# COMAR Title 13A — State Board of Education

## Subtitle 18 — Large Family Child Care Homes

### Chapter 12 — Nutrition

**Authority:** 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)

**Administrative History:** Effective date: February 6, 2012 (39:2 Md. R. 142)

**Administrative History:** Regulation .01 repealed and new Regulation .01 adopted effective July 20, 2015 (42:14 Md. R. 884)

**Administrative History:** Regulation .01B amended effective January 13, 2020 (47:1 Md. R. 17)

**Administrative History:** Regulation .06D amended effective January 13, 2020 (47:1 Md. R. 17)

#### Regulation .01 Food Service.

*COMAR 13A.18.12.01*

A. Food and beverages that are furnished by a provider 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.

B. Unless provided by the child’s parent, the provider shall furnish:

  (1) All beverages, including beverages for meals and snacks; and

  (2) Milk with all meals.

C. A beverage furnished by the provider may not contain an added sweetener or caffeine, except for:

  (1) Infant formula: or

  (2) A beverage prescribed for a child by a health care provider.

D. If the child is:

  (1) Younger than 2 years old, milk furnished to the child shall be supplied or approved by the child’s parent; or

  (2) 2 years old or older, milk furnished to the child by the provider shall be 1% fat milk or nonfat milk, unless otherwise ordered by a health care provider or requested by the child’s parent.

E. The provider may arrange with the child’s parent to furnish milk of a type that is different from the milk ordinarily furnished by the provider.

F. Except during approved hours of overnight care, a provider shall serve meals and snacks at intervals of not more than 3 hours according to the following schedule:

G. If a provider chooses not to provide meals, the provider shall make arrangements with the parent of each child to provide food for meals.

H. A provider shall keep a supply of nutritious food on hand in order to provide food to a child whose parent has not supplied:

  (1) Food for meals or snacks; or

  (2) Sufficient food to meet the standards of the Child and Adult Care Food Program of the U.S. Department of Agriculture.

I. Menus. A provider shall:

  (1) Post in a conspicuous place a weekly planned menu of foods and beverages furnished by the provider for meals and snacks; and

  (2) Keep a dated record of food actually served in the home, and to each child on a modified diet, on file for at least 4 weeks, correcting the planned menu if necessary.

#### Regulation .02 Modified Diet.

*COMAR 13A.18.12.02*

If a provider agrees to accept a child who requires a modified diet for:

A. Medical reasons, the provider shall obtain from the child's parent a written prescription for the diet signed and dated by the child's registered health practitioner within the previous 6 months; or

B. Cultural or religious reasons, the provider shall obtain written, dated instructions for the diet signed by the child's parent.

#### Regulation .03 Food Sources.

*COMAR 13A.18.12.03*

A. A provider shall furnish food at the child care home 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.

B. A provider may not provide to the children home-canned goods or any other hermetically sealed food prepared in a place other than a registered food processing establishment.

C. A provider:

  (1) Shall provide only fluid milk and fluid milk products that are:

    (a) Pasteurized Grade A;

    (b) Except as provided by §C(3) of this regulation, served from the original container; and

    (c) Not more than 4 days older than the expiration date marked on the original container;

  (2) 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

  (3) 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.

#### Regulation .04 Food Storage and Preparation.

*COMAR 13A.18.12.04*

A. A provider shall:

  (1) Protect all food from contamination while it is being stored, transported, or displayed; and

  (2) Prepare and serve food, including infant formula, in a safe, sanitary, and healthful manner.

B. There shall be sufficient storage areas for all food brought from the child’s home and all food held in reserve for service by the provider.

C. Food shall be stored:

  (1) In an area that is dry, cool, well-ventilated, well-lighted, and equipped with easily cleanable shelving; and

  (2) If stored on open shelves, at least 6 inches off the floor.

D. Food may be stored:

  (1) Separately from family food; or

  (2) With family food if the provider chooses to have the entire family food storage area inspected.

E. If food is transferred for storage from its original container, the provider shall provide a secondary storage container that is:

  (1) Easily cleanable or disposable;

  (2) Nontoxic;

  (3) Nonabsorbent;

  (4) Tightly closed; and

  (5) Clearly labeled as to its contents.

F. The provider:

  (1) May not store food below overhead waste lines;

  (2) Shall maintain cooked, potentially hazardous hot food at or above a temperature of 140°F;

  (3) Shall refrigerate potentially hazardous food at or below a temperature of 40°F;

  (4) Shall keep frozen food at or below 0°F; and

  (5) Shall restrict the movement of pets and other animals so that food and food contact surfaces are not contaminated.

G. Single service items such as paper and plastic cups, containers, lids, plates, knives, forks, spoons, and placemats shall be:

  (1) Used only once; and

  (2) Stored, handled, and dispensed to protect them from contamination.

H. 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.

I. The provider shall discard:

  (1) All spoiled fruits, vegetables, or other food;

  (2) Refrozen food;

  (3) Potentially hazardous frozen food that has been thawed and not immediately cooked and served;

  (4) Swelled, rusty, or leaky canned foods;

  (5) Foods exposed to fire, smoke, or water damage;

  (6) After a child finishes eating, any remaining food that has come into contact with:

    (a) The child's mouth; or

    (b) An eating utensil that has been used by the child; and

  (7) 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.

J. The provider shall send home or discard at the end of each day all opened containers of food brought from home for a child.

#### Regulation .05 Food Preparation Area and Equipment.

*COMAR 13A.18.12.05*

A. Appliances and equipment in the food preparation area shall be:

  (1) Cleaned and sanitized;

  (2) In good repair;

  (3) Capable of normal operation; and

  (4) Not conducive to the harboring of insects and rodents.

B. Food contact surfaces shall be nontoxic, smooth, in good repair, and free of breaks, open seams, cracks, pits, and similar imperfections.

C. Refrigeration shall be:

  (1) Of sufficient capacity to store all food and beverages that require refrigeration;

  (2) Operated at or below 40°F; and

  (3) Equipped with an indicating thermometer graduated at 2°F intervals.

D. All frozen food units shall be operated at 0°F or less, and shall be provided with an indicating thermometer.

E. 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.

#### Regulation .06 Feeding Infants and Toddlers.

*COMAR 13A.18.12.06*

A. The provider shall ensure that the written feeding schedule for each infant and toddler, as required by COMAR 13A.18.03.02C, is:

  (1) Followed; and

  (2) Updated as necessary or at least every 3 months while the child is in care.

B. Self-Feeding by Children Younger than 18 Months Old.

  (1) The child shall be held for each bottle feeding except when developmentally able and insistent upon self-feeding.

  (2) The child may hold the bottle only:

    (a) When seated; and

    (b) If the bottle is made of unbreakable material.

C. Except as specified by §D of this regulation, a provider may serve a child younger than 18 months old only developmentally appropriate:

  (1) Commercially prebottled formula;

  (2) Breast milk, formula, juice, or water which has been prebottled for the child and provided by the child's parent;

  (3) Commercially processed baby food that is opened and used the same day;

  (4) Commercial infant formula, in concentrate, powder, or ready-to-feed form, if the:

    (a) Child's parent has provided prior written authorization for the use of the formula; and

    (b) Formula is prepared directly from a factory-sealed container and in accordance with the manufacturer's instructions; and

  (5) Other foods supplied by the provider or the parent that are consumed the same day.

D. Only whole, pasteurized milk will be served to a child younger than 2 years old who is not receiving formula or breast milk, except that skim milk, reconstituted nonfat dry milk, or 1 or 2 percent milk may be served upon the written prior approval of the child’s parent and health care provider.

E. A provider shall ensure that:

  (1) All food and bottles intended for consumption or use by a child younger than 18 months old are labeled with the child’s name, dated, and refrigerated at 40°F or below if potentially hazardous;

  (2) All nipples on bottles are protected;

  (3) Breast milk or formula which has been bottled for the child is:

    (a) Placed immediately in a refrigerator when brought to the child care home;

    (b) Warmed to the desired temperature immediately before feeding; and

    (c) Served to the child at a temperature that is safe and conducive to the child's comfortable feeding;

  (4) Foods that present a high risk of choking for children younger than 2 years old are not served to them; and

  (5) Reusable bottles and nipples are:

    (a) Reused only after they have been washed, rinsed, and sanitized; or

    (b) If supplied by the child's parent, rinsed after use and returned daily to the parent.