Section 148-33-18 - INFANT/TODDLER CAREA.Additional rules for providers serving infants and toddlers. In addition to the preceding rules, a Provider serving Children ages six weeks to 36 months must also comply with this section.B.Promoting developmental needs. The developmental needs of Infants and Toddlers must be promoted in the following ways: 1. The provider must ensure that Infants and Toddlers are given a variety of activities to promote proper development in all areas of learning, consistent with each Child's developmental needs.2. Each Child must be allowed to form and follow his or her own pattern of sleeping, resting, and waking periods;3. Infants and Toddlers must not be allowed to use toys or objects which could be swallowed or cause choking. Foods that are choking hazards due to the size, shape or texture must not be served to Infants and toddlers;4. Each Infant's position must be changed every 30 minutes, when the Child is awake;5. Infants must be offered supervised tummy time / floor time daily;6. Use of Infant equipment to include, but not limited to bouncers, jumpers, and swings must be limited to 30 minutes at a time.C.Feeding1. Breast milk must be labeled with the Child's name, dated, and stored or discarded in accordance with the table below. Storage Location and Temperatures |
Type of Breast Milk: | Countertop | Refrigerator | Freezer |
77°F (25°C) or colder (room temperature) | 40°F (4°C) | 0°F (-18°C) or colder |
Freshly Expressed or Pumped | Up to 4 Hours | Up to 4 Days | Within 6 months is best Up to 12 months is acceptable |
Thawed, Previously Frozen | 1-2 Hours | Up to 1 Day (24 hours) | NEVER refreeze breast milk after it has been thawed |
Leftover from a Feeding | If the Infant did not finish the bottle, use within 2 hours after the Infant is finished feeding. |
2. Formula must be made from commercially prepared products. Homemade formula solutions are prohibited.3. Formula and breast milk must be labeled with the Child's name and date.4. Use prepared Infant formula within 2 hours of preparation and within 1 hour from when feeding begins. If the prepared Infant formula is not used within 2 hours, immediately store the bottle in the refrigerator and use it within 24 hours.5. The feeding schedule amount and type must meet the Infant's needs.6. Providers must hold Infants who are not independently bottle-feeding in their arms for feeding.7. Children who are independently bottle-feeding must be in a seated position within reach of a Provider.8. If breast milk or formula is to be warmed, bottles must be placed in hot (not boiling) water for no longer than five minutes, after which the bottle must be shaken well, and the temperature tested before feeding. Bottles of formula or breast milk must never be warmed in a microwave oven.9. A chair or table used for feeding Infants and Toddlers must be designed to prevent the Child from slipping or falling.10. Dishes and bottles used for feeding must be made of unbreakable material or sheathed in material that prevents shattering and may not contain bisphenol A (BPA).11. Parents must be immediately informed if a Child is accidentally fed another Child's breast milk. Providers must have information available regarding follow-up testing and sharing results.D.Napping/Resting. The Provider must observe the provisions of Section 14(L) of this rule, and: 1. Infants must be placed on their backs in an approved bassinet, crib, or play yard for sleeping, unless the Child's Parent provides a physician's recommendation. The written documentation from the physician must be in the Child's file.2. Each Infant/Toddler must be allowed to follow his/her own sleep/rest pattern, unless specific written documentation from the physician is in the Child's file.3. Bibs and garments with ties or hoods must be removed before placing an Infant in the crib to sleep.4. Swaddling of Infants and Toddlers is prohibited.5. Sleeping Infants must be checked in person at least every 30 minutes.6. Cribs, cots, and play yards may only be used by one Child at a time.10-148 C.M.R. ch. 33, § 18