PURPOSE: This rule sets forth the requirements for the care of children, including supervision, emergency drills, discipline, diapering and toileting, and daily activities.

1. (1) Care of the Child.

   1. (A) General Requirements.

      1. 1. Caregivers shall not leave any child without competent

supervision.

1. 2. A caregiver personally shall admit each child upon

arrival and personally shall dismiss each child upon departure. Children shall be dismissed only to the parent(s), guardian, legal custodian, or to individuals approved by the parent(s), guardian, or legal custodian.

1. 3. Caregivers shall provide frequent, direct contact so

children are not left unobserved on the premises.

1. 4. Children under three (3) shall be supervised and assisted

while in the bathroom.

1. 5. A caregiver shall remain in the room with preschool

and school-age children while they are napping or sleeping and shall be able to see and hear them if they have difficulty during napping or when they awaken.

1. 6. Preschool children who do not sleep shall rest on cots

or beds at least thirty (30) minutes, but shall not be forced to remain on cots or beds for longer than one (1) hour. They shall then be permitted to leave the napping area to engage in quiet play.

1. 7. Caregivers shall provide special attention on an

individual basis for new children having problems adjusting, distressed children, etc. Children shall be encouraged but not forced to participate in group activities.

1. 8. Children shall not be subjected to child abuse/neglect

as defined by section 210.110, RSMo.

1. (B) Fire and Tornado Drills.

   1. 1. Fire, tornado, and other disaster drills shall meet the

requirements of 19 CSR 30-62.087 Fire Safety.

1. (C) Discipline.

   1. 1. The provider shall establish simple, understandable

rules for children’s behavior and shall explain them to the children.

1. 2. Expectations for a child’s behavior shall be appropriate

for the developmental level of that child.

1. 3. Only constructive, age-appropriate methods of disci-

pline shall be used to help children develop self-control and assume responsibility for their own actions.

1. 4. Praise and encouragement of good behavior shall be

used instead of focusing only upon unacceptable behavior.

1. 5. Brief, supervised separation from the group may be

used based on a guideline of one (1) minute of separation for each year of the child’s age.

1. 6. Firm, positive statements or redirection of behavior

shall be used with infants and toddlers.

1. 7. Physical punishment including, but not limited to,

spanking, slapping, shaking, biting, or pulling hair shall be prohibited.

1. 8. No discipline technique which is humiliating, threaten-

ing, or frightening to children shall be used. Children shall not be shamed, ridiculed, or spoken to harshly, abusively, or with profanity.

1. 9. Punishment or threat of punishment shall not be asso-

ciated with food, rest, or toilet training.

1. 10. Children shall not be placed in a closet, a locked or

unlit room, or any other place which is frightening.

1. 11. Children shall not be permitted to intimidate or harm

others, harm themselves, or destroy property.

1. (D) Care of Infants and Toddlers.

   1. 1. Infants and toddlers shall have constant care and super-

vision. Home monitors or commercial devices marketed to reduce the risk of Sudden Infant Death Syndrome (SIDS) shall not be used in place of supervision while children are napping or sleeping.

1. 2. Children shall be cared for by the same caregiver on a

regular basis.

1. 3. Caregivers shall be alert to various needs of the child

such as thirst, hunger, diaper change, fear of or aggression by other children, and the need for attention.

1. (E) Diapering and Toilet Training.

   1. 1. Disposable tissues or wipes shall be used to cleanse the

child at each time of diapering. Any diapering creams, powders, or other products applied at the time of diapering shall be provided by the parent(s) and labeled with the child’s name.

1. 2. The diapering table shall be cleaned thoroughly with a

disinfectant after each use.

1. 3. The child shall not be left unattended at any time while

on the diapering table.

1. 4. Diapers and wet clothing shall be changed promptly.
2. 5. Wet or soiled diapers shall be placed in an airtight dis-

posal container located in the diaper change area. If cloth diapers are provided by the parent(s), individual airtight plastic bags shall be used to store each soiled diaper for return each day to the parent(s).

1. 6. Caregivers changing diapers shall wash their hands

with soap and running water each time after changing a child’s diaper.

1. 7. The diapering area and handwashing area shall be sep-

arate from any food service area and any food-related materials.

1. 8. No effort shall be made to toilet train a child until the

parent(s) and provider agree on when to begin.

1. 9. The routine for toilet training shall be discussed with

the parent(s) so the same method will be used at the facility and the child’s home.

1. 10. Children shall not be punished, berated, or shamed in

any way for soiling their clothes. The parent(s) shall provide extra clothing for his/her child in case the child accidentally soils him/herself.

1. (2) Daily Activities for Children.

   1. (A) A daily schedule shall be established in written form which shall include activities for all ages of children in care.

   2. (B) Daily activities for preschool and school-age children shall include—

      1. 1. Developmentally appropriate play experiences and

activities planned to meet the interests, needs, and desires of the children;

1. 2. Individual attention and conversation with caregivers;
2. 3. Indoor and outdoor play periods which provide a

balance of quiet and active play, and individual and small group activities. Activities shall provide some free choice experiences;

1. 4. A total of at least one (1) hour of outdoor play for children

in attendance a full day unless prevented by weather or special medical reasons. (Based on wind chill factor or heat index, children shall not be exposed to either extreme element.);

1. 5. Toileting and handwashing times;
2. 6. Regular snack and meal times;
3. 7. A supervised nap or rest period for preschool children

after the noon meal;

1. 8. A quiet time for school-age children after the noon

meal with a cot or bed available for those who wish to nap or rest; and

1. 9. A study time for school-age children who choose to do

homework, with a separate, quiet work space.

1. (C) Daily activities for infants and toddlers shall include—

   1. 1. Developmental and exploratory play experiences and

free choices of play appropriate to the interests, needs, and desires of infants and toddlers;

1. 2. Regular snack and meal times according to each

infant’s individual feeding schedule as stated by the parent(s);

1. 3. Supervised “tummy time” for children under one (1)

year of age to promote healthy development;

1. 4. A supervised nap period that meets the child’s

individual needs shall meet the following requirements:

1. A. A child under twelve (12) months of age shall be

placed on his/her back to sleep;

1. B. An infant’s head and face shall remain uncovered

during sleep;

1. C. Infants unable to roll from their stomachs to their

backs and from their backs to their stomachs shall be placed on their backs when found face down. When infants can easily turn from their stomachs to their backs and from their backs to their stomachs, they shall be initially placed on their backs, but shall be allowed to adopt whatever positions they prefer for sleep;

1. D. An infant shall not be overdressed when sleeping to

avoid overheating. Infants should be dressed appropriately for the environment, with no more than one (1) layer more than an adult would wear to be comfortable in that environment;

1. E. When, in the opinion of the infant’s licensed health

care provider, an infant requires alternative sleep positions or special sleeping arrangements that differ from those set forth in this rule, the provider shall have on file at the facility written instructions, signed by the infant’s licensed health care provider, detailing the alternative sleep positions or special sleeping arrangements for such infant. The caregiver(s) shall put the infant to sleep in accordance with such written instructions;

1. F. Pacifiers, if used, shall not be hung around the

infant’s neck. Pacifier mechanisms or pacifiers that attach to infant clothing shall not be used with sleeping infants;

1. G. After awakening, an infant may remain in the crib

as long as s/he is content, but never for periods longer than thirty (30) minutes; and

1. H. Toddlers shall be taken out of bed for other activities

when they awaken;

1. 5. Individual attention and play with caregivers,

including holding, cuddling, talking, and singing;

1. 6. Opportunities for sensory stimulation which includes

visual stimulation through pictures, books, toys, nonverbal communication, games, and the like; auditory stimulation through verbal communication, music, toys, games, and the like; and tactile stimulation through surfaces, fabrics, toys, games, and the like;

1. 7. Encouragement in the development of motor skills

by providing opportunities for supervised “tummy time,” reaching, grasping, pulling up, creeping, crawling, and walking; and

1. 8. Opportunity for outdoor play when weather permits.

AUTHORITY: section 161.092, RSMo 2016, and sections 210.221 and 210.223, RSMo Supp. 2023.* This rule previously filed as 13 CSR 40-62.170, 13 CSR 40-62.182, and 19 CSR 40-62.182. Original rule filed March 29, 1991, effective Oct. 31, 1991. Changed to 19 CSR 40- 62.182, effective Dec. 9, 1993. Changed to 19 CSR 30-62.182 July 30, 1998. Amended: Feb. 18, 1999, effective Sept. 30, 1999. Amended: Filed Jan. 28, 2011, effective July 30, 2011. Emergency amendment filed Nov. 10, 2015, effective Nov. 20, 2015, expired May 17, 2016. Amended: Filed Nov. 10, 2015, effective April 30, 2016. Moved to 5 CSR 25-500.182, effective Aug. 30, 2021. Amended: Filed June 7, 2023, effective Jan. 30, 2024. *Original authority: 161.092, RSMo 1963, amended 1973, 2002, 2003, 2013, 2014; 210.221, RSMo 1949, amended 1955, 1987, 1993, 1995, 1999, 2015, 2019, 2020, 2022; and 210.223, RSMo 2015, amended 2022.