(A) Center policies and practices shall support parent preferences in infant feeding, including breastfeeding and shall recognize the center for disease control's determination that handling and storage of breast milk does not require the use of universal precautions and that breast milk is not considered a biohazard. Center policies and practices shall also support the introduction of solid foods as long as developmentally appropriate and not detrimental to the health of the child.
(B) Each infant shall be removed from his or her crib for all feedings. Infants shall be held or fed sitting up for bottle feedings. At no time shall a bottle be propped for an infant.
(C) Infant food shall be prepared and served in a manner appropriate to the developmental needs of each child according to his stage of development.
(D) Infants shall be served food in conformity with dated written instructions from the parent or guardian or physician. The instructions shall include amounts of food, type of food, and feeding times and be updated as needed based upon the child's needs and parent's instructions.
(E) Should the parent or guardian not provide instructions for the serving of food to their infant, the infant shall be served food in amounts that meet the meal pattern and quantity of the United States department of agriculture (USDA) child and adult care food program child care component.
(F) When infant formula is prepared by the center, it shall be prepared according to the manufacturer's instructions or instructions from the child's physician or advance practice nurse.
(G) The center shall clean and sanitize all surfaces just prior to preparing formula, breast milk or food. All equipment, including bottles and nipples, shall be washed in a dishwasher or scrubbed with hot water containing soap, thoroughly rinsed and boiled for one minute prior to use or reuse. Handwashing facilities shall not be used for formula, breast milk or food preparation or for rinsing or washing dishes and bottles.
(H) Centers that care for infants shall have available the appropriate commercially prepared formula for the infant in the event that the parent or guardian does not provide a quantity of formula sufficient to meet the infant's daily requirement. Formula beyond its expiration date shall not be served.
(I) The center shall develop and implement a plan for the safe storage of food, formula and breast milk.
(1) 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.
(2) Until used, all formula or food shall be labeled with the child's name and date of preparation and refrigerated immediately after preparation or upon arrival if prepared by the parent or guardian, and sent home daily. Formula or food that is commercially prepared may not be required to be refrigerated until after opening and shall be stored and served according to the manufacturer's instructions and the expiration date on the label and labeled with the child's name and date of preparation.
(3) If breast milk is provided by the parent or guardian, it shall be labeled with the child's name, date expressed and the date of receipt. Centers shall follow the chart below in regard to storing breast milk:
Breast milk storage guidelines
If breast milk is stored: Then keep it as long as:
at room temperature (up to 78 degrees Fahrenheit) 6 to 8 hours
in the refrigerator (39 degrees Fahrenheit or lower) up to 5 days counted from the day the breast milk was expressed
in a freezer compartment inside a refrigerator (5 degrees Fahrenheit) 2 weeks
in a freezer compartment of a refrigerator with separate doors (0 degrees Fahrenheit) 3 to 6 months
chest or upright deep freezer (- 4 degrees Fahrenheit) 6 to 12 months
(4) If formula or fluid breast milk is to be warmed, bottles shall be placed in a container of hot, not boiling, water or be placed in a commercial bottle warmer. The container of water shall be emptied and cleaned each day. The bottle shall be shaken well, and the formula or breast milk temperature tested before feeding. Frozen breast milk shall be thawed under cold running water or in the refrigerator.
(5) Microwave ovens shall not be used for heating formula, breast milk or other liquids.
(6) Infant bottles, formula, breast milk and food shall be readily available to staff. Staff/child ratios and supervision shall be maintained when staff are obtaining, preparing or warming bottles or food.
(7) 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.
(8) Food heated in a microwave oven shall be stirred or shaken to avoid uneven heating.