Rules for the Licensing of Child Care Facilities 10-148 cmr chapter 32

INFANT/TODDLER PROGRAM

143. 
     Additional rules for infant/toddler programs. In addition to the preceding rules, Infant/Toddler Programs serving children ages six (6) weeks to thirty-six (36) months must also comply with this section.
     

144. 
     Restriction to first floors. Infant/Toddler programs are restricted to first floors or floors having direct exit at grade level.
     

145. 
     Promoting developmental needs. The developmental needs of infants and toddlers shall be promoted in the following ways:
     

1. 
   Each child shall be allowed to form and follow his or her own pattern of sleeping and waking periods;
   

2. 
   Toys shall be large enough to prevent swallowing or choking;
   

3. 
   Each infant/toddler's position and/or places shall be changed at least each half hour, when infant/toddler is awake;
   

4. 
   Infants and toddlers shall spend time outdoors daily when weather permits;
   

5. 
   Infants and toddlers may be combined in a group only when the total number does not exceed eight (8); and
   

6. 
   Infants and toddlers shall not occupy the play area at the same time as older children.
   

146. 
     Feeding
     

1. 
   The facility shall be responsible for hand-washing of all adults and all infant and toddlers prior to all feedings.
   

2. 
   Formula and breast milk must be labeled with the child's name, dated, stored in the refrigerator and discarded within forty-eight (48) hours. Frozen breast milk must be discarded within two (2) weeks.
   

3. 
   No previously opened baby food jars shall be accepted at the Child Care Facility. Open jars shall be disposed of or returned to the parent the same day they are opened.
   

4. 
   Formula shall be made from commercially prepared products.
   

5. 
   The feeding schedule shall be in accordance with the infant's needs rather than according to the hour.
   

6. 
   Infants shall be held for bottle-feeding.
   

7. 
   If breast milk or formula is to be warmed, bottles shall be placed in a pan of hot (not boiling) water for no longer than five (5) minutes, after which the bottle shall be shaken well and the milk temperature tested before feeding. Bottles of formula or breast milk shall never be warmed in a microwave oven.
   

8. 
   A chair or feeding table shall be provided as appropriate.
   

9. 
   Dishes and nursing bottles used must be unbreakable.
   

147. 
     Diapering/toileting
     

1. 
   Wet or soiled diapers and other clothing must be changed promptly.
   

2. 
   Wet or soiled disposable diapers must be placed in a lined, lidded container, separate from other trash or garbage and separate from play or food preparation areas.
   

3. 
   Children in diapers or other soiled or wet clothing shall be changed on a washable vinyl table or mat that is cleaned and sanitized after each use or has a disposable single use covering.
   

4. 
   The changing table or mat shall be located in a designated area. The kitchen/food preparation area may not be used as a designated area.
   

5. 
   Staff shall wash their hands and the child's with soap and warm running water after every diaper change.
   

6. 
   Child Care Facilities using cloth diapers must comply with diapering guidelines available from the Department of Health and Human Services, Division of Licensing and Regulatory Services. Cloth diapers may be used only when the child has a medical reason that does not permit the use of disposable diapers (such as allergic reactions). The child’s health care provider must document the medical reason. The documentation must be placed in the Child Care Facility’s file.
   

7. 
   All containers of soiled cloth or disposable diapers must be removed daily from the childcare areas.
   

148. 
     Toileting practice
     

1. 
   The facility must inform parents as to its toilet training practice as it applies to their child.
   

2. 
   Toileting practices must be developed by the family and staff, and must be based on the individual needs of the child.
   

3. 
   Potty-chair receptacles, must be emptied, rinsed, and sanitized after each use.
   

149. 
     Napping/resting
     

1. 
   Each infant/toddler shall be allowed to follow his/her own sleep/rest pattern.
   

2. 
   Infants shall be placed on their backs for sleeping, unless contraindicated by a physician. Placing children on their abdomens for any reason shall be avoided, unless specifically instructed by the child's physician to do so.
   

150. 
     Cots, cribs and bedding
     

1. 
   A crib must be provided for each child up to eighteen (18) months of age.
   

2. 
   No crib shall be used by more than one child at a time.
   

3. 
   Each crib must be of sturdy construction with bars closely spaced to prevent injury.
   

4. 
   Each crib must be equipped with a waterproof, firm, snug fitting mattress.
   

5. 
   No child shall be placed directly on a waterproof crib mattress or crib mattress cover.
   

6. 
   Restraining devices of any type must not be used in cribs.
   

7. 
   Crib sides must be up while the child is in the crib.
   

8. 
   Pillows are prohibited in cribs.
   

9. 
   No double or multi-decked cribs may be used.
   

10. 
    Cots and/or mats and cribs used by any infant or toddler must be cleaned and disinfected on a regular basis.
    

11. 
    Sheets must be washed before being used by another child.
    

12. 
    There must be at least one designated wheeled evacuation crib.