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<div class=3DSection1>

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rder-alt:
  solid windowtext .5pt;padding:0in 5.4pt 0in 5.4pt'>
  <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'><span
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Arial'><!--[if gte vml 1]><v:shapetype
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width:48.75pt;
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  </v:shape><![endif]--><![if !vml]><img width=3D65 height=3D65
  src=3D"CD117_files/image002.jpg" v:shapes=3D"_x0000_i1025"><![endif]></sp=
an></p>
  </td>
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ext 1.0pt;
  border-left:none;mso-border-left-alt:solid windowtext .5pt;mso-border-alt:
  solid windowtext .5pt;padding:0in 5.4pt 0in 5.4pt'>
  <p class=3DMsoNormal>MISSOURI DEPARTMENT OF SOCIAL SERVICES</p>
  <p class=3DMsoNormal>CHILDREN&#8217;S DIVISION</p>
  <p class=3DMsoNormal>SAFE SLEEP PRACTICES RECOMMENDED BY THE <st1:place w=
:st=3D"on"><st1:PlaceName
   w:st=3D"on">AMERICAN</st1:PlaceName><span style=3D'mso-bidi-font-family:=
Arial'> <st1:PlaceType
   w:st=3D"on">ACADEMY</st1:PlaceType></span></st1:place><span style=3D'mso=
-bidi-font-family:
  Arial'> OF PEDIATRICS</span></p>
  </td>
 </tr>
</table>

<p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'>The Childre=
n's
Division has adopted the following recognized practices for resource provid=
ers
regarding safe sleep of children placed in their home:</p>

<p class=3DMsoNormal style=3D'mso-margin-top-alt:auto;mso-margin-bottom-alt=
:auto;
margin-left:.25in;text-indent:-.25in;mso-list:l0 level1 lfo1;mso-list-chang=
e:
"%1\:1\:0\:\." roetuwb 20081125T1601;tab-stops:list .25in'><![if !supportLi=
sts]><span
style=3D'font-size:8.0pt'><span style=3D'mso-list:Ignore'>1.<span style=3D'=
font:7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
</span></span></span><![endif]><span style=3D'mso-bidi-font-family:Arial'>H=
ealthy
babies should always sleep on their backs. <o:p></o:p></span></p>

<p class=3DMsoNormal style=3D'mso-margin-top-alt:auto;mso-margin-bottom-alt=
:auto;
margin-left:.25in;text-indent:-.25in;mso-list:l0 level1 lfo1;mso-list-chang=
e:
"%1\:2\:0\:\." roetuwb 20081125T1601;tab-stops:list .25in'><![if !supportLi=
sts]><span
style=3D'font-size:8.0pt'><span style=3D'mso-list:Ignore'>2.<span style=3D'=
font:7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
</span></span></span><![endif]><span style=3D'mso-bidi-font-family:Arial'>S=
ide
sleeping is not as safe as back sleeping and is not advised. <o:p></o:p></s=
pan></p>

<p class=3DMsoNormal style=3D'mso-margin-top-alt:auto;mso-margin-bottom-alt=
:auto;
margin-left:.25in;text-indent:-.25in;mso-list:l0 level1 lfo1;mso-list-chang=
e:
"%1\:3\:0\:\." roetuwb 20081125T1601;tab-stops:list .25in'><![if !supportLi=
sts]><span
style=3D'font-size:8.0pt'><span style=3D'mso-list:Ignore'>3.<span style=3D'=
font:7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
</span></span></span><![endif]><span style=3D'mso-bidi-font-family:Arial'>G=
et a
physician's note for non-back sleepers that explains why the baby should not
use a back-sleeping position. <o:p></o:p></span></p>

<p class=3DMsoNormal style=3D'mso-margin-top-alt:auto;mso-margin-bottom-alt=
:auto;
margin-left:.25in;text-indent:-.25in;mso-list:l0 level1 lfo1;mso-list-chang=
e:
"%1\:4\:0\:\." roetuwb 20081125T1601;tab-stops:list .25in'><![if !supportLi=
sts]><span
style=3D'font-size:8.0pt'><span style=3D'mso-list:Ignore'>4.<span style=3D'=
font:7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
</span></span></span><![endif]><span style=3D'mso-bidi-font-family:Arial'>U=
se cribs
and firm mattresses safety-approved by the Consumer Product Safety Commissi=
on
(CPSC). <o:p></o:p></span></p>

<p class=3DMsoNormal style=3D'mso-margin-top-alt:auto;mso-margin-bottom-alt=
:auto;
margin-left:.25in;text-indent:-.25in;mso-list:l0 level1 lfo1;mso-list-chang=
e:
"%1\:5\:0\:\." roetuwb 20081125T1601;tab-stops:list .25in'><![if !supportLi=
sts]><span
style=3D'font-size:8.0pt'><span style=3D'mso-list:Ignore'>5.<span style=3D'=
font:7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
</span></span></span><![endif]><span style=3D'mso-bidi-font-family:Arial'>K=
eep
cribs free of toys, stuffed animals, and extra bedding. <o:p></o:p></span><=
/p>

<p class=3DMsoNormal style=3D'mso-margin-top-alt:auto;mso-margin-bottom-alt=
:auto;
margin-left:.25in;text-indent:-.25in;mso-list:l0 level1 lfo1;mso-list-chang=
e:
"%1\:6\:0\:\." roetuwb 20081125T1601;tab-stops:list .25in'><![if !supportLi=
sts]><span
style=3D'font-size:8.0pt'><span style=3D'mso-list:Ignore'>6.<span style=3D'=
font:7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
</span></span></span><![endif]><span style=3D'mso-bidi-font-family:Arial'>P=
lace
the child's feet to the foot of the crib and tuck in a light blanket along =
the
sides and foot of the mattress. The blanket <b>should not </b>come up higher
than the infant's chest. <o:p></o:p></span></p>

<p class=3DMsoNormal style=3D'mso-margin-top-alt:auto;mso-margin-bottom-alt=
:auto;
margin-left:.25in;text-indent:-.25in;mso-list:l0 level1 lfo1;mso-list-chang=
e:
"%1\:7\:0\:\." roetuwb 20081125T1601;tab-stops:list .25in'><![if !supportLi=
sts]><span
style=3D'font-size:8.0pt'><span style=3D'mso-list:Ignore'>7.<span style=3D'=
font:7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
</span></span></span><![endif]><span style=3D'mso-bidi-font-family:Arial'>U=
se
sleep clothing and nothing else in the infant's crib. <o:p></o:p></span></p>

<p class=3DMsoNormal style=3D'mso-margin-top-alt:auto;mso-margin-bottom-alt=
:auto;
margin-left:.25in;text-indent:-.25in;mso-list:l0 level1 lfo1;mso-list-chang=
e:
"%1\:8\:0\:\." roetuwb 20081125T1601;tab-stops:list .25in'><![if !supportLi=
sts]><span
style=3D'font-size:8.0pt'><span style=3D'mso-list:Ignore'>8.<span style=3D'=
font:7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
</span></span></span><![endif]><span style=3D'mso-bidi-font-family:Arial'>S=
leep
only 1 baby per crib. <o:p></o:p></span></p>

<p class=3DMsoNormal style=3D'mso-margin-top-alt:auto;mso-margin-bottom-alt=
:auto;
margin-left:.25in;text-indent:-.25in;mso-list:l0 level1 lfo1;mso-list-chang=
e:
"%1\:9\:0\:\." roetuwb 20081125T1601;tab-stops:list .25in'><![if !supportLi=
sts]><span
style=3D'font-size:8.0pt'><span style=3D'mso-list:Ignore'>9.<span style=3D'=
font:7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
</span></span></span><![endif]><span style=3D'mso-bidi-font-family:Arial'>K=
eep
the room at a temperature that is comfortable for a lightly clothed adult. =
<o:p></o:p></span></p>

<p class=3DMsoNormal style=3D'mso-margin-top-alt:auto;mso-margin-bottom-alt=
:auto;
margin-left:.25in;text-indent:-.25in;mso-list:l0 level1 lfo1;mso-list-chang=
e:
"%1\:10\:0\:\." roetuwb 20081125T1601;tab-stops:list .25in'><![if !supportL=
ists]><span
style=3D'font-size:8.0pt'><span style=3D'mso-list:Ignore'>10.<span
style=3D'font:7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp; </span></sp=
an></span><![endif]><span
style=3D'mso-bidi-font-family:Arial'>Visually check on sleeping babies ofte=
n. <o:p></o:p></span></p>

<p class=3DMsoNormal style=3D'mso-margin-top-alt:auto;mso-margin-bottom-alt=
:auto;
margin-left:.25in;text-indent:-.25in;mso-list:l0 level1 lfo1;mso-list-chang=
e:
"%1\:11\:0\:\." roetuwb 20081125T1601;tab-stops:list .25in'><![if !supportL=
ists]><span
style=3D'font-size:8.0pt'><span style=3D'mso-list:Ignore'>11.<span
style=3D'font:7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp; </span></sp=
an></span><![endif]><span
style=3D'mso-bidi-font-family:Arial'>No smoking around babies. Make sure ba=
bies
are being watched when you go outside to smoke. Child care providers who sm=
oke
should do so outside. Never allow smoking in a room where babies sleep. <o:=
p></o:p></span></p>

<p class=3DMsoNormal style=3D'mso-margin-top-alt:auto;mso-margin-bottom-alt=
:auto;
margin-left:.25in;text-indent:-.25in;mso-list:l0 level1 lfo1;mso-list-chang=
e:
"%1\:12\:0\:\." roetuwb 20081125T1601;tab-stops:list .25in'><![if !supportL=
ists]><span
style=3D'font-size:8.0pt'><span style=3D'mso-list:Ignore'>12.<span
style=3D'font:7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp; </span></sp=
an></span><![endif]><span
style=3D'mso-bidi-font-family:Arial'>Have supervised &quot;tummy time&quot;=
 for
awake babies. This will help babies strengthen their muscles and develop
normally. <o:p></o:p></span></p>

<p class=3DMsoNormal style=3D'mso-margin-top-alt:auto;mso-margin-bottom-alt=
:auto'><span
style=3D'mso-bidi-font-family:Arial'>I_____________________________________=
______
have read the above listed safe sleep practices recommended by the <st1:pla=
ce
w:st=3D"on"><st1:PlaceName w:st=3D"on">American</st1:PlaceName> <st1:PlaceT=
ype
 w:st=3D"on">Academy</st1:PlaceType></st1:place> of Pediatrics and accepted=
 as
policy by the Missouri Department of Social Services Children&#8217;s
Division.<span style=3D'mso-spacerun:yes'>&nbsp; </span>I understand and wi=
ll adhere
to these practices with infants placed in my home<o:p></o:p></span></p>

<p class=3DMsoNormal><span style=3D'mso-bidi-font-family:Arial'>___________=
____________________________________________________________</span></p>

<p class=3DMsoNormal style=3D'mso-margin-top-alt:auto;mso-margin-bottom-alt=
:auto'><span
style=3D'mso-bidi-font-family:Arial'>Signed<span style=3D'mso-tab-count:8'>=
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nb=
sp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;=
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nb=
sp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;=
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nb=
sp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;=
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span>Date<o:p></o:=
p></span></p>

<p class=3DMsoNormal style=3D'mso-margin-top-alt:auto;mso-margin-bottom-alt=
:auto'><span
style=3D'mso-bidi-font-family:Arial'><o:p>&nbsp;</o:p></span></p>

<p class=3DMsoNormal><span style=3D'mso-bidi-font-family:Arial'>___________=
____________________________________________________________</span></p>

<p class=3DMsoNormal style=3D'mso-margin-top-alt:auto;mso-margin-bottom-alt=
:auto'><span
style=3D'mso-bidi-font-family:Arial'>CD licensing worker<span style=3D'mso-=
tab-count:
6'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;=
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nb=
sp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;=
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nb=
sp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;=
 </span>Date
<o:p></o:p></span></p>

<p class=3DMsoNormal><o:p>&nbsp;</o:p></p>

</div>

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