All cribs should have a waterproof plastic mattress cover, a sheet over the cover, and bedding that allows the infant to be comfortable and warm. Infants should never be placed directly on a plastic mattress cover, and the cover should be thick and taut enough so as not to pose a suffocation hazard.  All bedding and coverings should be washed at least weekly, when another infant is going to use the bed, or immediately if the material becomes soiled or wet. Crib frames should be wiped down and sanitized on a weekly basis.

Frequent and consistent procedures for cleaning and disinfecting may help to prevent the transmission of lice, ringworm, and scabies, three of the most infectious disease that plague child care centers. In addition, illness caused by fecal contamination or respiratory secretion will be reduced by frequent

laundering of bedding.