Your baby-room and emergency-response reference. The two most drill-critical compliance courses on 2 pages: Safe Sleep & Baby-Room Practice · Anaphylaxis & Choking Response Drill. Print, punch, file — or save the PDF. The seconds you save by having drilled it are the seconds that matter.
😴 Safe Sleep & Baby-Room Practice
Bronze · every baby, every sleep
Lullaby Trust ABC
A — Alone
Own cot. No adults, siblings or older children in sleep space.
B — on Back
Every sleep. Face up. Never front or side unless paediatrician-signed instruction.
C — Clear cot
No pillows, cot bumpers, loose blankets covering face, soft toys, muslins within reach of face.
No hat indoors
Babies release heat through head — overheating is a SIDS risk.
Feet-to-foot
If using blanket, feet touching foot of cot so baby can't wriggle under.
Firm mattress
Snug-fitting sheet, no gaps between mattress and cot side.
Baby rolls in sleep?
- Under 6m + can't roll back: gently reposition. Log.
- Over 6m + rolls both ways: leave — but keep the cot clear and continue checks.
- Never wedge or prop. Wedges are themselves a SIDS risk.
The JLK 4-point sleep check — every 10 minutes
1. Breathing
Look for chest rise-and-fall. Feel warmth & movement if unsure.
2. Position
Still on back? Face uncovered? Clear cot?
3. Colour
Normal skin tone. Not blue-tinged around lips or fingernails.
4. Temperature
Hand on back of neck: warm not sweating, not clammy or cold.
Named checker per shift · rotates hourly · formal handover on break · logged on the sleep-check form.
Room environment
- Temp: 16–20°C. Thermometer checked hourly.
- Ventilation: fresh air circulating. Never sealed for over an hour.
- Lighting: dimmed but not black-out. Enough light to see chest movement + skin colour.
- Cots ≥30cm apart. Never touching. No shared bedding ever.
TOG guide by temp
16–18°C
Vest + all-in-one + 2.5 tog bag or light blanket
18–20°C
Vest + all-in-one + 1.0 tog bag or light blanket
20°C+
Vest only + 0.5 tog or no bag
Never
Hat indoors during sleep · duvet · anything covering face
Family asks for a different position/comforter? Warmly hold ABC. Escalate to manager. Only paediatrician-signed medical instruction overrides. Never quietly break ABC to please a family — it's the one place where "trying to please" can cost a life.
Concern during a check — 3-step: ASSESS · CALL for help LOUD ("I need help NOW") · MANAGER + 999. If not breathing, someone dials 999 while first-aider begins infant CPR — don't wait for the manager to arrive to dial.
🚨 Anaphylaxis & Choking Response Drill
Bronze · drilled termly · muscle memory removes the freeze
Anaphylaxis — AAAA signs
A — Airway
Tongue/throat swelling. Difficulty swallowing. Hoarse voice.
A — Air (breathing)
Wheeze. Rapid or laboured breathing. Struggling to speak.
A — Alertness
Sudden extreme sleepiness. Confusion. Floppy child.
A — Appearance
Widespread rash/hives. Facial swelling. Pale or blue-tinged.
ANY ONE of Airway, Air, or Alertness → treat as anaphylaxis. Epi-pen. Now.
JLK anaphylaxis timed sequence
- Recognise. LOUD call: "ANAPHYLAXIS — SECOND ADULT NOW."
- Get epi-pen from room-exit kit.
- Second adult dials 999. States: "Anaphylaxis. Child aged X. Adrenaline being administered. [Site address]."
- Administer epi-pen: outer mid-thigh, firm press, hold for device count. Record time.
- Position: breathing issue → sit up leaning forward. Floppy → lying flat, legs raised. NEVER stand.
- Third adult moves other children away calmly.
- Manager alerted — brings family emergency contact list.
- Manager takes over 999. First adult stays with child. Second adult calls family.
- Second epi-pen if no improvement or symptoms return — only under 999 guidance.
The 3 fears that kill: "not really anaphylaxis" → if in doubt, TREAT · "using the pen wrong" → drill termly · "overreacting on 999" → Category 1 call, never apologise.
Choking — mild vs severe
Mild: coughing effectively, can breathe → encourage coughing, stay close, watch. Do NOT do back blows — coughing is more effective.
Severe: silent, can't cough, can't breathe, may go blue → act now.
Severe choking — INFANT (under 1)
- Loud call: "CHOKING — HELP."
- Baby face-down along your forearm, head lower than body, jaw supported (don't press throat).
- Up to 5 sharp back blows between shoulder blades with heel of hand. Check mouth between each.
- If unsuccessful: flip face-up. Two fingers on breastbone one finger-width below nipple line. Up to 5 firm inward-upward chest thrusts.
- Cycle back blows → chest thrusts until clear or unresponsive.
- Second adult dials 999 immediately — don't wait for first-aider to try first.
NEVER abdominal thrusts on an infant under 1. Can cause internal injury.
Severe choking — CHILD (1–8)
- Loud call: "CHOKING — HELP."
- Child leaning forward, adult supporting chest with one hand.
- Up to 5 sharp back blows between shoulder blades.
- If unsuccessful: stand behind, one fist above navel, other hand over fist, up to 5 sharp upward abdominal thrusts.
- Cycle until clear or unresponsive.
- Second adult dials 999 immediately.
After ANY successful rescue: same-day medical review required (ambulance or GP). Object may have caused internal injury.
Termly drills at JLK
- 3 per term: anaphylaxis · choking · fire evacuation.
- Anaphylaxis drill: trainer epi-pen. Second adult runs the 999 call script aloud (don't actually call). Manager times — recognise-to-adrenaline under 60s.
- Choking drill: infant + child manikins. Every staff member practises.
Drill debrief — JLK 4 questions
- What went well? (Specific and named.)
- What was clumsy?
- What would we change for real?
- What are we doing before next term?
Real incident — post-response checklist
- Ambulance called. Family notified by manager. Ofsted notified within 14 days for any serious accident/injury/death.
- Incident form same shift. Factual, no speculation.
- Debrief same day or next. Warm, not blame-focused.
- Wellbeing check on staff involved — individually. Emergency response is traumatic.
- Prevention review: how did it get past prevention? What changes now?
🦠 Infection Control & Outbreak Response
Bronze · exclusion breaks transmission
Top exclusion periods (UKHSA)
D&V / norovirus
48h from LAST episode of vomit/diarrhoea. Not 24h. Not "feeling better".
Chickenpox
5 days from rash OR all lesions crusted (sooner). Warn high-risk families urgently.
Scarlet fever / Strep A
Until 24h after antibiotics. Notifiable to UKHSA within 3 working days.
Impetigo
Until lesions crusted & healed OR 48h after antibiotics.
Measles
4 days from rash onset. Notifiable to UKHSA same day.
Whooping cough
48h after antibiotics OR 21 days from cough onset. Notifiable.
HFMD
Return when well; JLK asks stay home while fresh blisters/open sores.
Conjunctivitis
UKHSA no exclusion; JLK asks 24h from symptom onset.
If in doubt, err longer. A day of unnecessary exclusion is a much smaller cost than a spreading outbreak.
Outbreak threshold & response
JLK outbreak = 2+ children, same room, same symptoms, within 48h.
- Manager alerted the moment threshold is met.
- Cluster confirmed — same symptoms.
- Room deep-clean triggered SAME day.
- Parent notification message sent same day.
- Any symptomatic child home. Any developing symptoms in the day → separated, parent called immediately.
- Staff self-monitor. Anyone with symptoms goes home.
- UKHSA notified if: outbreak >20% of room · spreads to 2nd room · notifiable disease.
- Ofsted notified if setting closes / service significantly affected (within 14 days).
- Debrief once resolved.
Deep-clean routine (norovirus / gastro)
- Remove children. Ventilate. PPE: gloves, apron, mask.
- Chlorine-based disinfectant. 0.1% sodium hypochlorite or higher.
- Soft furnishings out — bagged for hot wash 60°C+.
- Spillage: cover with paper towels → apply disinfectant → let sit 5 min → remove → bag as clinical waste. NEVER sweep or vacuum — aerosolises the virus.
- Hard surfaces: tables, chairs, door handles, sinks, taps, toilet flushes, toy shelves.
- Toys: dishwasher hot cycle or wiped. Fabric hot-washed. Books left 72h for natural die-off.
- Ventilate 30 min after clean. Return children when surfaces dry.
Daily-during-outbreak measures
- Enhanced handwashing every hour, always before food + after bathroom.
- Adult handwashing between rooms.
- Individual portions, no shared serving spoons.
- Continue daily deep-clean until 48h after last symptomatic case.
Staff working through gastro is a firing offence for a reason. 48h clear before return (D&V) · 24h fever-free without medication (fever) · GP-cleared for contagious skin.
Parent-notification tone
Warm · factual · not panicky · not dismissive. Explain what happened, what we're doing, what we ask of them, and end with reassurance that this is normal nursery life — not a crisis.