Section 407.210  Special Requirements for Infants and Toddlers

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.

e)         Child care shall be given in a manner that meets the children's health and safety needs, as well as their nurturing requirements.

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.

i)          A written plan shall be provided prior to reassignment for children who are moved to a new group. The development of this plan shall involve the child's parents and the child care staff in both the sending and receiving rooms.

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.

(Source:  Amended at 38 Ill. Reg. 17293, effective August 1, 2014)