Infant Sleep and Infant Equipment 620-01-95-05

(Revised 9/9/25 Manual Letter #3941)

View Archives

Back Sleeping

Providers and staff members shall always initially place infants completely flat on their backs for sleep. Once an infant can roll from back to front and front to back, the infant can be allowed to remain in the sleep position the infant chooses. The infant does not have to be returned to a back sleeping position.
An infant may not sleep in any equipment or place other than an approved crib or portable crib, or in any other position other than completely flat on their back, unless the parent has supplied the provider with a written order from a medical provider instructing otherwise stating the medical reason and the time frame to follow the order. Written parental permission to follow the order is recommended to be obtained.
Children may not be confined to car seats, swings, bouncy chairs, inclined sleepers (example: Rock ‘n Play), or other equipment for extended periods of time. It is recommended that infants spend no more than 15 minutes at a time, twice a day, confined to infant equipment. Research indicates that when an infant is not allowed adequate time to crawl, stretch, roll, or move freely, the infant’s brain development and motor skills may be delayed.
- Safety straps provided by the manufacturer must always be used and adjusted properly to fit the infant when the infant is placed in equipment.
- Children are recommended to be within sight at all times when using restrictive equipment.
- If an infant falls asleep in a piece of restrictive equipment, the infant must be moved immediately to a crib or portable crib for sleep.
Positioning devices (example: wedges) are not allowed unless a written order from a health care provider is provided with a medical reason and a time frame to follow the order. It is recommended to obtain written parental permission to follow the order.

Cribs and Portable Cribs

All cribs must be approved by the Consumer Product Safety Commission (CPSC).
- All cribs are required to have a date of manufacture on the crib, usually under the mattress.
- If the crib was manufactured before June 28, 2011 the crib may not be in compliance and the provider must show proof of compliance with Title 16 of the Code of Federal Regulations (CFR), Parts 1219 or 1220. Proof of compliance must come from the manufacturer of the crib.
- Cribs manufactured after June 28, 2011 meet compliance standards.
- Programs should check all cribs/portable cribs used in the program to see if the crib or portable crib has been recalled on the CPSC website (www.cpsc.gov).
- Recalled cribs and portable cribs cannot be used.
Portable cribs are defined as a playpen, play yard or pack and play type of equipment approved by the manufacturer for infant sleep, following the manufacturer’s guidelines.
Cribs and portable cribs must be used according to the manufacturer’s guidelines and should not be used if the child is able to climb out.
Bassinets are not allowable, except for child care facilities that have been utilizing bassinets in infant rooms for non-mobile (not yet rolling) infants prior to December 1, 2014; those designated programs may continue to utilize them in accordance with the manufacturer’s guidelines. Bassinet inserts for portable cribs are not allowed.
For information regarding mattresses and pads and sheets visit Child Care Aware of North Dakota (CCA).

Alternate Sleep Surfaces

For more information on alternate sleep surfaces visit Child Care Aware of North Dakota.

Visual Checks

Infants that are sleeping are required to be visually checked regularly (every 10-15 minutes) even if a staff member is in the same room.
It is required to have a monitor in the room with sleeping infants unless a staff member is in the room with the infants at all times while the infants are sleeping. The monitor can be a video or sound monitor. Video monitors cannot replace regular visual checks.
Visual checks require the staff person to physically walk over to the crib or portable crib to closely view the infant.
Visual checks consist of the following: re-adjust clothing and blanket if needed; make sure infant’s head and face are uncovered; make sure infant is breathing; and check color of infant’s skin to make sure it is normal for the infant.
The lighting in the room must be bright enough to assess the infant’s color of skin and breathing.
Music and sound machines must be placed at a low volume to ensure infant’s noises can be heard.
Vital sign monitors are not allowed unless a written order from a health care provider is provided with a medical reason and a time frame to follow the order. It is recommended to obtain written parental permission to follow the order.
All monitors and music and sound machines, along with their cords, must be kept out of the reach of children.

Spacing

The provider shall ensure that there is a minimum of two feet of space between cribs or portable cribs to minimize the transmission of illness, prevent children from touching each other and ensure staff have easy access to each infant in an emergency.
In infant rooms with infants who are not able to pull themselves up to standing, the cribs or portable cribs may be lined up end-to-end with a solid barrier between the ends, and a 2 feet space between aisles.
In infant rooms where the infants are able to pull themselves up to standing, there must be a two feet aisle all around the crib or portable crib, with the exception of those against walls.
Cribs and portable cribs can be against walls, as long as there is 2 feet between cribs or portable cribs and between aisles.
Crib and portable crib must be placed in a safe location. It must be away from heaters, monitor cords, blind cords, bi-fold doors, top of stairs, etc. Picture frames and wall hangings or shelves should not be hung above a crib or portable crib.

The Early Childhood Licensing Staff will follow Child Care Aware safe sleep recommendations and CCA’s Infant Sleep Permission form. More information on safe sleep can be found by visiting Child Care Aware of North Dakota.