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ITS-SIDS Project

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.
  • 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.

Safe Sleep Policies and Sleep Charts 

This sample safe sleep policy is a template that shows child care facilities the required and optional practices they can include in their policy. It also provides a way to organize a safe sleep policy. This template should be changed to include the specifics of the facility’s safe sleep policy. At a minimum, policies should reflect what is required in NC Child Care Rules .0606 or .1724. Policies should also reflect additional practices that will be carried out in the facility. It is recommended that the policy be reviewed annually with staff to ensure consistent practice. Policies can be changed or revised as needed, but families and staff must receive notice of any changes to the policy at least 14 days before the changes go into effect.

A sample sleep chart that can be used to document a daily record of how sleeping babies are visually checked is provided in the link below.



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. Those waivers are as follows:

Infant Sleep Position Waiver – 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 Infant Sleep Position Waiver – Health Care Professional. 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.  

Infant Sleep Position Waiver – Parent Request

A parent or legal guardian may request an alternate sleep position for infants older than 6 months of age. The parent/guardian must complete the Infant Sleep Position Waiver - Parent. Child care facilities are not required to accept parent request waivers. Their position on parent request waivers should be reflected in the facility’s Safe Sleep Policy. 

Facilities should follow these guidelines when using a waiver: 

  • Give the parent/legal guardian the appropriate waiver. For medical situations provide the Infant Sleep Position Waiver – Health Care Professional Waiver. If the facility accepts parent waivers for children over 6 months of age they may provide the  parents with the Infant Sleep Position Waiver - Parent Waiver. 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 the infant’s name and birthdate, the signature and date of the infant’s health care professional, and the infant’s authorized sleep positions. If a wedge is needed, specifications must be included about why it is needed and how it is to be used.
  • Notice A notice shall be posted by the infant’s crib indicating the use of a waiver. No confidential medical information, including an infant’s medical diagnosis, shall be shown on the notice. The recommended sleep position and dates the waiver is in effect should be included and the location of the signed waiver. 
  • Check the parent request waiver If parent waivers are accepted for children over 6 months they should include the requested sleep position and the dates the waiver is in effect.
  • Keep a copy of waiver in the child's file for the duration of care.

ITS-SIDS On-Going 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 practices. 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. 

Child care centers licensed to care for infants 12 months and younger shall require child care administrators and all staff scheduled to work with infants, including volunteers counted in staff/child ratios, meet the following training requirements:

  • Complete the ITS-SIDS training within 2 months of assuming responsibilities in the infant room, or within 90 days of assuming responsibility as a child care administrator.
  • 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 12 months prior to applying for a family child care home license.
  • Complete the ITS-SIDS training again no more than 3 years from the completion of previous ITS-SIDS training.


In-Person Training

To find an Infant/Toddler Safe Sleep – SIDS (ITS-SIDS) training, contact an ITS-SIDS trainer in your community.


Information for Current and Prospective ITS-SIDS Trainers 

For technical assistance and on-going support regarding SIDS and infant safe sleep contact the North Carolina Child Care Health and Safety Resource Center or 1-800-367-2229.

Prospective ITS-SIDS Trainers 

The NC Child Care Health and Safety Resource Center offers the ITS-SIDS Online Train-the-Trainer Course several times each year. There is no charge for the course. Those interested and who meet the eligibility criteria should complete the online application to take the course.

All ITS-SIDS trainers are required to offer ITS-SIDS training to child care providers in their communities. 


IDS Risk Reduction Online Resources

The National Institute of Child Health and Human Development (NICHD) provides information about the National Back to Sleep Campaign (BTS) and safe sleep practices. 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 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.

American Academy of Pediatrics is the leading American professional association of pediatricians. The Academy publishes current research and policy statements ranging from advocacy issues to practice recommendations on all topics related to child health, including infant safe sleep.




2201 Mail Service Center | Raleigh, NC 27699-2200
919-814-6300 | 1-800-859-0829 (In State Only)

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