Policies,Clinical,UWHC Clinical,Department Specific,Nursing Patient Care,Basic Nursing Procedures

AFCH Safe Sleep for Inpatients (13.25)

AFCH Safe Sleep for Inpatients (13.25) - Policies, Clinical, UWHC Clinical, Department Specific, Nursing Patient Care, Basic Nursing Procedures



Effective Date:
February 19,

Administrative Manual
Nursing Manual (Red)
Other _______________

Policy #: 13.25P


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Title: Safe Sleep for Inpatient Infants


A. To implement the American Academy of Pediatrics (AAP) recommendations
regarding safe sleep practices to reduce the risk of Sudden Infant Death Syndrome
(SIDS) and other sleep-related causes of infant deaths.
B. To promote parental understanding of safe sleep practices through education and
role modeling.
C. To decrease the injury potential for hospitalized infants up to 1 year of age.


SIDS is the sudden death of an infant younger than one year of age that remains
unexplained after a complete investigation. There has been a significant decrease in
the number of infants who have died from SIDS as a result of healthcare provider and
public health campaigns educating parents and caregivers regarding the risk factors
related to SIDS. There are several sleep environment factors that have been identified
that place an infant at an increased risk of SIDS, including:
* prone sleeping
* head of bed elevated
* sleep surfaces that are soft (loose, fluffy bedding)
* overheating during sleep
* maternal smoking (during pregnancy or in the infant’s environment),
* bed sharing.

As role models, healthcare professionals are critical in communicating and
demonstrating SIDS risk reduction strategies to parents and families by promoting
safe sleep practices while infants are hospitalized.


A. The AAP’s recommendations for sleep positioning of infants will be the standard
of care. Infants will sleep on their back with the head of bed flat unless there is a
provider’s order for an alternate position.
B. Infants for whom a supine position is not preferred require a provider’s order
together with a documented explanation. These infants will also require a
cardiorespiratory monitor while asleep and not supine.

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C. If an infant is found in a chair, bed or cot with a sleeping parent, the infant will be
placed in the crib by the nurse or parent. The parent or caregiver should be re-
educated on safe sleep practices as soon as it is practical.
D. Once the infant can roll from supine to prone and from prone to supine, the infant
will be allowed to remain in the sleep position assumed.


Caregivers of hospitalized infants will be screened for safe sleep practices on
admission. If there is concern regarding their ability to provide a safe sleep
environment after discharge, appropriate education and, if necessary, referral to the
Kohl Safety Center will take place.

A. Infants will be placed in a crib, in a supine position for every sleep. The head of
bed is not to be elevated
B. A firm crib mattress covered by a fitted sheet will be used for a sleeping surface.
Car safety seats, strollers, and positioning devices will not be used for sleep
C. Infants should not share a bed, crib, couch, or chair with a parent or guardian
during sleep.
D. Soft objects and loose bedding should not be in the crib.
E. Family members/visitors will be encouraged to minimize secondhand smoke
exposure to the infant.
F. Breastfeeding will be encouraged and supported.
G. A pacifier may be offered at naptime and bedtime by three to four weeks of age.
Pacifiers will not be artificially secured to an infant or item in the infant’s bed.
H. Infants will be dressed in no more than 1 layer more than an adult to be
comfortable in the environment in order to avoid overheating during sleep.
Exceptions to supine sleep position include the following:
1. Infants for whom the risk of death from complications of
gastroesophageal reflux is greater than the risk of SIDS (i.e., those with
upper airway disorders, for whom airway protective mechanisms are
impaired), including infants with anatomic abnormalities such as type
3/4 laryngeal clefts who have not undergone antireflux surgery, or with
infants for whom the supine position is contraindicated such as neural
tube defects or Pierre-Robin sequence.
2. Elevating the head of the crib while the infant is supine is not
recommended as it does not reduce gastroesophageal reflux and might
result in the infant sliding to the foot of the crib into a position that
might compromise respiration.
3. The head of the bed may be elevated for infants who are post-operative
status post cleft repair in order to reduce swelling.
4. Any symptomatic preterm infant with signs of respiratory distress
(increased work of breathing, apnea, or tachycardia) or any
asymptomatic, very low birth weight preterm infant (less than 1250
grams) for whom prone positioning provides a respiratory and
developmental advantage. Preterm infants are at increased risk of SIDS

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so they should be placed in the supine position for sleep as soon as they
are medically stable. They should sleep in the supine position by 32
weeks’ gestational age to allow them to become accustomed to sleeping
in that position before hospital discharge.
5. Infants with known or suspected airway obstruction.
6. Infants on assisted ventilation who benefit from prone positioning.
7. Infants with birth defects for whom the supine position would be
contraindicated (such as neural tube defects or Pierre Robin sequence).
8. Other infants as deemed necessary by the treating provider.
I. During the hospital stay, parents/guardians of all infants will be educated about
safe sleep practices in the following ways:
1. Watch the National Institute of Child Health & Human Development
(NICHD) “Safe Sleep for Your Baby Video: Reduce the Risk of Sudden
Infant Death Syndrome (SIDS) and Other Sleep-Related Causes of
Infant Death”.
2. Provided the NICHD “Safe Sleep for Your Baby: Reduce the Risk of
Sudden Infant Death Syndrome (SIDS) and Other Sleep-Related Causes
of Infant Death” brochure and flyer to parents prior to discharge.
3. If there is concern that caregivers are not utilizing safe sleep practices,
nurses will provide additional one-on-one education and modeling of
behaviors, for example with the Safe Sleep Flipchart (available at
http://cribsforkids.org/hospital-initiative-tools/). Nurses may also
request a consultation from the Kohl Safety Center for further one-on-
one education by placing an order via the clinical health record.
4. Documentation of education will be provided in the patient’s clinical
record using the Safe Sleep education template, which is applied for all
patients who meet the age criterion.


Nursing Patient Care Policy 13.16, Basic Care – Inpatient Pediatrics
(Birth-18 years of age)


A. Hitchcock, S. (2012). Endorsing safe infant sleep: a call to action. Nursing for
Women’s Health, 15(5), 387-396.
B. Moon, R. & Hauck, F. (2015). Hazardous bedding in infants’ sleep environment
is still common and a cause for concern. Pediatrics. 135(1): 178-9.
C. Task Force on Sudden Infant Death Syndrome, Moon, RY (2011). SIDS and other
sleep-related infant deaths: expansion of recommendations for a safe infant
sleeping environment. Policy Statement. Pediatrics, 128(5), e1341-1367.
D. Task Force on Sudden Infant Death Syndrome, Moon, RY (2011). SIDS and other
sleep-related infant deaths: expansion of recommendations for a safe infant
sleeping environment. Technical Report. Pediatrics, 128(5), e1-e27.

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Clinical Nurse Specialist, Universal Care Unit
Clinical Nurse Specialist, NICU
Director, Child Health Advocacy
Pediatric Sleep Physician, Wisconsin Sleep Center
AFCH Practice Council February 2016
Nursing Patient Care Policy and Procedure Committee, February 2016


Beth Houlahan, DNP, RN, CENP
Senior Vice President Patient Care Services, Chief Nursing Officer