Feeding Children Safely in Childcare
Feed infants and young children safely, covering bottles, first foods, choking hazards and calm, supervised mealtimes.
Table of contents
Feeding takes up a large part of the day in childcare. For a baby, a bottle is food, comfort and time with a trusted adult. For a toddler, a snack is a chance to practice new skills. It also carries real risks: choking, spoiled milk, a mix-up between bottles, or a food that a child cannot have. Careful routines keep mealtimes safe and pleasant.
Guidance here comes from the Centers for Disease Control and Prevention (CDC), the American Academy of Pediatrics (AAP) and the U.S. Department of Agriculture (USDA). State licensing rules and your program's policy can be stricter, and they win. Families and health care providers make decisions about a child's diet. You follow the written plan.
What You Will Be Able to Do
- Store, label, warm and serve breast milk and formula correctly
- Feed a baby on cue, and explain why a bottle is never propped
- Know which foods to hold back and which to change for young children
- Prepare food to lower the risk of choking
- Run a calm, supervised mealtime that meets basic program meal rules
Feeding Infants
Feed babies when they show hunger, not by the clock. Rooting, sucking on hands and fussing are early signs. Turning away, slowing down and falling asleep mean the baby has had enough. Do not push a baby to finish a bottle. Ask each family for a feeding plan, and update it as the baby grows.
Hold a baby during every bottle feeding, in a semi-upright position, and look at them. Holding gives comfort and lets you watch for trouble.
Warning: Never prop a bottle or put a baby to bed with one. A propped bottle can cause choking, and it takes away the contact a baby needs.
Breast Milk
Handle breast milk as carefully as you would handle any baby's food. Families should supply it labeled with the child's name and the date it was expressed. Use the oldest milk first. CDC guidance for healthy, full-term babies gives these limits. Your state or program may set shorter ones.
| Where | How long |
|---|---|
| Freshly expressed, on the counter at 77 degrees F or colder | Up to 4 hours |
| Freshly expressed, in the refrigerator | Up to 4 days |
| In the freezer | About 6 months is best, up to 12 months is acceptable |
| Thawed in the refrigerator | Use within 24 hours of fully thawing |
| Thawed or warmed to room temperature | Use within 2 hours |
| Left in the bottle after a feeding | Use within 2 hours after the baby finishes, then discard |
Never refreeze thawed milk. Store milk at the back of the refrigerator, not in the door. CDC guidance for childcare suggests giving each child a storage bin and sending unused milk home each day.
Infant Formula
Follow the label, and use only what the family has approved. Prepare it with clean hands and clean equipment. CDC limits for prepared formula are:
| Situation | Limit |
|---|---|
| Prepared bottle at room temperature | Use within 2 hours of preparing |
| Once the baby starts feeding | Use within 1 hour, then throw out what is left |
| Prepared but not used right away | Refrigerate at once and use within 24 hours |
| Formula left in a bottle after feeding | Throw it away. Do not put it back in the refrigerator |
Bacteria from the baby's mouth get into a bottle during feeding, which is why you cannot save the rest. Powdered formula needs extra care for babies under 2 months, babies born early and babies with weak immune systems. Follow any special directions from the family or doctor.
Warming a Bottle
Milk and formula do not have to be warmed. If a baby prefers it warm, hold the bottle under warm running water or stand it in a container of warm water, then swirl it and test a few drops on your wrist.
Warning: Never heat a bottle in a microwave. It creates hot spots that can burn a baby's mouth, and it can damage nutrients in breast milk.
Preventing Bottle Mix-Ups
Check the name on every bottle before you feed. Keep each child's bottles apart, and label caps as well as bottles if your program does so. If a baby is given another mother's milk, tell your director right away. Both families need to be told, and CDC advises sharing when the milk was expressed and how it was handled. Your director handles the calls, and you complete the incident report.
Starting Solid Foods
Most babies are ready for solid foods at about 6 months. Starting before 4 months is not recommended. Readiness shows up as skills, including sitting with support, holding the head steady, opening the mouth for a spoon, and swallowing food instead of pushing it out. The family and the baby's doctor decide when to start.
Follow these limits for babies under 12 months:
| Food or drink | Rule | Why |
|---|---|---|
| Honey, in any form | None before 12 months | Can cause infant botulism, a serious illness |
| Cow's milk as a drink | None before 12 months | Babies need breast milk or formula. Yogurt and cheese can come earlier if the family agrees |
| Fruit juice | None before 12 months | No nutrition need, and it adds sugar |
| Foods that are hard, round or sticky | Change them or leave them out | Choking risk |
Ask families which foods a baby has already eaten. Most programs let families introduce a new food at home first, especially foods that commonly cause allergies, such as peanut, egg and shellfish. Follow the family's plan and your policy. Do not try out a new food in care unless the plan says so.
Toddlers and Preschoolers
- Milk. Whole milk from 12 months to 2 years, then fat-free or low-fat. A child's doctor may advise differently.
- Juice. No more than 4 ounces a day for ages 1 through 3, and none in a bottle or a covered cup that a child can carry around. Whole fruit is better.
- Water. Offer it through the day, and make sure it is available outside.
- New foods. Expect picky eating. A child may need many tries before accepting a new food, and that is normal. Keep offering it, without pressure.
- Portions. Small portions work best, and children can ask for more.
Preventing Choking
Food is the most common thing that young children choke on. Children under 4 are at highest risk, because they are still learning to chew and their airways are small. CDC lists these as common choking hazards:
| Type | Examples |
|---|---|
| Fruits and vegetables | Whole grapes, cherry tomatoes, hard raw carrots and apples, corn kernels, raisins |
| Protein | Hot dogs, sausages, nuts and seeds, chunks of meat or cheese, spoonfuls of nut butter |
| Grains | Popcorn, chips, pretzels, seeded crackers, granola bars |
| Sweets | Hard candy, gummy candy, marshmallows, chewing gum |
You can make many of these safer with simple changes:
- Cut round foods lengthwise first. Cut grapes and cherry tomatoes in half lengthwise, then into quarters for younger toddlers.
- Cut hot dogs lengthwise, then into small pieces. Never serve round slices.
- Keep pieces small, with no piece larger than about half an inch for young children.
- Cook or grate hard vegetables and fruit until they are soft.
- Spread nut butters thinly, and never serve them on a spoon.
- Remove bones, seeds and pits.
Some foods should not be served to children under 4, however you prepare them. Check your program's list. It usually includes popcorn, whole nuts and hard candy.
Keep children seated during meals. Running, laughing and talking with food in the mouth all raise the risk. Know how to respond to choking. For a baby under 1 year, the response is back blows and chest thrusts, never abdominal thrusts. Keep your infant and child CPR and first aid training current, because this skill needs hands-on practice.
Running a Safe Mealtime
- Clean and sanitize tables and high chair trays before and after eating.
- Wash your hands and the children's hands before food.
- Check the allergy list and any special diet plans before serving.
- Seat each child upright in a chair or high chair, with the straps fastened. Never feed a child in a car seat, stroller or bouncer, and never let a child walk around with food.
- Test hot food before serving it. Keep hot drinks and dishes away from children.
- Sit with the children. Stay close enough to see faces and hear coughing.
- Keep the meal calm, and give children enough time.
Serving and storage temperatures matter too. Food codes generally call for keeping hot food at 135 degrees F or above and cold food at 41 degrees F or below. Your local code may differ. Label food brought from home with the child's name and the date, and refrigerate it if needed. Refrigerate leftovers promptly, check dates, and when you are not sure a food is safe, throw it out. Clean and sanitize food preparation surfaces before and after use.
For infants, record what they eat and drink through the day so that you can share it with the family.
Healthy Habits at the Table
Let children decide how much to eat from what you offer. Do not force a child to finish, and do not make them clean their plate. Never use food as a reward or a punishment, and never withhold a meal as discipline. Many states prohibit this.
Family-style meals, where children serve themselves with help, build skills and independence. Talk about the food and model trying it. Mealtime is a good time for conversation, and it supports language learning.
Respect cultural, religious and family food practices. Ask families what they need and do not comment on it in front of children.
Allergies and Special Diets
Get a written list of food allergies and special diets for each child before the first day, and keep it up to date. Know the difference: a food allergy involves the immune system and can be life-threatening, and an intolerance mostly causes digestive discomfort. A child with a severe allergy should have a written action plan signed by the family and a health care provider.
Post allergy information where staff who serve food can see it, while protecting privacy. Your program's policy decides how, and a common method is to use first name and allergen only, kept out of public view. Train all staff, including substitutes and kitchen helpers. Read the label on every packaged food, because ingredients change. Keep food for a child with an allergy from touching any surface that held the allergen, and wash hands and tables well. Keep epinephrine and the plan within reach of trained staff.
USDA Meal Rules
Many programs take part in the USDA Child and Adult Care Food Program (CACFP), which reimburses meals that meet set patterns. If your program does, follow its menus and portions, because a meal that does not meet the pattern cannot be claimed. The basics for children ages 1 and older are:
| Meal | Must include |
|---|---|
| Breakfast | Milk, a vegetable or fruit, and a grain |
| Lunch or supper | Milk, a meat or meat alternate, a vegetable, a fruit (or a second vegetable), and a grain |
| Snack | Two of the five groups |
A few rules come up often. Children age 1 get unflavored whole milk, and ages 2 to 5 get unflavored low-fat or fat-free milk. Juice can count at only one meal or snack a day. At least one grain serving a day must be whole grain-rich. Grain-based desserts do not count toward a meal. Infants have their own pattern, based on age. Your food program sponsor or director can tell you the portion sizes, and limits on added sugars in foods such as yogurt and cereal are updated from time to time.
Common Mistakes
| Mistake | What it costs |
|---|---|
| Propping a bottle to free your hands | Choking risk, and no contact for the baby |
| Saving leftover formula for later | Bacteria can grow in it |
| Feeding without checking the name on the bottle | Wrong milk or formula for that child |
| Serving whole grapes to toddlers | They can block a small airway |
| Letting children walk with a snack | Choking risk rises |
| Using dessert as a reward | Teaches unhealthy habits, and may break program rules |
Check Your Understanding
1. A baby took 2 ounces of formula from a bottle 50 minutes ago and fell asleep. She wakes up hungry and you still have 3 ounces left. Can you give it to her?
If it has been under 1 hour since feeding started, you can offer it now. After 1 hour, throw it out and make a fresh bottle. Do not put it back in the refrigerator.
2. A parent drops off breast milk and asks you to microwave it for a few seconds to take off the chill. What do you do?
Explain that you cannot use a microwave. Stand the bottle in warm water instead, or serve it cold if the baby accepts that.
3. A menu lists grapes, cheese cubes and whole-grain crackers for the toddler room. What do you change?
Cut the grapes lengthwise and into quarters, make the cheese into small thin pieces, and check that the crackers are soft and have no seeds. Seat all children and sit with them.
4. A 10-month-old's grandparent wants to give him a spoon of honey for a cough. What do you say?
Thank them and explain that children under 12 months should not have honey in any form because it can cause infant botulism. Suggest that the family speak with the baby's doctor about the cough.
Key Takeaways
- Hold babies during bottle feeding, and never prop a bottle or heat it in a microwave
- Label milk with the name and date, and follow CDC time limits or your stricter policy
- Throw out formula left in a bottle after feeding
- No honey, cow's milk as a drink, or juice before 12 months
- Cut round foods lengthwise, keep pieces small and keep children seated
- Never use food as a reward or punishment, and always read the allergy list before you serve