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<chapter num="12" heading="Nutrition" title_num="13A" subtitle_num="16">
  <regulation prefix="Regulation" num=".01" heading="Food Service.">
    <paragraph num="A.">
      <text>Food and Beverages.</text>
      <paragraph num="(1)">
        <text>Food and beverages that are furnished by an operator for meals or snacks, or both, shall comply with the guidelines of the Child and Adult Care Food Program of the U.S. Department of Agriculture, as indicated on a chart supplied by the office.</text>
      </paragraph>
      <paragraph num="(2)">
        <text>For children in care, unless provided by the child’s parent, the operator shall furnish:</text>
        <paragraph num="(a)">
          <text>All beverages, including beverages for meals and snacks; and</text>
        </paragraph>
        <paragraph num="(b)">
          <text>Milk with all meals.</text>
        </paragraph>
      </paragraph>
      <paragraph num="(3)">
        <text>A beverage furnished by the operator may not contain an added sweetener or caffeine, except for:</text>
        <paragraph num="(a)">
          <text>Infant formula: or</text>
        </paragraph>
        <paragraph num="(b)">
          <text>A beverage prescribed for a child by a health care provider.</text>
        </paragraph>
      </paragraph>
      <paragraph num="(4)">
        <text>If a child is:</text>
        <paragraph num="(a)">
          <text>Younger than 2 years old, milk furnished to the child shall be supplied or approved by the child’s parent; or</text>
        </paragraph>
        <paragraph num="(b)">
          <text>2 years old or older, milk furnished to the child by the operator shall be 1% fat milk or nonfat milk, unless otherwise ordered by a health care provider or requested by the child’s parent.</text>
        </paragraph>
      </paragraph>
      <paragraph num="(5)">
        <text>The operator may arrange with a child’s parent to furnish milk of a type that is different from the milk ordinarily furnished by the operator.</text>
      </paragraph>
      <paragraph num="(6)">
        <text>The operator shall keep a supply of nutritious food on hand in order to provide food to a child whose parent has not supplied:</text>
        <paragraph num="(a)">
          <text>Food for meals or snacks; or</text>
        </paragraph>
        <paragraph num="(b)">
          <text>Sufficient food to meet the standards of the Child and Adult Care Food Program of the U.S. Department of Agriculture.</text>
        </paragraph>
      </paragraph>
    </paragraph>
    <paragraph num="B.">
      <text>Hours of Operation. If a center operates:</text>
      <paragraph num="(1)">
        <text>4 or more consecutive hours a day, the operator shall furnish either:</text>
        <paragraph num="(a)">
          <text>All meals and snacks; or</text>
        </paragraph>
        <paragraph num="(b)">
          <text>Snacks; or</text>
        </paragraph>
      </paragraph>
      <paragraph num="(2)">
        <text>Less than 4 consecutive hours a day, the operator shall either:</text>
        <paragraph num="(a)">
          <text>Furnish food and beverages for meals or snacks, or both; or</text>
        </paragraph>
        <paragraph num="(b)">
          <text>Make arrangements with the parent of a child to provide food and beverages for meals or snacks, or both.</text>
        </paragraph>
      </paragraph>
    </paragraph>
    <paragraph num="C.">
      <text>Except during approved hours of overnight care, an operator shall serve meals and snacks at intervals of not more than 3 hours according to the following schedule:</text>
    </paragraph>
    <paragraph num="D.">
      <text>If an operator chooses not to provide meals, the operator shall make arrangements with the parent of each child to provide food for meals.</text>
    </paragraph>
    <paragraph num="E.">
      <text>Menus. An operator shall:</text>
      <paragraph num="(1)">
        <text>Post in a conspicuous place a weekly planned menu of foods and beverages furnished by the center for meals and snacks; and</text>
      </paragraph>
      <paragraph num="(2)">
        <text>Keep a dated record of food actually served in the center, and to each child on a modified diet, on file for at least 4 weeks, correcting the planned menu if necessary.</text>
      </paragraph>
    </paragraph>
  </regulation>
  <regulation prefix="Regulation" num=".02" heading="Modified Diet.">
    <text>If an operator agrees to accept a child who requires a modified diet for:</text>
    <paragraph num="A.">
      <text>Medical reasons, the operator shall obtain from the child's parent a written prescription for the diet signed and dated by the child's licensed health practitioner within the previous 6 months; or</text>
    </paragraph>
    <paragraph num="B.">
      <text>Cultural or religious reasons, the operator shall obtain written, dated instructions for the diet signed by the child's parent.</text>
    </paragraph>
  </regulation>
  <regulation prefix="Regulation" num=".03" heading="Food Sources.">
    <paragraph num="A.">
      <text>An operator shall furnish food at the center only if it is wholesome and free from spoilage, filth, or other contamination and obtained from sources that comply with all laws relating to food, food processing, food handling, and food labeling.</text>
    </paragraph>
    <paragraph num="B.">
      <text>If an operator contracts to have food furnished from an outside source, such as a catering service, the operator shall ensure that the food:</text>
      <paragraph num="(1)">
        <text>Has been prepared and processed in a licensed food service facility or in a licensed food processing plant; or</text>
      </paragraph>
      <paragraph num="(2)">
        <text>Consists of a snack or party food which is not potentially hazardous and does not present a significant risk of transmitting food-borne disease.</text>
      </paragraph>
    </paragraph>
    <paragraph num="C.">
      <text>An operator may not provide to the children home-canned goods or any other hermetically sealed food prepared in a place other than a licensed food processing establishment.</text>
    </paragraph>
    <paragraph num="D.">
      <text>An operator:</text>
      <paragraph num="(1)">
        <text>Shall provide only fluid milk and fluid milk products that are:</text>
        <paragraph num="(a)">
          <text>Pasteurized Grade A;</text>
        </paragraph>
        <paragraph num="(b)">
          <text>Except as provided by §D(3) of this regulation, served from the original container; and</text>
        </paragraph>
        <paragraph num="(c)">
          <text>Not more than 4 days older than the expiration date marked on the original container;</text>
        </paragraph>
      </paragraph>
      <paragraph num="(2)">
        <text>Except as provided at Regulation .06D of this chapter, may use dry milk, dry milk products, or reconstituted dry milk only for cooking purposes; and</text>
      </paragraph>
      <paragraph num="(3)">
        <text>For meals and snacks, may serve milk family-style from a pitcher or similar container into which the milk has been poured from the original container.</text>
      </paragraph>
    </paragraph>
  </regulation>
  <regulation prefix="Regulation" num=".04" heading="Food Storage and Preparation.">
    <paragraph num="A.">
      <text>An operator shall:</text>
      <paragraph num="(1)">
        <text>Protect all food from contamination while it is being stored, transported, or displayed; and</text>
      </paragraph>
      <paragraph num="(2)">
        <text>Prepare and serve food, including infant formula, in a safe, sanitary, and healthful manner.</text>
      </paragraph>
    </paragraph>
    <paragraph num="B.">
      <text>There shall be sufficient storage areas for all food brought from home and all food held in reserve for service by the operator.</text>
    </paragraph>
    <paragraph num="C.">
      <text>Food shall be stored:</text>
      <paragraph num="(1)">
        <text>In an area that is dry, cool, well-ventilated, well-lighted, and equipped with easily cleanable shelving; and</text>
      </paragraph>
      <paragraph num="(2)">
        <text>At least 6 inches off the floor to facilitate cleaning.</text>
      </paragraph>
    </paragraph>
    <paragraph num="D.">
      <text>In a small center, food may be stored:</text>
      <paragraph num="(1)">
        <text>Separately from family food; or</text>
      </paragraph>
      <paragraph num="(2)">
        <text>With family food if the operator chooses to have the entire family food storage area inspected.</text>
      </paragraph>
    </paragraph>
    <paragraph num="E.">
      <text>If food is transferred for storage from its original container, the operator shall provide a secondary storage container that is:</text>
      <paragraph num="(1)">
        <text>Easily cleanable;</text>
      </paragraph>
      <paragraph num="(2)">
        <text>Nontoxic;</text>
      </paragraph>
      <paragraph num="(3)">
        <text>Nonabsorbent;</text>
      </paragraph>
      <paragraph num="(4)">
        <text>Tightly closed; and</text>
      </paragraph>
      <paragraph num="(5)">
        <text>Clearly labeled as to its contents.</text>
      </paragraph>
    </paragraph>
    <paragraph num="F.">
      <text>The operator:</text>
      <paragraph num="(1)">
        <text>May not store food below overhead waste lines;</text>
      </paragraph>
      <paragraph num="(2)">
        <text>Shall maintain cooked, potentially hazardous hot food at or above a temperature of 140° F;</text>
      </paragraph>
      <paragraph num="(3)">
        <text>Shall refrigerate potentially hazardous food at or below a temperature of 40° F;</text>
      </paragraph>
      <paragraph num="(4)">
        <text>Shall keep frozen food at or below 0° F; and</text>
      </paragraph>
      <paragraph num="(5)">
        <text>Shall restrict the movement of pets and other animals so that food and food contact surfaces are not contaminated.</text>
      </paragraph>
    </paragraph>
    <paragraph num="G.">
      <text>Single service items such as paper and plastic cups, containers, lids, plates, knives, forks, spoons, and placemats shall be:</text>
      <paragraph num="(1)">
        <text>Used only once; and</text>
      </paragraph>
      <paragraph num="(2)">
        <text>Stored, handled, and dispensed to protect them from contamination.</text>
      </paragraph>
    </paragraph>
    <paragraph num="H.">
      <text>During an activity in which the children prepare food, the activity shall be planned and carried out in a manner consistent with the safety and health practices required in this subtitle.</text>
    </paragraph>
    <paragraph num="I.">
      <text>The operator shall discard:</text>
      <paragraph num="(1)">
        <text>All spoiled fruits, vegetables, or other food;</text>
      </paragraph>
      <paragraph num="(2)">
        <text>Refrozen food;</text>
      </paragraph>
      <paragraph num="(3)">
        <text>Potentially hazardous frozen food that has been thawed and not immediately cooked and served;</text>
      </paragraph>
      <paragraph num="(4)">
        <text>Swelled, rusty, or leaky canned foods;</text>
      </paragraph>
      <paragraph num="(5)">
        <text>Foods exposed to fire, smoke, or water damage;</text>
      </paragraph>
      <paragraph num="(6)">
        <text>After a child finishes eating, any remaining food that has come into contact with:</text>
        <paragraph num="(a)">
          <text>The child's mouth; or</text>
        </paragraph>
        <paragraph num="(b)">
          <text>An eating utensil that has been used by the child; and</text>
        </paragraph>
      </paragraph>
      <paragraph num="(7)">
        <text>After being left out for consumption by children during a meal or snack, any milk remaining in an opened original container, a pitcher or similar container, or a drinking vessel.</text>
      </paragraph>
    </paragraph>
    <paragraph num="J.">
      <text>The operator shall send home or discard at the end of each day all opened containers of food brought from home for a child.</text>
    </paragraph>
  </regulation>
  <regulation prefix="Regulation" num=".05" heading="Food Preparation Area and Equipment.">
    <paragraph num="A.">
      <text>Appliances and equipment in the food preparation area shall be:</text>
      <paragraph num="(1)">
        <text>Cleaned and sanitized;</text>
      </paragraph>
      <paragraph num="(2)">
        <text>In good repair;</text>
      </paragraph>
      <paragraph num="(3)">
        <text>Capable of normal operation; and</text>
      </paragraph>
      <paragraph num="(4)">
        <text>Not conducive to the harboring of insects and rodents.</text>
      </paragraph>
    </paragraph>
    <paragraph num="B.">
      <text>Food contact surfaces shall be nontoxic, smooth, in good repair, and free of breaks, open seams, cracks, pits, and similar imperfections.</text>
    </paragraph>
    <paragraph num="C.">
      <text>Refrigeration shall be:</text>
      <paragraph num="(1)">
        <text>Of sufficient capacity to store all food and beverages that require refrigeration;</text>
      </paragraph>
      <paragraph num="(2)">
        <text>Operated at or below 40° F; and</text>
      </paragraph>
      <paragraph num="(3)">
        <text>Equipped with an indicating thermometer graduated at 2° F intervals.</text>
      </paragraph>
    </paragraph>
    <paragraph num="D.">
      <text>All frozen food units shall be operated at 0° F or less, and shall be provided with an indicating thermometer.</text>
    </paragraph>
    <paragraph num="E.">
      <text>Centers operating more than 4 consecutive hours shall provide refrigeration.</text>
    </paragraph>
    <paragraph num="F.">
      <text>Except in a small center or when only snacks are provided by the operator, a separate handwashing sink which is equipped with soap and paper towels shall be provided in or adjacent to each food preparation area. Food preparation and utensil washing sinks may not be used for handwashing.</text>
    </paragraph>
    <paragraph num="G.">
      <text>A cooking exhaust hood shall be provided when routine cleaning does not eliminate condensation or greasy film.</text>
    </paragraph>
    <paragraph num="H.">
      <text>Utensils and equipment used for the preparation and service of food and beverages shall be cleaned, sanitized, air dried, and stored in a manner approved by the office.</text>
    </paragraph>
    <paragraph num="I.">
      <text>Floors and walls in a food preparation area shall be easily cleanable and maintained in a clean condition.</text>
    </paragraph>
  </regulation>
  <regulation prefix="Regulation" num=".06" heading="Infant Feeding.">
    <paragraph num="A.">
      <text>The operator shall ensure that the written feeding schedule for an infant or toddler, as required by COMAR 13A.16.03.02D(1), is:</text>
      <paragraph num="(1)">
        <text>Followed; and</text>
      </paragraph>
      <paragraph num="(2)">
        <text>Updated as necessary or at least every 3 months while the child is in care.</text>
      </paragraph>
    </paragraph>
    <paragraph num="B.">
      <text>Infant Self-Feeding.</text>
      <paragraph num="(1)">
        <text>An infant shall be held for each bottle feeding except when the infant or toddler is developmentally able and insistent upon self-feeding.</text>
      </paragraph>
      <paragraph num="(2)">
        <text>When an infant or toddler holds the bottle, the infant or toddler may do so only:</text>
        <paragraph num="(a)">
          <text>When seated; and</text>
        </paragraph>
        <paragraph num="(b)">
          <text>If the bottle is made of unbreakable material.</text>
        </paragraph>
      </paragraph>
    </paragraph>
    <paragraph num="C.">
      <text>Except as specified by §D of this regulation, an operator may serve an infant or toddler only developmentally appropriate:</text>
      <paragraph num="(1)">
        <text>Commercially prebottled formula;</text>
      </paragraph>
      <paragraph num="(2)">
        <text>Breast milk, formula, juice, or water which has been prebottled for the child and provided by the child's parent;</text>
      </paragraph>
      <paragraph num="(3)">
        <text>Commercially processed baby food that is opened and used the same day;</text>
      </paragraph>
      <paragraph num="(4)">
        <text>Commercial infant formula, in concentrate, powder, or ready-to-feed form, if the:</text>
        <paragraph num="(a)">
          <text>Child's parent has provided prior written authorization for the use of the formula; and</text>
        </paragraph>
        <paragraph num="(b)">
          <text>Formula is prepared directly from a factory-sealed container and in accordance with the manufacturer's instructions; and</text>
        </paragraph>
      </paragraph>
      <paragraph num="(5)">
        <text>Other foods supplied by the operator or the parent that are consumed the same day.</text>
      </paragraph>
    </paragraph>
    <paragraph num="D.">
      <text>Only whole, pasteurized milk will be served to an infant or toddler who is not receiving formula or breast milk, except that skim milk, reconstituted nonfat dry milk, or 1—2 percent milk may be served upon the written prior approval of the child's parent and health care provider.</text>
    </paragraph>
    <paragraph num="E.">
      <text>An operator shall ensure that:</text>
      <paragraph num="(1)">
        <text>All infant foods and bottles are labeled with the infant's name, dated, and refrigerated at 40° F or below if potentially hazardous;</text>
      </paragraph>
      <paragraph num="(2)">
        <text>All nipples on bottles are protected;</text>
      </paragraph>
      <paragraph num="(3)">
        <text>Breast milk or formula which has been bottled for the child is:</text>
        <paragraph num="(a)">
          <text>Placed immediately in a refrigerator when brought to the center;</text>
        </paragraph>
        <paragraph num="(b)">
          <text>Warmed to the desired temperature immediately before feeding; and</text>
        </paragraph>
        <paragraph num="(c)">
          <text>Served to the child at a temperature that is safe and conducive to the child's comfortable feeding;</text>
        </paragraph>
      </paragraph>
      <paragraph num="(4)">
        <text>Foods that present a high risk of choking for infants and toddlers are not served to them; and</text>
      </paragraph>
      <paragraph num="(5)">
        <text>Reusable bottles and nipples are:</text>
        <paragraph num="(a)">
          <text>Reused only after they have been washed, rinsed, and sanitized; or</text>
        </paragraph>
        <paragraph num="(b)">
          <text>If supplied by the child's parent, rinsed after use and returned daily to the parent.</text>
        </paragraph>
      </paragraph>
    </paragraph>
  </regulation>
  <annotations>
    <annotation type="Authority">Education Article, §§9.5-401, 9.5-404—9.5-411 and 9.5-413—9.5-418; 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)</annotation>
    <annotation type="History" subtype="Administrative History">Effective date: October 20, 2008 (35:21 Md. R. 1826)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .01 amended effective July 20, 2015 (42:14 Md. R. 883)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .01A amended effective January 13, 2020 (47:1 Md. R. 14)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .03E repealed effective April 19, 2010 (37:8 Md. R. 618)</annotation>
  </annotations>
</chapter>