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Child Care Licensing
Use of restrictive equipment

When infants are placed in beds—furniture manufactured and sold in the United States as infant sleep equipment—they should be placed on their backs to sleep. Studies show that infants sleeping in a semi-seated position, such as in a car seat, swing, or bouncy seat, for example, can have their blood oxygen level drop to such a low level that brain cell damage occurs.

Positional asphyxia is a type of suffocation that occurs when the body is put in a position that restricts airflow. In infants, positional asphyxia can occur when they are placed in a semi-seated position. Positional asphyxia can occur due to the prominence of the occiput (back of the head), as well as the overall lack of neck muscle strength, which forces the head to slouch forward pushing the infant’s chin down against the chest. This body position causes the windpipe to narrow or close.

Imagine a drinking straw and then bend that straw over. This is the picture child care providers need to have in order to understand what could occur to an infant’s windpipe when the head flops over in restrictive infant equipment while sleeping.

The invention of the infant car seat carrier changed the care methods for infants in the United States. Parents and caregivers have adapted this vehicle passenger restraint device into restrictive devices for feeding, sleeping, and play and as an infant holding device. In addition, manufacturers have created and adapted other equipment such as restaurant high chairs, shopping carts, stroller bases, and similar travel systems to accommodate and further propagate the use of infant car seats for purposes other than protecting the infant during a motor vehicle crash.

Infant car seats are passenger restraint devices designed and intended to absorb and distribute crash impact forces over the infant’s body while keeping the infant secure in the vehicle during a motor vehicle crash. Passenger restraint devices are essential protection for infants traveling in motor vehicles. Reviews of infant deaths in passenger restraint devices, however, show that the majority of infant deaths in car seats are not occurring when the infant is being transported in a vehicle, but rather when the infant is being cared for indoors.

The bottom line is that restrictive infant equipment may not be used as sleep equipment in regulated child care. Parents and child care providers should transfer infants who fall asleep in one of these devices to a crib, except when the infant is being transported in a vehicle. Infants can suffer serious harm from sleeping in equipment not designed for sleeping. Direct supervision is always required for infants using restrictive infant equipment while awake.

Important reminder: Any child placed in a swing, bouncy seat, high chair, and similar devices must follow the manufacturer’s instructions for using safety straps correctly to ensure the child’s safety.

§746.2407 Must the equipment I use for infants be equipped with safety straps?
Subchapter H, Basic Care Requirements for Infants, September 2003

Medium-High If you use high chairs, swings, strollers, infant carriers, rockers and bouncer seats, or similar types of equipment, they must be equipped with safety straps that must be fastened whenever a child is using the equipment.


Licensing Website tip
Did you know you can access the entire Technical Assistance (TA) Library from our public website? It is filled with information that can assist you with running your center and provide valuable information for families and helpful information for your staff.

Recently the TA library was updated to include many documents in English, Spanish, and Vietnamese. Many of the additions can assist with family communication, inclusive care, and safe sleep.