Starting infant care: feeding, bottles and naps at daycare

Your baby's day follows their own pattern of feeding, sleep and play, with time out of the crib built in. Ohio's infant care rule, Ohio Administrative Code 5180:2-12-23, requires centers to:

• Take each baby out of the crib, swing, infant seat or other equipment during the day for one-on-one attention
• Let babies sit, crawl, toddle, walk and play as their development allows
• Give every baby who isn't crawling yet tummy time outside the crib each day
• Send home a written record each day of what your baby ate, sleep patterns, the times and results of diaper changes, and daily activities

Ohio allows 1 caregiver for every 5 babies under 12 months, or 2 for 12 in one room. From 12 to 18 months it allows 1 for every 6, and infant groups top out at 12 (rule 5180:2-12-18). Our ratio guide covers other ages.

Staff feed your baby from a written plan, which Ohio requires from you or your baby's doctor, physician assistant or certified nurse practitioner (rule 5180:2-12-23). It lists the type and amount of milk or food and the feeding times or frequency, and you update it as your baby's needs change.

For most healthy full-term babies, the American Academy of Pediatrics (AAP) advises feeding when your baby shows hunger rather than by the clock. Early cues include licking lips, rooting, putting a hand to the mouth and fussing, and crying is a late sign (AAP). Tell staff your baby's cues and how much they usually take.

Ohio's rule also sets these bottle basics:

• Babies come out of the crib for every feeding and are held or fed sitting up, and a bottle is never propped.
• Bottles are never heated in a microwave. They're warmed in water no hotter than 120°F or in a commercial bottle warmer, then shaken and checked before feeding.
• Formula is mixed by the manufacturer's directions or your doctor's, and every bottle is labeled with your baby's name and the date it was prepared.
• Milk or formula left in a bottle your baby drank from is never reheated or reused, and unused prepared formula goes home or is thrown out daily.

Label every bottle with your baby's name, the date you pumped and the date you prepared it, as Ohio's rule requires. Staff thaw frozen milk under cold running water or in the refrigerator (rule 5180:2-12-23).

The CDC suggests sending milk in small amounts of 2 to 4 ounces, so less goes to waste if your baby doesn't finish. It also says centers should send unused milk home every day (CDC: Breast Milk in Early Care and Education).

Ohio centers follow the storage chart in appendix A to the rule, adopted in 2021. For room temperature and the refrigerator, its limits are longer than the CDC's current guidance, so ask your center which times it uses.

The center starts new foods only after talking with you, as Ohio's rule requires. Babies under 4 months get only formula or breast milk unless a doctor, physician assistant or certified nurse practitioner documents otherwise in writing (rule 5180:2-12-23).

The AAP recommends breast milk alone for about the first 6 months. Signs of readiness for solids include good head control, sitting in a high chair, opening the mouth for food and reaching for yours (AAP: Starting Solid Foods). Ask your pediatrician when to offer peanut foods, especially if your baby has severe eczema or an egg allergy.

Once your baby eats solids, Ohio requires food that isn't a choking hazard and that suits your baby in size, amount and texture. Food can go straight on a high chair tray only if the tray is removed, washed and sanitized (rule 5180:2-12-22).

Babies under 12 months nap on their backs in their own labeled crib with no blankets, and they can't sleep in swings or car seats (rule 5180:2-12-20). Our safe sleep guide explains the rest of the rules and what to ask.

Ohio's rule requires staff to change diapers and clothing right away when wet or soiled (rule 5180:2-12-23). Staff use a fresh liner on shared changing tables, never leave a baby alone on the table, and wear non-latex gloves if they use gloves. Soiled clothes come home in a covered container or plastic bag.

Diaper cream needs your written permission and must come in its original container with your baby's name on it. Your baby must also have had it applied at home at least once before the center uses it (rule 5180:2-12-25).

Pack what your center doesn't supply, labeled with your baby's name, plus the forms Ohio requires:

• Diapers and wipes, unless your center supplies them
• Formula if your center doesn't provide it, or breast milk in labeled bottles of 2 to 4 ounces
• Written feeding instructions, updated when your baby's routine changes
• Diaper cream in its original container, labeled with your baby's name, plus a signed permission form
• A few changes of clothes, since wet or soiled clothes are changed right away
• A one-piece sleeper or wearable blanket for naps, not a loose blanket
• The enrollment form, due on the first day, and your baby's immunization record, due within 30 days (rule 5180:2-12-15)

The AAP says most babies up to 7 months adjust well to good child care (AAP: Preparing Your Child for Child Care). Babies 7 to 12 months often feel stranger anxiety, so easing in gradually can help at that age (AAP: Making Baby Drop Off Easier).

• Visit the center with your baby before care begins, and ask staff about the best time to start.
• Keep goodbyes short and the same each day: say goodbye, then leave calmly.
• If you're returning to work, the AAP suggests starting midweek, which gives you a 2- or 3-day trial before a full week (AAP).

Expect the change to feel hard for you, too. The AAP notes that starting child care is often harder on parents than on the child.