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Daily activities must promote healthy growth and development, while taking into account different cultural backgrounds/traditions familiar to the children, and incorporate indoor/outdoor activities that are age and developmentally appropriate for the children in care.

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Each child must be offered a choice of and an opportunity to participate in activities that may include:

age-appropriate toys

play equipment

books

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Activities, supplies, and equipment shall be designed to promote:

Large, small, and visual motor development

Running

Climbing

Jumping

Grasping objects

Drawing

Buttoning

Tying

Creative expression

Dramatic play

Music

Art

Math & science skills

sorting

matching

counting

measuring

Language development & literacy

reading

singing

fingerplays

writing

stories

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Each child is to be giving the opportunity for at minimum 1 hour of physical activity daily, either outdoors or indoors.

Unless prohibited by medical or extreme weather conditions, each child shall be taken outdoors daily. Children 12 months or older shall have the opportunity for at least 1 hour outdoor play daily.

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Each licensee and temporary permit holder must ensure that the following are met if inclusion of media viewing:

every media program is age-appropriate and, if rated, shall have the rating appropriate for ages and developmental levels of children

no child shall be required to participate in media viewing. Each child that is not engaged in media viewing, there is an activity provided for that time period.

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Toys and other items used by children are required to meet the following:

be clean, of safe construction, and in good repair

be washed and sanitized daily when used by children under 18 months

be washed and sanitized before being used by another child if contaminated by saliva or other bodily fluids

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Each provider shall ensure that each child is assisted, as needed, with hand washing, toileting, and other personal care.

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No provider is to use tobacco products while providing direct care to children. Smoking in any room, enclosed area, or other enclosed space on the premises shall be prohibited when children are in care.

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Each licensee and temporary permit holder shall develop and implement menu plans for meals and snacks that contain a variety of healthful foods including:

fresh fruits

fresh vegetables

whole grains

lean meats

low-fat dairy products

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Requirements for children under 18 months of care are:

each child shall be held when bottle-fed until the child can hold their own bottle

no child shall be allowed to sleep with a bottle in their mouth

Prepared formula requirements:

bottles containing prepared formula must be stored in the fridge with the nipple covered

bottles are to be labeled with the child's name, contents, and time/date prepared and are to be used within 24 hours of the time on the label

If the child doesn't finish the bottle, contents shall be discarded within 1 hour from when the feeding from that bottle started

Breast milk requirements:

all breast milk is to be labeled with child's name and time/date expressed

unfrozen breast milk shall be stored and used within 96 hours from the time it was expressed

frozen breast milk shall be stored in a freezer and used within 6 months of the time it was expressed and 24 hours of unfreezing

If the child doesn't finish the breast milk bottle within 2 hours of beginning of feeding, contents are to be discarded

Accommodations are to be provided to breastfeeding parents

No formula or breast milk is to be heated in a microwave

Solids shall be offered when the provider and parent/legal guardian of the child determine that the child is ready for solids. Open containers of solids shall be labeled with name, contents, and date opened. Containers are to be covered and stored in a fridge.

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Each temporary permit holder and licensee must serve nutritious meals and snacks based on the amount of time a child is in care.

at least 2.5 hours but under 4 hours: 1 snack at least

at least 4 hours but under 8 hours: 1 snack and 1 meal

at least 8 hours but under 10 hours: 2 snacks and 1 meal; or 1 snack and 2 meals

10+ hours: 2 meals and 2 snacks

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Requirements for meals/snacks:

Breakfast

a fruit, vegetable, full-strength fruit juice, or full-strength vegetable juice

bread or grain product

milk

Noon/evening meals (1 item from each)

meat/meat alternative

2 vegetables/2 fruits; or 1 vegetable/1 fruit

bread or grain product

milk

midmorning/afternoon snacks (at least 2)

milk

fruit, vegetable, full-strength fruit juice, or full-strength vegetable juice

meat/meat alternative

bread or grain product

Juice shall not be served if milk is served as the only other item

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A sufficient quantity of food shall be prepared for each meal to allow children to have a second portion of:

bread

milk

and either vegetables or fruits

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Drinking water shall be available to each child at all times while in care.

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All milk products served are pasturized.

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All juices served are pasteurized and full-strength (100%).

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Food allergies or special dietary need arrangements are to be made by the provider and parent(s)/legal guardian for alternative foods/beverages.

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Catered/meal delivery from off-site location requirements:

food provided from a centeral kitchen/vendor and delivered to the facility shall be obtained from a source licensed or inspected by the Kansas Department of Agriculture or an equivalent food safety licensing agency in another state

Food shall be transported in covered and temperature-controlled containers and shall not be allowed to stand.

Hot foods shall be maintained at no less than 140 degrees Fahrenheit

Cold foods shall be maintained at 45 degrees Fahrenheit or less

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Meals and snacks shall be served to each child using individual tableware that is appropriate for the food/beverage being served. Food shall be served on tableware appropriate for that food and shall not be served directly on a bare surface (i.e. tabletop).

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Tableware shall be washed, rinsed, and air-dried or placed in a dishwasher after each meal.

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Sanitary methods of food handling and storage shall be followed.

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A washable/disposable towel and washcloth shall be provided for each child.

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Hands shall be washed using soap and warm running water and dried with an individual towel or disposable product.

If cloth towels are used, they are to be labeled with the child's name and laundered at least weekly.

When soap and water are not readily available, an alcohol-based hand sanitizer may be used only by adults and, under adult supervision, by children 2 years and older.

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Individuals caring for children must wash hands when hands are soiled and when the following occurs:

start of hours of operation or when first arriving at the facility

returning from outdoors

after toileting, diapering, assisting a child with toileting, or handling any bodily fluids

before preparing each snack and meal

before/after eating each snack and meal

before/after administering any medications

after feeding/handling any animal

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Children must was their hands when soiled and when the following occurs:

arriving to the facility

returning from outdoors

after toileting, diapering, or changing wet/soiled clothing

before/after eating each snack and meal

after feeding/handling any animal

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A completed medical record on the form provided by the department shall be on file for each child under 10 enrolled and each child under 16 living in the child care facility. Each file must include:

results of a health assessment conducted by a nurse approved to preform health assessments/licensed physician/physician assistant. Assessment shall not be conducted no more than 12 months before and no later than 60 days after the child's initial enrollment in a child care facility

medical history obtained from the parent/legal guardian. Temporary permit holders and licensees are to review with each parent/legal guardian the child's medical history at least 1 time every 12 months.

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Children under 16 shall not be required to have a routine TB test.

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Immunizations for each child shall be current as medically appropriate and shall be maintained current for protection from diseases.

A record of each child's immunizations shall be obtained no later than 60 days after the child's initial enrollment in the facility and shall be maintained on the child's medical record.

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Exemptions to the immunization requirements shall be permitted as specified in KSA 65-508 and must have documentation of each exemption on file.

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If an infant who has not had the immunization MMRV because of age when enrolled and there are children in care that have not had MMRV immunizations dur to an exception, the parents of the infant at risk shall sign a statement that the parents have been informed of the risk to their child. This shall be in the infant's file at the facility.

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If a child is moved to a different care facility, a new health assessment shall not be required if the previous health assessment is available.

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Each temporary permit holder and licensee shall provide information to parents of children about the benefits of annual well-child health assessments for children under 6 years and biennial health assessments for children 6 years and older. They must also provide information about the importance of seeking medical advice when children exhibit health problems.

This information shall be given on a form provided by the department to the parent when the child is enrolled or be posted in a conspicuous place, with copies available to parents upon request.

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Each temporary permit holder and licensee shall ensure that a file is maintained for each individual child.

Files must include:

full name, home/business addresses, and telephone numbers of parent(s) or legal guardian and the name, address, and telephone number of the individual(s) to notify in case of emergency

full name and telephone number of individuals authorized to remove the child from the facility

medical record as required by KAR 28-4-117(a)

written permission from the parent(s)/legal guardian for emergency medical care and for the child to go off the license premises