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Safe and Healthy Sleep for Infants and Young Children, in partnership with Region 9 Head Start Association

Safe and Healthy Sleep for Infants and Young Children, in partnership with Region 9 Head Start Association
Charlotte Hendricks, PhD
December 22, 2020
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Editor’s note: This text-based course is an edited transcript of the webinar, Safe and Healthy Sleep for Infants and Young Children, in partnership with Region 9 Head Start Association, presented by Charlotte Hendricks, PhD.

Due to the evolving recommendations of health care agencies regarding COVID-19 precautionary procedures, the information contained in this course may not completely represent the most current information available from public health agencies.  While this course is based on the recommendations at the time of course creation, please check your local regulations to ensure you are providing the safest environments for the children and families you serve.​

Learning Outcomes

After this course, participants will be able to:

  • List ways to reduce the risk of SUIDs/SIDS.
  • Describe how to ensure a safe sleep environment for infants and young children.
  • Describe sanitation practices to reduce the risk of disease transmission.

Infant Sleep Safety

Sudden Unexplained Infant Deaths, or SUIDs, are deaths that occur suddenly and unexpectedly in previously healthy infants. This is a term that you may not have heard of. Most of us have heard of SIDS, Sudden Infant Death Syndrome. SIDS is one subgroup of SUID. The whole term of SUIDs includes accidental suffocation. There are about 3,500 SUIDs in the US each year. You cannot really categorize all infant deaths as either SUIDS or SIDS. It simply means that an infant died, it was not expected and it is usually after you have put them down to sleep. We are going to talk about all those incidents. Often, the death may be coded as SIDS or it may be coded as accidental suffocation or just unknown.

Risk Factors for SUID/SIDS

There are many risk factors for SIDS.
  • Prematurity and/or low birth rate
  • Maternal smoking during pregnancy
  • Second-hand smoke
  • Sleeping space other than a crib
  • Sharing a bed with others
  • Quality of supervision at time of death
  • Obesity, fatigue, or drug/alcohol use by person supervising or sleeping with child
  • Infants sleeping on their stomachs
  • Soft sleep surfaces
  • Loose bedding, toys, or other objects in crib
  • Faulty design of crib or beds
  • Overheating
If the baby is born premature or is born with a low birth rate then that baby is at higher risk for SUID. If the mother smokes during pregnancy or is around secondhand smoke then that is a great risk factor. Smoking during pregnancy or exposure to smoke during pregnancy can often cause a baby to be born at a low birth rate. If you are doing home visits or have a prenatal program such as an Early Headstart where you are working with pregnant mothers, talk to them about that. If they are smoking or if their spouse or significant other or anybody in the family or the household is smoking, encourage them to not do that because it is putting that unborn baby at risk.
 
Using a sleeping space other than a crib is a risk factor. Very often people will put the babies to sleep on a bed or a couch or something soft and that is highly dangerous. If the infant is sharing a bed with other children or with other adults, that is a risk factor. That is where it often becomes what they call a rollover death. If the infant is in the bed and the adult goes to sleep and suddenly rolls over, they might not feel the baby. This is sometimes categorized as SIDS when they do the death report.
 
The quality of supervision at the time of death is a risk factor. Related is obesity, fatigue, or drug and alcohol use by a person who is supervising or sleeping with the child. Regarding obesity, if you are a large person and you roll over on a tiny little infant you will not know it. Even in the childcare environment, if the person who is charged with watching the babies while they sleep is exhausted herself, that can be a risk factor. You might just say, oh, I am going to close my eyes just for a second, but you cannot do that. Or if the person is under the influence of drugs or alcohol, then their decision-making skills are not going to be top-notch, so that is a risk factor for SIDS.
 
Another risk factor is infants sleeping on their stomachs. In 1994 the Back to Sleep campaign was started, which encouraged putting infants to sleep on their back. Most people do that now. You still have some people who believe that the infant will throw up or something else might happen if you put the child to sleep on their back, but that is simply not true. Unless there is a medical reason the infant should not sleep on their backs, they should be put to sleep on their backs. One of the greatest risk factors is if the parent is putting the infant asleep on their back at home, then they bring them to child care and if the caregiver puts that infant to sleep on its stomach, then it just intensifies the risk. Always put the infants to sleep on their back.
 
Soft sleep surfaces are also a risk factor, whether it is a chair, a couch, or an adult bed, especially a feather bed or water bed. Beanbag chairs would be one of the worst places you could have a baby to sleep. Loose bedding or toys or other objects in the crib are other risk factors. If the sheet on the bed is not tight-fitting and comes up on the corner, then the baby, as he is moving around, can get that bedding around him which can cause suffocation. Toys, pillows, and bumper do not belong in the infant's crib.
 
Faulty design of the crib or the beds, which could include loose hardware or cutouts, can allow the baby to get his head caught. It is dangerous. Another one that people do not think of is overheating. I do not know why people think that babies get cold but they are just like we are. With the baby, if he is just sleeping in footed pajamas and he is all covered up, he is all cozy and comfortable. You do not need to put blankets on him or three layers of clothing or anything else. That is even true when you have them out for a walk or you are going in the store or anything like that.
 
I remember walking into a store and saw a young man pushing his baby in a stroller. I looked down at the baby and I looked at him and said, "Your baby is overheating." He had come into the store and the man had taken his jacket off but the baby was still bundled up in a jacket with a blanket over him and in a stroller. I told him he needed to take some of those blankets and things off of the baby.

Lower the Risk Factors

It is important to lower the risk factors. One thing you can do when working with moms is to promote breastfeeding. We want to promote it during pregnancy so that they are ready to begin breastfeeding when the baby is born. In childcare, we can help by encouraging moms to continue to breastfeed. Breastfeeding can be an uncomfortable situation, especially for new moms who have not done that before and they may feel nervous about doing it and that it is not going to be easy. We need to make it easy for them. Provide breastfeeding mothers a comfortable place within your childcare environment with privacy, comfortable chairs, plain blankets, and access to electrical outlets in case they are pumping.
 
Another thing to do is to encourage families to schedule and go to all well-child visits. If that infant is supposed to go back at one month, in two months, three months, or whatever the healthcare provider has suggested, encourage the parents to make and keep those appointments to be sure that everything is okay with the baby.
 
It is very important to keep the environment smoke-free, including staff vehicles and their clothing. Cigarette smoke sticks to you. It gets in your hair, it is on your skin, and it is on your clothes. When you are holding a baby up close, the baby is right there smelling whatever is on your clothes. Keep the childcare environment smoke-free but also know if the childcare workers in your program smoke or if they are living in households where there is smoking. If so, then they need to be sure they have freshly laundered clothes when they come in. Perhaps you can provide them with a lab coat or some other tunic that they put on that is clean and not exposed to smoke so that whatever they are wearing when they are holding that baby has no smoke on it.
 
The same is true for other fragrances such as perfumes, colognes, bath salts, etc. Infants do not need all those fragrances because they can become irritants. This is especially true if the baby has anything respiratory going on normally in their life as the fragrances could cause problems that could then lead to unexplained infant death. We want to do is protect babies at all times.

Sleep Position Policy

Look at the sleep position policy for your childcare program. Infants should be placed on their backs for every nap or sleep time. It does not matter if it is for two hours or just five minutes. Always place them on their backs. However, if you have an infant that is getting a little bigger and starting to roll over on his own it is okay if he rolls onto his side or tummy.  You still want to place him on his back to start with. If he wants to move, let him move, but you are constantly watching him.

If there is a reason to have the infant in any other sleep position than on his back, you should require a signed waiver from the child's primary health care provider. This should not just be because the mother or the father wants it, it should be a medical reason. 

Crib Safety

Many people want cute cribs with bumper pads, stuffed animals, and mobiles.  However, cribs should not have any of those items in them.  A crib needs to be a place for the baby to sleep safely.
 
One way to ensure crib safety is by making sure every infant has his or her own crib. Also, cribs are only for sleeping. They are not for playing and they are not a place to put the baby while you go do something else. Since cribs are for sleeping, there is no reason to attach a mobile or any play equipment to that crib. If the infant falls asleep in a safety seat, a chair, or somewhere else, make sure to move the child to his crib and place him on his back. Even if the parent brings the child into the classroom in his carrier and says to let him sleep, you need to take him out of the car carrier and put him in the crib on his back.
 
Cribs should meet Consumer Product Safety Commission (CPSC) and ASTM standards. In In 2011, the CPSC established new guidelines and requirements, making a lot of changes to crib design and crib safety. If you buy a crib from a big box store or a department store in the US and it is from the US, it should meet those standards. However, if you are shopping at yard sales or somebody offers you a crib that their child has outgrown, you need to see what the date is when it was purchased and make sure it was manufactured after 2011 so that it meets those safety standards. Be very cautious of any donated or secondhand cribs that you might acquire.
 
Another reason to purchase a crib new is that it comes with the manufacturer's instructions.  Read those instructions, making sure you have assembled the crib properly and the hardware, such as screws and bolts, are securely fastened. A lot times cribs can be broken down so that you can store them until the next baby comes along. 
 
Do not use a crib if it is broken or if it has been modified in any way. For example, if someone decided the headboard was a little too high and cut it down, you cannot use that crib in the childcare setting. Evacuation cribs are also important in the childcare environment.  If you have evacuation cribs, they can be used for sleeping just like your regular cribs. They must also meet the CPSC 2011 and ASTM standards. 
 
Crib mattresses should be supported completely. Make sure that they fit in the crib, are firmly supported underneath the mattress so they are not going to slip or slide, and are firm and fit tightly in the crib. There should be no gaps longer than two fingers between the crib and the mattress. This makes it much safer for infants. It can also make it hard to change the sheets because you are trying to wrestle with the tight crib. If the sheet goes on too easily and the mattress is loose, you need a new mattress that fits better. Crib sheets must fit securely. When you buy sheets, make sure you get the proper size. They should be almost difficult to get on. Once they are on the mattress they should stay put. The elastic around the bottom should be secure so they will not slip off.
 
Avoid any blankets, pillows, bumper pads, or stuffed toys in the crib. When these recommendations came out, it was a little difficult for me because I grew up in a generation where we had the cute bumper pads and baby blankets that your mother or your grandmother made. They were so pretty and you felt good when you used them. After these recommendations came out, I would walk into a childcare center and see a crib with a mattress and a sheet on it, but nothing else was in the crib. It does look a little institutional to me, but it is safe and it is what they need. That is how it should look when you go in and look at a crib. You should have a good sturdy crib with a firm mattress that fits the crib and a nice clean sheet right on it, nothing else.
 
The room that the babies are sleeping in should be a comfortable temperature for an adult in lightweight clothes. For example, if you are wearing a short-sleeve shirt and jeans or pants and are comfortable in the room, then that temperature will be comfortable for the baby as well. Dress infants in footed pajamas to keep their feet and toes from getting cold. They should be dressed in only one more layer that you are wearing. They do not need a blanket or a lot more clothing than we do.
 
Swaddling infants is something that has been around for generations. A lot of parents swaddle their infants, especially preemies or babies in the first month they are home. Swaddling them can help them to sleep and gives them a nice, cozy feeling. In the child care environment, it is not necessary and it is not recommended.
 
If parents swaddle babies at home, they need to make sure that they are doing it correctly and that the swaddling is not too tight. When a baby is old enough that he is trying to roll over, then you should stop swaddling. If a parent says they normally swaddle their baby at night to help him sleep and they want you to do that in childcare, be aware that it is not recommended. Deal with everything on a case by case basis. There may be a medical reason that swaddling is needed but you need to check that out on an individual basis.

Crib Placement

Let's talk first about where you do not want to place the crib. Do not put the crib right beside the door where parents come into the room. A lot of childcare programs have the parents bring the child into one receiving area and they never actually go into the baby's room but in other childcare or home childcare environments, the parent comes right in and brings the baby in and the cribs are right there.
 
The reason I say you not to put a crib right beside the door is that things can accidentally be placed in the crib. For example, when my child was an infant, his bed was right next to the door of his classroom. I walked in one day and looked and there was a rock in his crib. It was not a very big rock, but it was still a rock. I had no idea why there was a rock in my baby's crib. It was a choking hazard and I did not want a rock in his crib. It turned out that another parent coming in had their baby in one hand and the diaper bag in the other hand and set the diaper bag in my baby's crib. The rock fell out of the diaper bag into my baby's crib. I told them to move my baby's crib. You need to be sure that people do not come in and set their purse or diaper bag or anything else in the crib. Cribs are only for the babies to sleep and nothing else ever goes into the crib. This also prevents contamination of the crib.
 
Do not put cribs under shelves that are holding objects or near unsecured cabinets or shelves that could fall and injure the child. This is especially true in areas of California or other places that are prone to earthquakes and ground tremors or areas near train tracks where there might be a vibration that could cause objects to move towards the edge of the shelf and potentially fall off. Do not place cribs anywhere near window cords, electrical cords, baby monitor cords, or anything with strings hanging. The strings can get wrapped around the baby's neck which could cause strangulation. 
 
Evacuation cribs can be used for infants to sleep in. You should have enough evacuation cribs for the number of children that you are caring for. For example, if you have five infants in one room and five toddlers in another room, you would need two evacuation cribs in the infant room so that one could be used to put five infants in and the other for the five toddlers. This would allow you to evacuate those children very quickly in case of an emergency.
 
When you are setting up your sleep environment, always think about what if situations. What if there is a fire? What if we have a lockdown? What if there is an earthquake? Any kind of emergency situation that could occur. Can I get these infants, toddlers, and preschoolers out safely? That is what evacuation cribs are used for. Again, be sure that they meet all the CPSC standards. It is important that you place them for easy access to the doorway. Again, I do not recommend putting cribs right beside the door, but evacuation cribs should be the ones closest so they do have easy access to the doorway.

Pacifiers

Pacifiers were my lifesaver when my child was an infant. I counted one time and we had 14 pacifiers in his crib. We got a good night's sleep that way. If one fell out, he just reached over and could always find another one. Ten years later, we were still occasionally finding pacifiers behind a drawer or under a chair cushion. Some babies like them and some babies do not.
 
There is some limited research that shows that pacifiers may reduce the risk of SIDS. The sucking reflex is a very healthy reflex for babies. It may or may not reduce the risk of SIDS. If the baby does not want a pacifier, do not force it. If the baby does like the pacifier, I am all for them. I have never seen a child that had to go to college with his pacifier. They will outgrow them eventually. 
 
In the crib, you can have the pacifier loose. It does not need to be attached to the baby's clothing. If you are attaching a pacifier, it should be on a very short ribbon. You can get really good pacifier clips that will clip to the baby's clothing that have a short string that reaches the mouth easily. I once saw a pacifier clip that was on a small string of beads and then it was pinned to the baby. I thought, okay, the pin is going to stick the baby and if it breaks, those beads are a choking hazard. There are different products that are sold by craft people or in other countries that are not considered to be safe. Just remember, in the crib, the pacifier should not be attached to the child's clothing.
 
Never prop bottles or allow an infant to take a bottle to bed. If a child goes to sleep with a bottle in their mouth, the liquid can go back in their throat and they can choke on it. There is also research to indicate that it can increase the risk of ear infections. You do not want to ever let a baby take a bottle to bed even if it is only water in it.

Sleep Supervision

A caregiver who is trained in safe sleep practices should always be present and alert during nap time or whenever babies are asleep. It is not time for you to take a break or play games or talk on your phone. Your job is to take care of these infants and that is what you should be doing. You should be constantly checking on them. Even if you turn the lights down or off, the room lighting still has to allow you to walk over and see each infant. You need to be able to see their face, their skin color, and check on their breathing. Position the cribs so that you can easily see each child, access each crib, as well as pick up the babies. It has to be easy for you to check on each infant.

Sanitation

The first thing to think about regarding sanitation is that each child should have his or her own crib. You should clean and disinfect the cribs weekly or anytime they are soiled. If you have one set of children that come in the morning and a different set of children that come in the afternoon, then you must clean and disinfect the cribs between use by different children.
 
You should follow your current local, state, and federal recommendations for sanitation. That is a challenge at this time because at the time this course was created the world is in the middle of the COVID-19 pandemic. I have done a lot of training on sanitation in childcare and I used to talk about cleaning, sanitizing, and disinfecting. COVID-19 has changed everything. Now you clean and disinfect. There is no such thing as sanitation now, it is called disinfection. It seems to be changing on a regular basis. I am sure that many childcare and Head Start programs have been closed due to COVID-19. As you reopen, follow your local, state, and federal recommendations for sanitation and be aware of any changes. Until then, use the Caring For Our Children standards for health and safety. Be aware that those are not updated on a daily basis. 

Advise Parents About Safe Sleep

Finally, be sure to advise parents about safe sleep. You are doing everything you can to keep these infants safe while they are in your care in childcare. It is also your responsibility to work with parents and help them be comfortable with and know as much as they can to practice safe sleep at home. Room-sharing is advised for the first six to 12 months, but be sure parents understand that room-sharing means you can have a bassinet or crib in your bedroom. That does not mean bed-sharing. 
 
Never place an infant on a soft surface such as a couch, sofa, or armchair to sleep. Encourage parents to only bring the infant into their bed if they are feeding the baby, breastfeeding, or comforting the crying child. If there is any possibility that the parent may fall asleep, then it is important that when they are in the bed with the baby to be propped up with no pillows around or other items that could possibly cover the infant's face and neck and/or overheat the infant. Be sure that the parent's bed is also as safe as can be in case they have the child with them in bed and fall asleep. The best thing is to put the infant in their crib before you fall asleep.

Toddlers and Preschoolers Naptime

Cots and Mats

Let's move on to toddlers and preschoolers and their nap time. As with the infant, it is essential that every child have their own cot, sleeping bag, bed, mat, or a pad. These should not be shared by children. Children should not sleep on a bare, uncovered surface. Just because you have carpeting does not mean it is a good sleep area. Children need to have a mat or a cot or something else between them and the floor. If your floor is cooler than 65 degrees, such as a concrete floor, then the mats and sleeping bags should not be placed directly on that floor. They need to be on an elevated cot.
 
All the furniture and sleep surfaces must be in compliance with the current CPSC and ASTM safety standards. You can always go to the CPSC website and type in childcare cots, mats, or sleeping. There are a lot of different terms you could use if you are wanting to see what those safety standards are. Also, be aware of any recalls on cribs, cots, or beds you may have purchased.
 
Toddlers and older children may have small pillows or special sleep toys. It is important to make sure any sleep toys have everything sewn on well and are safe.  There should not be loose buttons that might come off and become choking hazards. Remember, we are just talking about toddlers and older children having small pillows to sleep with, not infants.

Placement

Placement of cots or sleeping mats may change with COVID-19 in reopening guidelines, so make sure you check on that. The Caring For Our Children guidelines state that cots or mats should be placed at least three feet apart. As you are placing them, make sure they are placed head to toe so that one child's head is at one end and the next child's feet are at the same end as the other child's head. Doing this reduces the transmission of respiratory secretions through breathing or coughing and it also reduces the interaction between children who might want to talk instead of sleep. Placing children head to toe reduces the chances of interaction and promotes settling down and relaxing for sleep.
 
Also, these three feet ensures visibility and easy access to children. You must always have clear pathways to the exits. Anytime you are setting up your childcare environment, whether it is for playtime, eating, or nap time, always be aware of emergency procedures. It is a good idea to occasionally have a fire drill or other drill during that time so that you can see how children are going to react when they are awakened and the fire alarm is going off. Will they be able to get out safely and are they going to be disoriented because they have been asleep? It is also important for the staff to recognize this. As you do emergency drills, keep in mind that nap time is also part of the entire childcare day and you should always prepare for that.
 
Just like with cribs, do not put cots or mats near windows, cords, or under shelves with items that could fall. With toddlers and preschoolers, they are going to be curious about things.
 
electrical outlet with covers
Figure 1. Electrical outlet with covers.
 
Make sure electrical outlets, both in use and unused, have secure coverings. You likely have outlet covers in all of your electrical outlets that are not being used, as seen in figure 1. The cover on the top is not correct because you can see that the hole at the bottom of the three-prong outlet is uncovered. The outlet at the bottom has all holes completely covered.  When you put these on, there is a right side up, so make sure you put them in correctly and cover all of the holes.
 
electrical outlet not in use
Figure 2. Electrical outlet not in use.
 
Figure 2 shows an outlet behind the plate that is never used, so it simply has a solid face cover on it. If children are not sleeping, they will find those little plastic outlet covers and pull them out and play with them. If you have outlets near the nap area and you are not using them, place some type of cover on it so that the children will not play with them.
 
I remember observing a Head Start classroom one day during nap time.  There was a little girl who was laying on her mat, very happily plugging and unplugging the record player that was right next to her cot. I brought it to the teacher's attention and he moved it so she could not play with it and wouldn't get hurt.
 
With all of the concern about respiratory diseases and transmission, people are coming up with a lot of different ways to provide separation. We are seeing Plexiglas in front of cash registers and between office cubicles, but in childcare that is not needed. You do not want to use folding screens or Plexiglass to separate sleeping children. If you have something placed between the cots or the cribs, you will not be able to see every child. You cannot just stand in one place and look around and see everybody. These dividers will affect your visual supervision and interfere with your immediate access to the child. They could potentially injure a child if they fall over, which can happen easily. You need to always have clear pathways to your exits. 

Storage

A lot of different types of cots and beds stack neatly on top of each other, which saves space. I have seen cots that were not stacked securely and propped against the wall. That is not a safe way to store them. You want to be sure that when the cots are not in use they are stacked, out of the way, will not tip over, and are not in the area that children are playing. There may be a corner of the room that you have the cots stored securely.
 
Each child's sheets, blankets, pillows, and any special sleep toys should be stored in the child's individual cubby. Do not throw them all into a big basket or hang them on hooks where they might touch. They need to be secured in the child's cubby. If you want to have small cloth bags that you put everything in and hang those bags that is okay but find a way that you can store these and keep them separated from other children's belongings.

Sanitation

Your mats and cots should be made with a waterproof material that can be easily washed and disinfected. If you have pads, they should be enclosed in washable covers or you can get the quilted pads with a built-in pillow that can go into the washing machine. Be sure that the sleeping pads are long enough for the child's full length. You do not want their head hanging off the end or their feet hanging off the other end. Provide clean sheets and sleep garments or blankets to maintain adequate warmth for your toddlers and preschoolers. If you have pillows, they should have removable and washable cases.
 
Your sleep items, whether the pacifier or a stuffed animal, should only be used at nap time. A child may have their favorite blankie or stuffed animal that they want to sleep with. At nap time you tell the child, "It is nap time so you can get Fred out of the closet and sleep with him, but when nap time is over Fred goes back into the cubby." It is best not to share those personal items. Also, sleep items are very special to children. They are their personal items. Children learn to share when they are in childcare and share all of the things that are in the childcare environment. But they do not have to share and we do not want them to share their special sleep item. Not only because it is their security item, but also you are reducing disease transmission.
 
Remember, state, local, and federal recommendations for cleaning may change in response to COVID-19, so cdc.gov is the best source of information that we have at this time and it is updated regularly. You should create and follow a daily checklist for cleaning and disinfecting surfaces.
 
Normal routine cleaning with soap and water is the best thing you can do, as it will decrease germs on surfaces and objects. Whether you are scrubbing something with soap and water or putting it in the washing machine, it is going to kill a lot of germs. It does not kill every germ but it is killing many. Wash and disinfect the cots and the bedding weekly and when soiled or between uses if it is used by different children.
 
Launder items according to the manufacturer's instructions. Use the warmest appropriate water and dry the items completely. You do not need to have the laundry detergents that have lasting fragrances that will stay there for a month. When you go into the baby department and look at different items, there is a reason that they have laundry detergents that are free of any fragrances and gentle for baby skin. No fragrance is a good thing. It is the same with toddlers and preschoolers. If you are washing things, you do not need fragrance because some children may have asthma or other respiratory illnesses or allergies and those fragrances can cause some problems that we do not need.
 
Most of your common Environmental Protection Agency (EPA) registered household disinfectants are effective for disinfecting. The bottles say they kill 99.9% of germs. There is always one little germ that can possibly get through, but most of your EPA registered disinfectants are effective.
 
Alternative disinfectants can be used. One alternative disinfectant is bleach. Bleach has had an interesting history in child care because in teaching about sanitation, I used to always talk about the bleach solution and how easy it is to use. In the last 10 to 15 years, people have moved away from using bleach and chose to use what is known as green sanitation. There are different products coming out.
 
As we are dealing with COVID-19 at the time this course was created, we are hearing a lot more about bleach. Bleach is an excellent disinfectant. The proper ratio is one-third cup of bleach added to one gallon of cool water. Notice it is cool water, not warm water or hot water. It is important to note that you have to mix the bleach solution daily. It breaks down after about eight to 10 hours. If you have it sitting in sunlight, it breaks down faster. If you are using a bleach solution, you should put it into a spray bottle that is labeled clearly with what it is and the ratio of bleach to water.  It should be stored out of children's reach. 
 
I am not recommending what you should use, I am simply providing options that will kill germs. Another disinfectant you can use is isopropyl alcohol, or rubbing alcohol. My bottle says it is 91% alcohol, but most of them will be 70%. It is interesting that the 70% alcohol is actually more effective at quickly killing germs than the 91% alcohol. When isopropyl alcohol is at the manufacturers and bottled, they mix it with a particular type of purified water. You cannot just add water to dilute it. Do not try to make your own solution. Try and find something that has been appropriately calibrated for actually killing germs. The difference between the 70% and the 91% is that the 70% alcohol will kill germs in about 10 seconds. If you use the 90%, the germs recognize it as something that is going to hurt them, so it forms a protective coating to protect the germs. While it will kill germs, it takes longer. You can just pour the alcohol into a spray bottle and spray it.
 
There are pros and cons of using different disinfectants. Bleach is very inexpensive and easily accessible. You have to mix it every day, so it is a good disinfectant. A disadvantage of using bleach is that the smell of the bleach may be an irritant to some children or adults and their respiratory system. Bleach takes anywhere from 10 minutes to up to an hour to kill germs, so you have to spray the object until it is wet and then let it work.
 
An advantage of using isopropyl alcohol is that 70% alcohol will kill germs in about 10 seconds, so it is very quick. You do not have to mix it with anything. You can put it in a bottle to use at any time. A disadvantage to using isopropyl alcohol is it is flammable. If you use that alcohol to disinfect continually throughout the day, it can cause some damage to rubber and certain plastics.
 
I am located in Kentucky and some of our local distilleries have gone from making moonshine to sanitizer. I have a bottle that says it is an alcohol antiseptic, 80% topical solution. This is ethyl alcohol and It is a hospital-grade sanitizer. You cannot drink it even though it is being processed by a distillery. It is a disinfectant just like isopropyl or rubbing alcohol. As with the isopropyl alcohol, you can put it in a spray bottle and it will kill the germs just like the isopropyl alcohol does. It is another solution to your disinfecting process.
 
Remember, never combine any cleaning or disinfectant products. When bleach is mixed with different products, especially ammonia, it causes toxic fumes. Also, make sure to keep all of your cleaning and disinfecting products out of children's sight and out of reach.

Relax

After all of that, you have to relax. Remember, nap time is when children are getting to relax and de-stress. That is what you want to help them do. As you are putting the babies down in their cribs or getting the toddlers ready for nap time, have some transition for them. Play some soft music, dim the lights a little, and read a story. It is helpful to have a routine for nap time to help the children relax and de-stress. The most important thing for children to know is that it is okay for them to sleep now because you are watching over them. As you help them to relax and to feel safe and secure, take a moment to sit back and say, I am doing a good job and the children are safe and life is good.

Questions and Answers

If a facility just has mats, is it okay to just use a mat instead of a cot if they do have a hard or concrete floor as long as the temperature is warmer?
 
It is not recommended, but there is no restriction on that. I looked it up in Caring For Our Children and some other resources to see what is the best thing for nap time. The only restriction was that if the floor is cold, you cannot put the mat directly on it. However, it is much better if they are elevated on a cot. It is safer, there is less chance of spreading a disease, and you are not putting the mat right where all of the children's shoes have been. 
 
Do you have any suggestions for if the teacher or children have reactions or allergies to bleach solution or any kind of sanitizers or cleaning agents?
 
You should know the children who are enrolled in your program and do a thorough enrollment process of asking if the child has any allergies, asthma, or prior problems that should be noted. If you know that you have a child who has any type of respiratory problem or an allergy to things like that, then you would want to avoid the bleach. Alcohol as a disinfectant does not have strong fumes and may be less likely to cause irritation, but you should check with the parents and if a child does have reactions then also check with that child's doctor. When choosing cleaning supplies, do not use any with fragrances. A cleaning supply that is full of perfumes could trigger irritation not only in children but also in adults.
 
You should be constantly watching children while they are napping, checking their skin color, checking their breathing, and looking for anything abnormal. f you notice that a child does not seem to be doing as well as he should be, for example coughing, sneezing, or his nose sounds stuffy, then there might be a reaction to the cleaning and disinfecting products that you are using. In that case, the best thing is going to be to ventilate the room and remove the irritant as much as possible. Think about what you might have been using that could be irritating this child. A visitor may have come in and their clothing smells like smoke. That can cause irritation or it could be that they are doing disinfecting in the hallway. When you are disinfecting, do not use aerosol sprays like Lysol that comes in a spray can. It can be an irritant and it can cause a lot of problems with breathing and the respiratory systems and can cause negative reactions. That is why it is better to use a pump spray bottle when you are disinfecting. You can aim the trigger where you want the disinfectant to go and it will not be airborne as much.

References

Healthychildren.org. Sleep resources. Available at https://www.healthychildren.org/English/ages-stages/baby/sleep/Pages/default.aspx
 
American Academy of Pediatrics, American Public Health Association, National Resource Center for Health and Safety in Child Care and Early Education. CFOC Standards Online Database. Aurora, CO; National Resource Center for Health and Safety in Child Care and Early Education; 2020. Available at https://nrckids.org/CFOC/Database/3.1.4.4
 
Head Start/ECLKC. Sleep resources. Available at https://eclkc.ohs.acf.hhs.gov/browse/keyword/sleep
 
CDC.gov. COVID-19 reopening guidance for cleaning and disinfecting. Available at https://www.cdc.gov/coronavirus/2019-ncov/community/reopen-guidance.html 
 
EPA.gov. 6 steps for safe & effective disinfectant use. Available at https://www.epa.gov/sites/production/files/2020-04/documents/disinfectants-onepager.pdf
 

Citation

Hendricks, C. (2020). Safe and healthy sleep for infants and young children, in partnership with Region 9 Head Start Association. continued.com - Early Childhood Education, Article 23701. Available at www.continued.com/early-childhood-education


charlotte hendricks

Charlotte Hendricks, PhD

Dr. Charlotte Hendricks has promoted health education for young children, families, and teachers for over 30 years and pioneered curriculum development and evaluation for preschool health education. Nationally recognized as a leader in her field, her career has spanned public health, higher education, Head Start, and research. She often presents to early childhood programs and at state and national conferences, delivering high energy presentations to illustrate practical and cost-effective approaches to best practice, national standards, and issues facing today’s early childhood staff and families.

Charlotte served as Editor for Healthy CHILDCare magazine for 16 years and has published extensively, including HIP on Health®: Health Information for Caregivers and Families and Growing, Growing Strong: A Whole Health Curriculum for Young Children. Her latest book, Redleaf Quick Guide to Disaster Planning and Preparedness in Early Childhood and Schoolage Care Settings, exemplifies her ability to present essential information in an easy-to-follow format.



Related Courses

Safe and Healthy Sleep for Infants and Young Children, in partnership with Region 9 Head Start Association
Presented by Charlotte Hendricks, PhD
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