Directive for Alternative Infant Sleep Position

This form is the approved format to direct an alternative sleep position and must remain on file at the licensed location.

The American Academy of Pediatrics (AAP)* and the National Institute of Child Health and Human Development (NICHD) recommend back sleeping for babies to reduce the risk of sudden unexpected infant deaths (SUID) due to sudden infant death syndrome, suffocation, and other sleep related causes. The AAP further states that an alternative sleep position be considered only for the rare exception of infants for whom the risk of death when sleeping on the back is greater than the risk of SUID when sleeping on the stomach.

Sleeping babies are safest on their backs.

Minnesota law requires that licensed providers place infants to sleep in a crib, directly on a firm mattress. The provider must place the infant on his/her back for sleep unless the provider has a signed directive from a physician, an advanced practice registered nurse (APRN), or a physician assistant (PA) for an alternate sleep position for the infant. Car seats, swings, couches, the floor on a blanket, etc. are not acceptable as an alternative sleep position.

In addition, Minnesota law requires licensed providers to use a fitted crib sheet that fits tightly on the mattress and overlaps the underside of the mattress so it cannot be dislodged by pulling on the corner of the sheet with reasonable effort. Nothing may be placed in the crib with the infant except the infant’s pacifier, with nothing attached to the pacifier. These requirements apply to license holders serving infants up to one year of age. Licensed providers may only use cribs that meet requirements specified in statute and must inspect cribs monthly to assure they are safe.

*American Academy of Pediatrics, American Public Health Association, National Resource Center for Health and Safety in Child Care and Early Education. Caring for Our Children: National Health and Safety Performance Standards; Guidelines for Early Care and Education Programs. 4th ed. Itasca, IL: American Academy of Pediatrics; 2019

I understand that back sleeping is recommended and is safest for babies. I am directing an alternative position for this infant for the medical reason(s) stated below. By signing this form, I acknowledge that I am directing only an alternative sleep position and that the infant must always be placed in an approved crib to sleep.

(Licensed providers must place an infant in a crib to sleep. Anything other than an approved crib is not acceptable as an alternative sleep position

One of the easiest ways to lower a baby’s risk of Sudden Unexpected Infant Death (SUID) due to sudden infant death syndrome (SIDS), suffocation, and other sleep related causes is to put the baby on the back to sleep for naps and at night. Health care providers used to think that babies should sleep on their stomachs, but research now shows that babies are less likely to die of SUID when they sleep on their backs. Since the recommendation to place a baby on their back for sleep began, the SIDS rate in the United States has dropped by more than 50 percent. Placing babies on their back to sleep is the best way to reduce the risk of SUID.

The Safe Sleep for Your Baby resource provides the following recommendations:

1.Always place a baby on their back to sleep, for naps and at night. The back sleep position is the safest position for all babies and every sleep time counts. 2.A baby should sleep in a safety-approved crib on a firm mattress covered by a fitted sheet appropriate to the mattress size. 3.Keep soft objects, toys, loose bedding, pillows, blankets, quilts, sheepskins and crib bumpers out of the baby’s sleep area. The only item that should be placed in the crib with the baby is a pacifier. If a pacifier is labeled, the label must be in good condition and securely adhered to the pacifier and nothing attached to the pacifier. Please note: In licensed programs, the only item allowed in a crib with an infant is a pacifier with nothing attached to the pacifier.

• regarding the AAP and NICHD recommendations for sleeping babies safely, Minnesota’s requirements for licensed providers, and recommendations from Safe Sleep for Your Baby. The Safe Sleep for Your Baby Brochure may be viewed at: https://www.nichd.nih.gov/sites/default/files/2023-01/STS_2022_Brochure_English.pdf

As the parent providing this signed form I acknowledge that I have read the above information

• As the parent providing this signed form, I acknowledge that I am aware that placing a baby on her/ his back for sleep has been recommended by health experts to be the safest way to place a baby for sleep.
• As the parent providing this signed form, I acknowledge that I am aware that since the recommendation to place babies on their back for sleep began, the SIDS rate in the United States has dropped by more than 50 percent.
• As the parent providing this signed form, I acknowledge that I am aware that placing a baby onthe stomach or side, increases the baby’s risk for dying from Sudden Unexpected Infant Death (SUID
• As the parent providing this signed form, I acknowledge that I am aware that Minnesota Statutes, section 245A.1435, requires licensed providers to position an infant on the back for sleep unless the provider has a signed directive from a physician, APRN, or physician assistant for an alternate sleep position.

Note: The second and third pages of the Alternative Infant Sleep Position form must be signed by the appropriate people and remain on file. 1/20243