(d)

1. (1) The caregiver shall implement relationship-based practices that promote consistency and continuity of care for infants and toddlers.

2. (2) Infant and toddler caregivers and teachers shall:

   1. (A) Respond promptly to cries and calls of distress by verbally acknowledging, gently touching, and holding children;
   2. (B)

(i) Engage children in frequent rich social exchanges in a variety of ways.

1. (ii) For example:

(b) (b) Patting;

1. (c) (c) Making frequent eye contact;

   1. (d) (d) Smiling;

(f) (f) Using a pleasant calm voice in conversation;

1. (C) Engage children in frequent positive social exchanges during routine care such as:

   1. (i) Eating;

      1. (ii) Diaper changing;
      2. (iii) Toileting; and
      3. (iv) Preparing for rest;

   2. (D) Provide consistent emotional support to infants and toddlers by:

      1. (i) Acknowledging their feelings and emotions; and
      2. (ii) Providing physical and verbal support;

   3. (E) Communicate consistently with parents and guardians by:

      1. (i) Greeting them warmly; and
      2. (ii) Exchanging information that promotes continuity between the center and the child’s home; and

   4. (F) Engage in play activities with children by:

      1. (i) Providing a safe environment to explore;
      2. (ii) Modeling play behavior such as imagination and use of toys and equipment; and
      3. (iii) Providing verbal encouragement and support.

(f)

1. (1) Outdoor play for infants and toddlers may include riding in a stroller.
2. (2) However, infants and toddlers shall be offered opportunities for gross motor play outdoors as well.

(h)

1. (1) Infants and toddlers shall be placed in age-appropriate cribs, cots, or mats meeting Consumer Product Safety Commission standards when they fall asleep.

2. (2) Note. Also, any items used in the crib must be used according to manufacturer guidelines, regardless of whether the child is sleeping or not, in accordance with 20 CAR § 476-1001(a).

   1. (i)
3. (1) Infants (children twelve (12) months and below) shall be placed flat on their backs to sleep, in accordance with American Academy of Pediatrics guidelines, to lessen the risk of suffocation and Sudden Infant Death Syndrome.
4. (2) If a child rolls over on his or her own, the facility is not required to reposition the child.

5. (3) If there is a medical reason a child cannot sleep on his or her back, then a signed statement from the child’s physician must be in the file stating the:

   1. (A) Reason;
   2. (B) Sleep position indicated; and
   3. (C) Time frame this is required.

(j)

1. (1) Infants’ sleep space (e.g., crib) shall be free of loose bedding.
2. (2) If a light blanket is necessary, it is recommended that it be kept at or below the midchest area of the child.
3. (3) Staff shall not cover the faces of infants.

(k) Pacifiers, if used, shall not be secured around the neck by a cord or by any other means that could represent a strangulation hazard.

1. (l) Pillows, including nursing or Boppy pillows, bumpers and bumper pads, and stuffed animals, shall not be placed in cribs.

   1. (m) Toys or materials used by younger children shall not be small enough to be swallowed.

(n)

1. (1) Toys used by infants and toddlers shall be safe and sanitized as needed to help prevent the spread of contagious diseases.
2. (2) Toys that cannot be cleaned and sanitized shall not be used.