R381-100-24. Infant and Toddler Care

  If the provider cares for infants or toddlers:

  (1) Each awake infant and toddler shall receive positive physical and verbal interaction with a caregiver at least once every 20 minutes.

  (2) To stimulate their healthy development, the provider shall ensure that infants receive daily interactions with adults; including on the ground interaction and closely supervised time spent in the prone position for infants less than 6 months of age.

  (3) Infant and toddler areas shall not be used to pass through or access other indoor and outdoor areas.

  (4) Infants and toddlers shall play in the same enclosed outdoor space with older children only when there are 8 or fewer children in the group.

  (5) Caregivers shall respond promptly to infants and toddlers who are in emotional distress due to conditions such as hunger, fatigue, a wet or soiled diaper, fear, teething, or illness.

  (6) For their healthy development, safe toys shall be available for infants and toddlers. There shall be enough toys accessible to each infant and toddler in the group to engage in play.

  (7) Mobile infants and toddlers shall have freedom of movement in a safe area.

  (8) An awake infant or toddler shall not be confined for more than 30 minutes in any piece of equipment, such as a swing, high chair, crib, playpen, or other similar piece of equipment.

  (9) Only one infant or toddler shall occupy any one piece of equipment at any time, unless the equipment has individual seats for more than one child.

  (10) Infants and toddlers shall not have access to objects made of styrofoam.

  (11) Each infant and toddler shall be allowed to eat and sleep on their own schedule.

  (12) Baby food, formula, or breast milk that is brought from home for an individual child's use shall be:

  (a) labeled with the child's name;

  (b) labeled with the date and time of preparation or opening of the container, such as a jar of baby food;

  (c) kept refrigerated if needed; and

  (d) discarded within 24 hours of preparation or opening, except for unprepared powdered formula or dry food.

  (13) If an infant is unable to sit upright and hold their own bottle, a caregiver shall hold the infant during bottle feeding. Bottles shall not be propped.

  (14) The caregiver shall swirl and test warm bottles for temperature before feeding to children.

  (15) Formula and milk, including breast milk, shall be discarded after feeding or within 2 hours of starting a feeding.

  (16) Caregivers shall cut solid foods for infants into pieces no larger than 1/4 inch in diameter, and shall cut solid foods for toddlers into pieces no larger than 1/2 inch in diameter.

  (17) Infants shall sleep in equipment designed for sleep such as a crib, bassinet, porta-crib or play pen. An infant shall not be placed to sleep on a mat, cot, pillow, bouncer, swing, car seat, or other similar piece of equipment unless the provider has written permission from the infant's parent.

  (18) Infants shall be placed on their backs for sleeping unless there is documentation from a health care provider requiring a different sleep position.

  (19) Soft toys, loose blankets, or other objects shall not be placed in cribs while in use by sleeping infants.

  (20) Caregivers shall document each infant's eating and sleeping patterns each day. The record shall:

  (a) be completed within an hour of each feeding or nap, and

  (b) include the infant's name, the food and beverages eaten, and the times the infant slept.

  (21) Within an hour of each infant or toddler's diaper change, caregivers shall record:

  (a) the infant or toddler's name,

  (b) the time of the diaper change, and

  (c) whether the diaper was dry, wet, soiled, or both.

  (22) The provider shall maintain on-site for review by the Department a six-week record of:

  (a) the eating and sleeping patterns for each infant; and

  (b) the diaper changes for each infant and toddler.