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ITS-SIDS Project

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ITS-SIDS Project
Infant/Toddler Safe Sleep & SIDS Risk Reduction in Child Care Line Image

Background Information

The NC SIDS Law 2003-407 (House Bill 152), which went into effect December 1, 2003, aims to lower the risks of Sudden Infant Death Syndrome (SIDS) in child care. The NC SIDS Law requires that:

  • infants be placed on their backs to sleep.
  • a completed waiver be on file for an alternate sleep position.
  • child care centers and family child care homes caring for infants 12 months of age or younger develop and maintain a safe sleep policy.
  • parents receive a copy of the child care center or family child care home’s safe sleep policy before the infant’s enrollment.
  • that parents sign a statement confirming they received a copy of the policy and that the facility reviewed the policy with them.
  • all child care providers caring for infants 12 months of age or younger receive training on safe sleep practices within four months of assuming caregiving responsibilities and every three years from the completion of previous ITS-SIDS training.

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ITS-SIDS for Child Care Providers

Law and Rules

NC SIDS Law – General Statute 110-91(15)

Child Care Center Licensing Rule .0606

Family Child Care Home Licensing Rule.1724

Safe Sleep Policies and Sleep Charts

Safe Sleep Policy Sample (Revised) This sample safe sleep policy is a template that shows child care facilities both the required practices and optional practices they can include in their policy. It also provides a way to organize a safe sleep policy. This template is a sample policy. It should be changed to include the specifics of the facility’s safe sleep policy. At minimum policies should reflect what is required in NC Child Care Rules .0606 or .1724. It should also reflect what will be carried out in the facility. It should be reviewed at least annually, and can be changed or revised as needed. Families and staff must receive notice of any changes to the policy at least 2 weeks before the changes go into effective Click here for Spanish.

Sleep Chart Samples – Any of these sample sleep charts can be used to keep a daily record of how sleeping babies are visually checked.

Sample 1

Sample 2

Sample 3

Sample 4


An Alternative Sleep Position Waiver is required for an infant to be put to sleep in any position other than the back to sleep position.

Alternative Sleep Position – Health Care Professional Recommendation: If an infant has a medical condition that requires an alternate sleep position, the child’s health care professional must complete the Alternative Sleep Position Waiver - Health Care Professional Recommendation. This waiver is also referred to as the medical waiver. The medical waiver is the only waiver that can be used for infants 6 months of age or younger. It may also be used for infants up to 12 months of age. Click here for Spanish version.

Alternative Sleep Position Waiver – Parent Request: A parent or legal guardian may request an alternate sleep position for infants older than 6 months of age and up to 12 months of age. In this situation they must complete the Alternative Sleep Position Waiver - Parent Request. Child care facilities are not required to accept parent request waivers. Their position on parent request waivers should be reflected in their Safe Sleep Policy. Click here for Spanish version.

Follow these guidelines when using a medical waiver:

  • Give the parent/legal guardian the official DCDEE form. The child’s health care professional and parent/legal guardian complete a medical waiver. A parent/guardian completes the parent request waiver. Tell the parents to return the completed waiver.
  • Check the medical waiver for inclusion of the medical condition, recommended sleep position, dates the waiver is in effect, health care professional’s contact information and signature and parent/guardian’s signature. Check the parent request waiver for requested sleep position and the check in the box requesting an alternate sleep position, dates the waiver is in effect, and parent/guardian’s signature.
  • Keep a copy of the waiver in the child's file for the duration of care.
  • Post a notice next to the infant's crib that states an alternative sleep position waiver is in effect and where the original waiver is located.

ITS-SIDS In-service Training Requirements

All adults who provide care for infants 12 months or younger are required to be trained in Sudden Infant Death Syndrome (SIDS) risk reduction. The Infant/Toddler Safe Sleep and SIDS Risk Reduction in Child Care (ITS-SIDS) is the approved training. It prepares child care providers to follow their facility’s safe sleep policy.

In child care centers licensed to care for infants 12 months and younger, the center director, owner or operator, and all child care providers scheduled to work in the infant room, including volunteers counted in staff/child ratios, must:
  • Complete the ITS-SIDS training within 4 months of assuming responsibilities in the infant room, or within 4 months of as assuming responsibility as a director, owner or operator.
  • Complete the ITS-SIDS training again, no more than 3 years from their previous ITS-SIDS training.

Family child care home operators licensed to care for infants 12 months and younger must:
  • Complete the ITS-SIDS training within 4 months of receiving their family child care home license.
  • Complete the ITS-SIDS training again, no more than 3 years from the completion of previous ITS-SIDS training.

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Information for Current and Prospective ITS-SIDS Trainers

Current ITS-SIDS Trainers

For technical assistance regarding the Infant Toddler Safe Sleep and SIDS Risk Reduction in Child Care 5th, edition (Nov. 2005), contact the North

Current ITS-SIDS Trainer List

Prospective ITS-SIDS Trainers

The NC Child Care Health and Safety Resource Center is offering the ITS-SIDS Online Training Course as a distance learning web-based train-the-trainer course. In selecting participants, priority is given to child care health consultants (CCHCs) and regional infant toddler specialists. If a county has a need for additional trainers, applicants must either meet the eligibility criteria or be approved by the NC Division of Child Development and Early Education (DCDEE) to become an ITS-SIDS trainer. The expectation for all ITS-SIDS trainers is that they take what they learn and the materials provided to them and offer ITS-SIDS training to child care providers in their counties and communities. Request for Approval and Application.

SIDS Risk Reduction Online Resources

  • The North Carolina Healthy Start Foundation works to reduce infant death and illness and to promote the health of young children

  • The National Institute of Child Health and Human Development (NICHD) provides information about the National Back to Sleep Campaign (BTS). The Back to Sleep Campaign sponsored by the National Institutes of Health and Human Services and was established to increase awareness about SIDS and ways to reduce the risk.

  • The First Candle/SIDS Alliance is a national organization with state affiliates that provides grief and bereavement support to families that have lost a child to SIDS or from another cause of death, and promotes education and advocacy around SIDS risk reduction.

  • NC.GOV NC Race to The Top Early Learning Challenge

    2201 Mail Service Center | Raleigh, NC 27699-2200
    919-527-6335 | 1-800-859-0829 (In State Only)

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