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.
- Separate space for infants and toddlers shall be available away
from older children except in facilities enrolling ten or fewer children or
in programs combining infants, toddlers, and two-year-olds.
- 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).
- 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.
Programs that are licensed for infants and toddlers on January 1, 1998 shall
come into compliance with this requirement by January 1, 2000.
- A toilet for the infant/toddler program shall be easily accessible.
- 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.
- 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.
- 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
of this Part.
- 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, rough edges, toxic paint, and objects small
enough to be swallowed.
- 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.
- 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 parent(s).
- 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.
- Flexible feeding schedule of infants shall be established to coordinate
with parents' schedules at home and to allow for nursing infants.
- 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.
- 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.
- Formula shall be milk-based, unless otherwise indicated in writing
by the child's physician.
- If the child's formula is provided by the parent, it shall be labeled,
dated and refrigerated upon arrival at the center.
- 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.
- 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 two hours.
- 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.
- Breast milk may be stored up to 48 hours in the refrigerator or
up to two weeks in the freezer before discarding.
- Breast milk shall be used only for the intended child.
- 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 five 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.
- Bottles shall never be warmed or defrosted in a microwave oven.
- 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 five 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.
- 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.
- When children are exclusively bottle-fed or breast-fed, supplemental
water shall be offered.
- Juice may be fed from a cup when the infant is old enough to drink
from a cup (approximately six months). Juices shall be 100 percent fruit juice.
- Children under two 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.
- Cooked carrots, corn, peas and bananas may be served to infants
only if mashed, grated or pureed.
- Whole milk shall be served to children under two years of age unless
low-fat milk is requested by the child's physician.
- The use of honey for sweetening infant foods is not allowed.
- Staff members shall wash their hands and the child's hands according
to Section 407.320 before feeding each child.
- Infants shall either be held or be fed sitting up for bottle feeding.
Infants unable to sit shall always be held for bottle feeding. When infants
are able to hold their own non-glass bottles, they may feed themselves The
bottle must be removed once the child has fallen asleep. Bottle propping and
carrying of bottles by young children throughout the day/night shall not be
permitted.
- 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.
- In accordance with the American Academy of Pediatrics recommendations,
solid foods shall be introduced generally between four and six months of age.
The time of introduction shall be indicated by each child's nutritional and
developmental needs after consultation with the parents.
- 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.
- 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.
- Children shall be free to creep, crawl, toddle and walk as they
are physically able. Walkers are not permitted unless prescribed by a physician.
- Toddlers shall be encouraged to explore and manipulate art materials
and shall not be expected to produce a finished art product.
- 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 lightening or extremely high or low temperatures.
- A variety of toys shall be accessible on low open shelves for the
children to use, and these shall be rotated with stored toys.
- 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.
- To avoid sudden infant death syndrome, children who cannot turn
over alone shall be placed on their sides or backs unless contraindicated
by a physician.
- 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 which
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: Added at 22 Ill. Reg., effective January 1, 1998)
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