(a) Environment. Infants, toddlers and two-year olds shall be in an environment which protects them from physical harm and stimulates physical, intellectual, emotional and social development.
(b) Feeding. Infants and toddlers shall be fed the infant formula and diet prescribed by the child's physician or authorized by the child's parent.
- (1) Infants up to the age of six months shall be held while being bottle-fed. Bottles shall not be propped by any means at any time or placed in cribs.
- (2) Infants of more than six months shall be held while bottle-fed until they are able to hold their bottles securely.
- (A) Staff shall be discouraged from placing children in bed with bottles due to increased risk of choking, ear infections and tooth decay.
- (B) Bottles shall be removed at once when empty or when children have fallen asleep.
- (3) Infants and toddlers no longer being held for feeding shall have a definite place for eating. They may sit in infant seats, high chairs with a safety strap or in low chairs at low tables without restraints.
- (4) Staff members shall wash their hands thoroughly with soap and water before feeding children including bottle-feeding.
- (5) Bottles and baby food provided by parents shall be labeled with the child's name.
- (6) Baby foods that have come into contact with the feeding spoon shall be discarded.
- (7) If microwave ovens are used, the requirements contained in (A)-(B) of this paragraph shall be met.
- (A) Staff shall be trained in assessing proper temperatures.
- (B) A warning to check food temperature before feeding children shall be posted on all microwave ovens.
(c) Diaper changing. The program shall comply with the requirements pertaining to diaper changing listed in this subsection.
- (1) Staff shall be instructed in the proper procedure for diaper changing and the procedure for diaper changing shall be posted in the diaper-changing area.
- (2) If cloth diapers and training pants are used, they shall not be rinsed when soiled. Fecal content may be disposed of in a toilet, but soiled diapers or training pants shall not be rinsed in the toilet.
- (3) If disposable gloves are used, staff shall discard them immediately after each diaper change and wash their hands.
- (4) Staff members shall wash and scrub their hands thoroughly with soap and warm, running water after each diaper change.
- (5) Diapers shall be changed promptly when wet or soiled.
- (6) Rooms in which children under three years of age are in diapers shall have an operable sink with hot and cold running water either in the same room or in a bathroom that opens directly into the room. This does not include:
- (A) rooms in which children, who are at least two years of age, are in disposable or cloth training pants if adequate provisions are made for supervision and sanitation; and
- (B) programs licensed for 15 or fewer children in buildings originally designed as a family residence if:
- (i) there is a centrally located bathroom sink with a changing table nearby; and
- (ii) children in diapers play throughout the house rather than in an assigned room.
- (7) The diaper-changing table shall be:
- (A) adjacent to or near the sink with a clean and moisture-proof surface;
- (B) sturdy and maintained in good repair;
- (C) a minimum of three feet above the floor; and
- (D) kept free of all objects except those used for diaper changing.
- (8) The surface shall be sanitized after each diaper change. If moisture-proof disposable surface products are used, staff shall discard them immediately after each diaper change and sanitize the surface.
- (9) Individual clean washcloths, towels or disposable towelettes shall be used to thoroughly cleanse the child and shall be washed or discarded after each use.
- (10) Clean cloth diapers or clean disposable diapers shall be used.
- (11) Soiled items shall be placed in a sealed moisture-proof bag or stored in a covered container which is cleaned daily.
- (12) Children shall not be left unattended on the diaper-changing table.
- (13) If disposable gloves are used, staff shall discard them immediately after each diaper change and wash their hands.
(d) Toilet learning. The plan and progress in toilet learning shall be discussed with the parents.
- (1) Toilet learning shall be relaxed and pressure free.
- (2) A child shall be encouraged through regular use of a toilet or potty chair for short periods of time not to exceed ten minutes.
- (3) Staff shall respond promptly when a child requests toileting assistance.
- (4) A child shall be encouraged for appropriate use of the potty chair or toilet.
- (5) Staff shall not show disapproval or punish children for accidents.
- (6) A child's clothing shall be changed immediately following a toileting accident. Soiled clothing shall be placed in a sealed moisture-proof bag to be sent home.
- (7) Staff shall wash their hands with soap and water after each toileting and shall assist children with handwashing.
(e) Program. Staff shall be present in each room occupied by children at all times.
- (1) To ensure consistency and stability in meeting the needs of infants, toddlers and two-year-olds, care shall be provided by familiar staff members whenever possible.
- (2) Children shall be:
- (A) removed from their cribs often when not sleeping.
- (B) provided with play equipment during the intervals they may be awake in their cribs; and
- (C) provided opportunities to play freely on a clean, safe floor.
- (3) Staff shall provide frequent stimulation in a variety of ways including talking to, playing with, and holding and rocking children.
- (4) Language development shall be encouraged by staff members through individual interaction with each child, such as singing, talking, reacting to the child's sounds, naming objects, reading stories and playing musical games.
- (5) Additional requirements regarding rest arrangements are found in 340:110-3-49.1.