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Child Care Safety


Day Care Centers

Programs that provide out-of-home care for infants and young children in general serve two purposes. They provide substitute care while parents work, and they promote socialization and early education. At least six out of 10 - nearly 13 million - infants, toddlers and preschool children are enrolled in child care, according to the National Center for Education Statistics (1). Yet, regulation relating to the health and safety of children in out-of-home child care programs varies widely. Some states have no or minimal regulation for before- and after- school child care, family-based child care, and preschool or nursery school programs, particularly if they operate on a part-time basis or if they are sponsored by a religious institution (2).

How big is the problem?

Although there is debate as to whether there is a higher incidence of injuries in out-of-home child care versus in home care (3), there is evidence nonetheless that many children are injured while in child care settings. In 1997, about 31,000 children 4 years old and younger were treated in U.S. hospital emergency rooms for injuries that occurred at child care/school settings. The Consumer Product Safety Commission is aware of at least 56 children who have died in childcare settings since 1990 (4).

Policy & Details

All staff involved in the provision of direct care at child care facilities, including family home caregivers, shall be certified in pediatric first aid that includes rescue breathing and first aid for choking. At least one certified staff person should be with the children at all times and in all places where children are in care.

Quality child care should take place in a safe and healthy setting. Nevertheless, injuries may occur, and all staff should be prepared to handle medical emergencies. In 1992, the American Public Health Association and the American Academy of Pediatrics developed National Health and Safety Performance Standards: Guidelines for Out-of-Home Child Care Programs (5). This policy is part of their recommended standards. This requirement should apply both at the regular childcare site and when the children are on field trips. The first aid training requirement should be a part of statewide child care regulations. In addition, facilities that serve children with special needs or have a swimming pool or built-in wading pool shall require infant and child CPR training for caregivers (6). Review the National Resource Center for Health and Safety in Child Care Website,, to see if your state regulations mandate this training for all child care staff and family home caregivers.


When an emergency occurs quick, proper action can make the difference between life and death. When a seriously injured child is found there should be no delay in delivering care. Waiting for a trained person to be found and to arrive can lead to an unacceptable delay. In some cases, such as choking, seconds count. A child care center that has been modified and/or designed to ensure the safety of children will help prevent injuries from occurring. Staff with current first aid certification will help ensure that those injuries that do occur are treated prompted and properly. One study found that first aid was sufficient for 84.4 percent of the injuries that occurred in child care centers (7).


National Resource Center for Health and Safety in Child Care
UCHSC at Fitzsimons, Campus Mail Stop F541, PO Box 6508
Aurora, CO 80045
Phone: 800-598-5437
Fax: 303-724-0960

Marsha Sherman
Executive Director
California Child Care Health Program
1322 Webster Street, Ste 402
Oakland, CA 94612
Phone: 510-839-1195
Fax: 510-839-0339

Sara B.K. Woo
Program Coordinator
California Child Care Health Program
6505 Alvarado Rd, Suite 108
San Diego, CA 92120
Phone: 619-594-4373
Fax: 619-594-3377

For Further Information


1. West, J., Wright, D., & Hausken, E. G. (1995). Child care and early education program participation of infants, toddlers, and preschoolers. Washington, DC: US Department of Education, National Center for Education Statistics. Available online:

2. American Academy of Pediatrics. The Application of Health and Safety Guidelines to Out-of-Home Child Care Programs. RE9417 Policy Statement. Pediatrics 1994; 93(6): 1016-1017.

3. Rivara FP, Sacks JJ. Injuries in Child Day Care: An Overview. Pediatrics 1994; 6(2): 1031-1033.

4. Consumer Product Safety Commission. CPSC Staff Study of Safety Hazards in Child Care Settings. April 1999. Available online:, May 11, 1999.

5. American Public Health Association and the American Academy of Pediatrics. National Health and Safety Performance Standards: GUIDELINES FOR OUT-OF-HOME CHILD CARE PROGRAMS. Available online: 1992.

6. Wiebe RA, Fuchs S. Emergency Medical Services in the Child Care Setting. Healthy Child Care America 1999; 3(1). Available online:, June 13, 2000.

7. Chang A, Lugg M, Nebedum A. Injuries among preschool children enrolled in day care centers. Pediatrics 1989; 83: 272-277.

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Last modified: 10-Aug-2000.