Appendix A -Breast Milk Storage

(A)       What are the requirements for infant daily care?

(1)       The center shall:

(a)       Allow infants to safely and comfortably sit, crawl, toddle, walk and play according to the infant's stage of development.

(b)       Remove each infant from the crib, swing, infant seat, exercise seat or other equipment throughout the day for individual attention.

(c)        Provide each non-crawling infant the opportunity for tummy time each day.

(d)       Maintain a daily written record for each infant that is provided to the infant's parent or person picking up the infant on a daily basis. The record shall include the following information:

(i)         Food intake.

(ii)        Sleeping patterns.

(iii)       Times and results of diaper changes.

(iv)       Information about daily activities.

(2)       Each infant shall be removed from his or her crib for all feedings. Infants shall be held or fed sitting up for bottled feedings. At no time shall a bottle be propped for an infant.

(B)       What are the requirements for infant bottle and food preparation?

The center shall:

(1)       Prepare and serve infant food in a manner appropriate to the developmental needs of each child. The center shall introduce new foods only after consultation with the parent. The center shall comply with written feeding instructions from the infant's parent, physician, physician's assistant, or certified nurse practitioner (CNP) which shall include the following:

(a)       Type of food and/or formula/breast milk.

(b)       Amount of food and/or formula/breast milk.

(c)        Feeding times or frequency of feedings.

(2)       Require the parent to update the written feeding instructions as needed.

(3)       Not feed any foods, other than formula or breast milk, to infants under four months of age, unless there is written documentation on file from a physician, physician's assistant or CNP.

(4)       Ensure that formula, breast milk, or other liquids in a bottle are not heated in a microwave oven.

(a)       If formula or breast milk is to be warmed, bottles shall be placed in a container of water not hotter than one hundred twenty degrees or be placed in a commercial bottle warmer. The container of water shall be kept out of reach of children and shall be emptied and cleaned each day. The bottle shall be shaken well, and the formula or breast milk temperature tested before feeding.

(b)       Frozen breast milk shall be thawed under cold running water or in the refrigerator.

(5)       Ensure that the unused portion of formula, breast milk or food remaining in a container from which the infant has been directly fed shall not be reheated or served again.

(6)       Store, prepare and serve food, formula and breast milk in a safe and clean manner.

(7)       If provider prepares infant formula they shall do so according to the manufacturer's instructions or instructions from the infant's physician, physician's assistant or CNP.

(8)       Ensure that open containers of ready-to-feed and concentrated formula shall be covered, dated and refrigerated according to the manufacturer's instructions. Prepared formula and food shall be discarded or sent home daily if not used.

(9)       Label all bottles or prepared food with the infant's name and date of preparation. All formula shall be refrigerated immediately after preparation or upon arrival if the formula is prepared by the parent. All commercially prepared food shall be stored according to the manufacturer's instructions and not served after the expiration date.

(10)     Ensure that if breast milk is provided by the parent, it shall be labeled with the infant's name, the date pumped, and the date the bottle was prepared. Centers shall follow the chart in appendix A to this rule for storing breast milk.

(C)       What are the requirements for diapering?

(1)       Diapers shall be changed immediately when wet or soiled.

(2)       Clothing shall be changed immediately when wet or soiled.

(3)       When changing diapers the center shall comply with the following:

(a)       The center shall wash all soiled areas of the child's body with either a wash cloth, which is then appropriately sanitized, or a disposable wipe.

(b)       If a diaper-changing surface is used to change more than one child, the provider shall place a disposable separation material between the child and the changing surface. A different separation material shall be used for each diaper change.

(c)        If an infant's diapers are to be changed in a crib, there shall be a separation material between the infant and the crib sheet. If the bedding becomes wet or soiled during the diaper change, it shall be replaced with clean bedding.

(d)       If a diapering product is used on more than one child:

(i)         The container shall not touch the child to avoid cross contamination.

(ii)        The product shall be administrered to avoid cross contamination.

(e)       No child shall be left unattended on the diaper changing table.

(f)        If restrooms are used for diapering, children who are waiting for toileting and diapering shall not be placed or required to sit directly on the floor.

(4)       The center shall ensure that each child has a clean supply of diapers and an extra change of clothing available at all times.

(5)(4)   The center shall store and launder soiled diapers or clothing as follows:

(a)       If soiled diapers or clothing are to be sent home with a parent, the center shall store the diapers or clothing for no longer than one day in an individual covered container or plastic bag away from the child's belongings and out of the reach of children.

(b)       The center shall store soiled diapers and diapering washcloths, which are to be laundered by the center, in a covered container with sanitizing solution.

(c)        If soiled diapers are to be commercially laundered, the center shall hold them for laundering pickup for no longer than seven days.

(d)       The center shall store soiled disposable diapers in a plastic-lined covered container that prevents hand contamination and is not easily accessible to children and discard diapers daily or more frequently as needed to eliminate odor.

(e)       If the center is laundering diapers, the center shall follow the manufacturer's guidelines.

(6)(5)   Toilet training shall occur based on a child's readiness and consultation with the parent regarding practices in the child's home. The center shall ensure that toilet training is never forced.

Effective: 10/29/2017

Five Year Review (FYR) Dates: 12/31/2021

Certification: CERTIFIED ELECTRONICALLY

Date: 10/12/2017

Promulgated Under: 119.03

Statutory Authority: 5104.015

Rule Amplifies: 5104.015

Prior Effective Dates: 3/1/81, 2/8/82, 6/1/84, 9/1/86, 4/1/03, 9/1/07, 12/31/16