The provider or substitute shall: Dress a child appropriately, both indoors and outdoors, for the temperature of the environment and the activity of the child; During an indoor or outdoor activity: Monitor each child for signs of discomfort due to over-activity, temperature or weather conditions, or other environmental factors; and If a child is experiencing discomfort, take appropriate steps to alleviate the discomfort; and Ensure that each child has adequate time for meals and snacks. The provider or substitute shall: Monitor children for signs and symptoms of acute illness; and Notify immediately a child's parent or other person designated on the child's emergency card upon observing a sign or symptom of acute illness. The provider or substitute may not allow a child to enter or remain in care if the child is exhibiting symptoms of acute illness such as, but not limited to: Vomiting; Fever; Seizures; Severe pain; or Diarrhea. A provider or substitute may not knowingly care for a child who has a serious transmissible infection or communicable disease during the period of exclusion for that infection or disease shown in the Communicable Disease Summary, as published by the Maryland Department of Health. Medication Administration. Medication, whether prescription or nonprescription, may not be administered to a child in care unless: Parental permission to administer the medication is documented on a completed, signed, and dated medication authorization form, provided by the office, that is received by the provider or substitute before the medication is administered; and A licensed health practitioner has approved the administration of the medication and the medication dosage. A prescription medication may not be administered to a child unless at least one dose of the medication has been given to the child at home. If medication is by prescription, it shall be labeled by the pharmacy or physician with: The child's name; The date of the prescription; The name of the medication; The medication dosage; The administration schedule; The administration route; If applicable, special instructions, such as “take with food”; and The duration of the prescription; and An expiration date that states when the medication is no longer useable. Topical Applications. A diaper rash product, sunscreen, or insect repellent supplied by a child's parent may be applied without prior approval of a licensed health practitioner. Medication shall be administered according to the instructions on the label of the medication container or a licensed health practitioner's written instructions, whichever are more recently dated. Recording Requirements. Each administration of a prescription or nonprescription medication to a child, including self-administration of a medication by the child, shall be noted in the child's record. Application of a diaper rash product, sunscreen, or insect repellent supplied by a child's parent shall be noted in the child's record. Medication Storage. Each medication shall be: Labeled with the child's name, the dosage, and the expiration date; Stored as directed by the manufacturer, the dispensing pharmacy, or the prescribing physician; and Discarded according to guidelines of the Office of National Drug Control Policy or the U.S. Environmental Protection Agency, or returned to the child's parent upon expiration or discontinuation. All medications shall be stored to make them inaccessible to children in care but readily accessible to the provider, substitute, or additional adult. Self-Administration of Medication. Before a child may self-administer medication while in care, a provider shall: Have a written order from the child's physician and the written request of the child's parent for the child's self-administration of medication; In consultation with the child's parent, establish a written procedure for self-administration of medication by the child based on the physician's written order; and Authorize the child to self-administer medication. Revocation of Authorization to Self-Administer. A provider may revoke a child's authorization to self-administer medication if the child fails to follow the written procedure required by §F(1)(b) of this regulation. Immediately upon revoking the child's authorization to self-administer medication, the provider shall notify the child's parent of that revocation. The provider shall document the revocation of authorization to self-administer and the notification to the child's parent in the child's record. Effective January 1, 2016, medication may be administered to a child in care only by an individual who has completed approved medication administration training, unless: The individual is a registered nurse, licensed practical nurse, or medication technician certified by the Maryland Board of Nursing to administer medication to children in care; or Responsibility for administering medication to children in care has been delegated to the individual by a delegating nurse in accordance with COMAR 10.27.11. Medical Cannabis. The administration of medical cannabis by a caregiver to a child who is a qualifying medical cannabis patient is governed by COMAR 10.62.01—10.62.37. The administration of medical cannabis that includes smoking or vaping is prohibited. If a resident of the family child care home smokes or vapes any substance, including but not limited to tobacco or cannabis, the provider shall make this known in advance to parents who are considering placing their children in the provider's care. A resident may not consume alcohol during the family child care home’s approved hours of operation. A provider and any other individual may not consume alcohol during the family child care home’s approved hours of operation. During the family child care home's hours of operation, if an enrolled child is or will be on the premises, the provider or any other individual may not smoke or vape or permit smoking or vaping anywhere inside the home or any outdoor area approved for child care use. A provider and any other individual may not consume or be under the influence of alcohol, cannabis, or an illegal or nonprescribed controlled dangerous substance while: Present at the family child care home during the home’s hours of operation; or Providing or assisting with the care of children on or away from the premises of the family child care home or during transport. A provider and any other individual shall ensure that all alcohol, tobacco, cannabis, cannabis edibles, and smoking and vaping paraphernalia and byproducts are kept out of the reach of the children in care. Education Article, §§9.5-301—9.5-308, 9.5-310—9.5-312, 9.5-320, and 9.5-321;General Provisions Article, §4-333; Human Services Article, §1-202; Annotated Code of MarylandAgency Note: Federal Statutory Reference — Americans with Disabilities Act of 1990 (42 U.S.C. §12101 et seq.);Pro-Children Act of 1994 (20 U.S.C. §6081 et seq.);Child Care Development Block Grant (45 CFR Parts 98 and 99 and 42 U.S.C. 9858 et seq.);Social Security Act §418 (42 U.S.C. 618) Effective date: October 20, 2008 (35:21 Md. R. 1826) Regulation .01C amended effective March 21, 2011 (38:6 Md. R. 396) Regulation .03 amended effective January 13, 2020 (47:1 Md. R. 12) Regulation .04 amended effective June 24, 2013 (40:12 Md. R. 1043) Regulation .04A, E amended effective April 19, 2010 (37:8 Md. R. 618) Regulation .04B amended effective March 21, 2011 (38:6 Md. R. 396) Regulation .04G adopted effective July 20, 2015 (42:14 Md. R. 882) Regulation .04G amended effective January 13, 2020 (47:1 Md. R. 12) Regulation .04H adopted as an emergency provision effective August 31, 2023 (50:20 Md. R. 885); adopted permanently effective February 5, 2024 (51:2 Md. R. 76) Regulation .05 amended as an emergency provision effective August 31, 2023 (50:20 Md. R. 885); adopted permanently effective February 5, 2024 (51:2 Md. R. 76) Regulation .06 amended effective January 13, 2020 (47:1 Md. R. 12) Regulation .06 repealed as an emergency provision effective August 31, 2023 (50:20 Md. R. 885); repealed permanently effective February 5, 2024 (51:2 Md. R. 76)