Current through Register Vol. 48, No. 38, September 20, 2024
a) A center receiving children within the
infant and toddler age range shall comply with standards for all day care
centers, except when inconsistent with the special requirements prescribed by
this Section.
b) A center serving
infants and toddlers shall have a licensed physician, registered nurse,
licensed practical nurse or licensed physician's assistant with training in
infant care to instruct child care staff in the proper health care of infants
and toddlers. The person shall visit the facility to observe the child care
techniques of the staff and provide in-service training. Visits shall be at
least weekly during the permit period and monthly thereafter.
c) A center for infants and toddlers shall
have sufficient indoor and outdoor space and appropriate furniture and
equipment to provide for support functions necessary to the program.
1) Separate space for infants and toddlers
shall be available away from older children except in facilities enrolling 10
or fewer children or in programs combining infants, toddlers, and
2-year-olds.
2) The amount of space
required for infants and toddlers shall be based on the sleeping and play area
arrangements, as required by Section
407.370(d).
3) A sink or lavatory for the infant/toddler
program shall be in the same room for the use of staff for hand washing and for
use by the children.
4) A toilet
for the infant/toddler program shall be easily accessible.
5) No extension cords shall be used in areas
where children are permitted. All electrical cords not in use with supervision
of an adult shall be unplugged and the outlets covered.
6) The means for warming bottles and food
shall be accessible only to adults. Microwave ovens shall not be used for the
purpose of warming bottles.
7) A
refrigerator shall be available and easily accessible to the children's
room.
d) Indoor and
outdoor play materials and equipment suitable for staff to use with infants and
toddlers to stimulate learning, growth, health, and overall development shall
be provided in accordance with the equipment requirements in Appendix A.
1) Equipment and play materials shall be
durable and free from characteristics that may be hazardous or injurious to
infants and toddlers. Hazardous or injurious characteristics include sharp or
rough edges, toxic paint, and objects small enough to be swallowed.
2) Toys and indoor equipment shall be cleaned
and disinfected daily.
f) Food for infants
shall be handled and served according to the provisions of Section
407.330
and this Section, as applicable.
1) Daily food
requirements for children under one year of age shall be offered to the child
as detailed in Appendix D, unless otherwise indicated in writing by a
physician, in consultation with the parents.
2) Food for infants not consuming table food
may be provided by either the day care center or the parent, according to the
center's written policy.
3)
Flexible feeding schedule of infants shall be established to coordinate with
parents' schedules at home and to allow for nursing infants.
4) Infants not consuming table food shall be
fed in consultation with the parents. Feeding times and amounts consumed shall
be documented in writing and available for review by the parents.
5) If provided by the day care center,
formula shall be diluted according to the manufacturer's instructions using
water from a source approved by the local health department.
6) Formula shall be milk-based, unless
otherwise indicated in writing by the child's physician.
7) If the child's formula is provided by the
parent, it shall be labeled, dated and refrigerated upon arrival at the
center.
8) Bottles of breast milk
and opened containers of unmixed concentrate shall be dated. When there is more
than one bottle-fed infant, all bottles shall be labeled with the child's
name.
9) All filled bottles of milk
or formula shall be refrigerated until immediately before feeding. Contents
remaining in a bottle after a feeding shall be discarded after 2
hours.
10) Formula prepared from
powder or concentrate or an open container of ready-to-feed formula shall be
labeled and dated. Prepared formula not used within 24 hours shall be
discarded.
11) Breast milk may be
stored up to 48 hours in the refrigerator or up to 2 weeks in the freezer
before discarding.
12) Breast milk
shall be used only for the intended child.
13) Frozen breast milk shall be thawed under
running water or in the refrigerator. Bottles of formula or breast milk shall
be warmed by placing them in a pan of hot (not boiling) water for 5 minutes or
in a bottle warmer according to the manufacturer's directions, followed by
shaking the bottle well and testing the milk temperature before
feeding.
14) Bottles shall never be
warmed or defrosted in a microwave oven.
15) Only sanitized bottles and nipples shall
be used. Bottles and nipples reused by the day care center shall be sanitized
by washing in a dishwasher, by boiling for 5 minutes or more just prior to
refilling or by other method if approved by the Illinois Department of Public
Health or local health department. Nipples are to be rinsed prior to
washing.
16) No food other than
formula, milk, breast milk, or water shall be placed in a bottle for infant
feeding unless otherwise indicated by the child's physician, in consultation
with the parents.
17) When children
are exclusively bottle-fed or breast-fed, supplemental water shall be
offered.
18) Juice may be fed from
a cup when the infant is old enough to drink from a cup (approximately 12
months). No juice is permitted for children under 12 months of age. Juices
shall be 100 percent fruit juice and limited to a 4 ounce daily
serving.
19) Children under 2 years
of age shall not be fed berries, candies, raisins, corn kernels, raw carrots,
whole grapes, hot dogs, nuts, seeds, popcorn, raw peas or peanut butter, as
these foods may cause choking.
20)
Cooked carrots, corn, peas and bananas may be served to infants only if mashed,
grated or pureed.
21) Human milk or
infant formula shall be served to children younger than 1 year of age. Children
between 1 and 2 years of age who are not on human milk or infant formula shall
be served whole milk, unless low-fat milk is recommended in writing by the
child's medical provider. Children 2 years of age and older shall not be served
milk with a fat content higher than 1 percent, unless recommended in writing by
the child's medical provider.
22)
The use of honey for sweetening infant foods is not allowed.
23) Staff members shall wash their hands and
the child's hands according to Section
407.320 before
feeding each child.
24) Infants
shall always be held for bottle feeding. Bottle propping and carrying of
bottles or no-spill cups by young children throughout the day/night shall not
be permitted, unless they contain plain water. The facility shall not permit
infants to have bottles in the crib.
25) Foods stored or prepared in jars shall be
served from a separate dish and spoon for each child. Any leftovers from the
serving dish shall be discarded. Leftovers in the jar shall be labeled with the
infant's name, dated, refrigerated and served within 24 hours or
discarded.
26) In accordance with
the American Academy of Pediatrics recommendations, solid foods shall be
introduced generally between 4 and 6 months of age. The time of introduction
shall be indicated by each child's nutritional and developmental needs after
consultation with the parents.
27)
Infants, according to their developmental ability, shall be allowed and
encouraged to feed themselves. Staff shall provide supportive help for as long
as each child needs such help.
g) Routines, such as naps and feeding, shall
take into consideration parents' information and wishes about the routines
followed in the home.
h) Infants
and toddlers shall be provided a daily program designed to meet the
developmental needs of children of this age.
1) The same staff member shall feed, diaper
and play with the child every day to establish interaction and establish
continuity in the child's relationship with as few adults as
possible.
2) Children shall be free
to creep, crawl, toddle and walk as they are physically able. Walkers are not
permitted unless prescribed by a physician.
3) Toddlers shall be encouraged to explore
and manipulate art materials and shall not be expected to produce a finished
art product.
4) Except as allowed
in Section
407.200(d)(3),
children shall be taken outdoors for a portion of every day unless the weather
conditions pose a danger such as lightning or extremely high or low
temperatures.
5) A variety of toys
shall be accessible on low open shelves for the children to use, and these
shall be rotated with stored toys.
6) For awake infants who cannot move about
the room, the staff shall hold, rock and/or carry the child at least every 30
minutes and change the place and position of the child and the selection of
toys available.
7) Infants shall
have supervised tummy time every day when the infant is awake. Staff shall
interact with an awake infant on his or her tummy for short periods of time
(3-5 minutes) and increase the amount of time as the infant shows enjoyment of
the activity.
8) Information about
feeding and elimination and other important information shall be recorded in
writing and made available to parents when the child is picked up at the end of
the day.
j) The daily program for infants and toddlers
shall provide experiences that promote the individual child's growth and
well-being in the development of gross and fine motor skills, sensory learning,
language, cognition, and positive self-concept.
k) Self-care such as washing, dressing,
toileting, brushing, and combing shall be encouraged as each child shows
evidence of ability to do so.
