Section 144-33-18 - INFANT AND TODDLER CAREA.General standards1. Infants and toddlers must not be allowed to use toys or objects which could be swallowed or cause choking. Foods that are choking hazards due to the size, shape or texture must not be served to infants and toddlers.2. The provider must ensure that infants and toddlers are given a variety of activities to promote proper development.3. Each infant or toddler's position must be changed at least each half hour, when the child is awake.B.Feeding. The provider shall: 1. Hold infants in their arms for bottle-feeding when such infants are not independently bottle-feeding;2. Feed each infant and toddler according to the child's needs;3. Place the child in a chair or table designed to prevent the child from slipping or falling when feeding infants and toddlers;4. Feed the child with dishes and bottles made of unbreakable material or sheathed in material that prevents shattering;5. Warm bottles of breast milk or formula by placing them in a pan of hot (not boiling) water for no longer than five minutes, after which the bottle must be shaken well and the milk temperature tested before feeding. Bottles of formula or breast milk must never be warmed in a microwave oven; and6. Immediately inform the parent if a child is accidentally fed another child's breast milk.C.Diapering. The provider shall check each child for wet or soiled diapers or clothing at least every two hours, and wash and/or change the child, as needed. 1. 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, or individually bagged and tied within a lidded shared garbage container.2. Diapering must be done on a changing table or washable vinyl mat which is cleaned and disinfected after each use, or has a disposable single-use covering.3. The changing table or mat must not be located in the kitchen or food preparation area.4. Providers may use cloth diapers at the parent's request. a. Cloth diapers must have a clean, absorbent inner lining completely contained within an outer covering made of waterproof material that prevents the escape of feces and urine.b. Cloth diapers and clothing that are wet or soiled must be immediately placed in a clean, sealable bag or container and sent home with the child's parent that day. This sealable bag or container must be stored out of reach of children.5. All containers of soiled cloth or disposable diapers must be emptied daily.D.Toilet training. The provider must work with parents to determine the best toileting practice for each child.1. Potty chair receptacles must be emptied immediately after each use.2. Potty chair receptacles must be rinsed and sanitized in a sink not used for food preparation.E.Napping and resting. Infants must be placed on their backs on a flat surface for sleeping, unless the child's parent provides a physician's recommendation. Written documentation from the physician must be stored in the child's file. The provider shall ensure that: 1. A crib or play yard that meets current Consumer Product Safety Commission (CPSC) safety standards, available at https://www.cpsc.gov/s3fs-public/5023.pdf, is provided for each child up to 18 months of age.2. Bassinets that meet current CPSC safety standards may be used for infants up to five months of age, within appropriate weight limits. A provider may not use a bassinet for an infant who can independently lift their chest off the sleep surface.3. Cribs, bassinets and play yards for infants less than 12 months old must not include soft or loose bedding including, but not limited to: bumper pads, pillows, quilts, comforters, blankets, sleep positioning devices, bibs or stuffed toys.4. Sleeping infants must be checked in person at least every 30 minutes.5. Each child must be given rest time, according to the child's age and other needs.6. Dimmed, but adequate, lighting to allow visual supervision of all children must be maintained at all times.10- 144 C.M.R. ch. 33, § 18