Health and Safety Policies Every Childcare Center Needs

Why written health and safety policies matter

Every state licensing agency requires childcare centers to maintain written health and safety policies. These are not optional guidelines. They are enforceable standards that licensing inspectors will review during every visit, announced or unannounced. Having clear, documented policies protects children from preventable harm, protects staff by giving them clear protocols to follow, and protects your program from liability.

Written policies must be shared with families, typically through a parent handbook provided at enrollment. Parents have a right to know how your center handles illness, emergencies, medications, and other health and safety matters before entrusting their child to your care.

Health and safety policies should be reviewed and updated at least annually, or whenever regulations change, an incident reveals a gap, or your program adds new services (such as infant care or transportation). Every staff member should be trained on all policies during onboarding and receive refresher training at least once a year.

Illness and exclusion policies

One of the most frequently referenced policies in any childcare center is the illness exclusion policy. It defines when a child is too sick to attend, when they must be sent home, and when they can return. A clear illness policy reduces the spread of contagious disease and sets consistent expectations for families.

Common exclusion criteria include:

• Fever: A temperature of 100.4 degrees Fahrenheit or higher is the threshold used by most state licensing agencies and the American Academy of Pediatrics. Children should be fever-free for at least 24 hours without fever-reducing medication before returning to care.

• Vomiting and diarrhea: Children who have vomited or had diarrhea should be excluded until they are symptom-free for at least 24 hours. Two or more episodes within 24 hours is a common trigger for sending a child home.

• Contagious conditions: Pink eye (conjunctivitis with discharge), hand-foot-and-mouth disease, strep throat, lice, scabies, and ringworm all typically require exclusion until treatment has begun or the child is no longer contagious, depending on the condition and your state's rules.

• Undiagnosed rashes: A rash accompanied by fever or behavioral changes should be evaluated by a healthcare provider before the child returns to the center.

When a contagious illness is identified at your center, other families should be notified about the exposure so they can watch for symptoms in their own children. However, you must not identify the sick child by name. Privacy considerations under HIPAA (for programs that receive federal health-related funding) and general best practice require that notifications be anonymous, for example: "A child in the Butterfly Room has been diagnosed with hand-foot-and-mouth disease."

Medication administration

Administering medication to children in care is a serious responsibility that requires careful documentation and strict procedures. Most states have specific regulations governing how childcare centers handle medications, and many require staff to complete medication administration training before they are authorized to give any medication to a child.

• Written parental authorization: A signed medication authorization form is required before any medication can be given. The form should include the child's name, medication name, dosage, route (oral, topical, etc.), frequency, and duration. A new form is typically required for each medication and each course of treatment.

• Original labeled container: All medications must be in their original, pharmacy-labeled container with the child's name, prescribing physician (for prescription medications), dosage instructions, and expiration date clearly visible. Staff should never administer medication from an unlabeled container.

• Documentation of each dose: Every time medication is administered, staff must record the medication name, dosage given, exact time, and the name of the staff member who administered it. This log must be kept on file and available for parent review and licensing inspection.

• Prescription vs. over-the-counter: Many centers have separate policies for prescription and over-the-counter medications. Some states restrict childcare providers from administering over-the-counter medications entirely, while others allow it with written parental consent and specific dosage instructions from the child's healthcare provider.

• Secure storage: All medications must be stored in a locked cabinet or container that is inaccessible to children. Medications requiring refrigeration must be stored in a separate, labeled container within a refrigerator, also inaccessible to children.

Immunization requirements

All 50 states require childcare centers to have up-to-date immunization records on file for every enrolled child. Immunization requirements are tied directly to the enrollment process: a child typically cannot begin attending until their immunization records have been submitted and verified as current.

• Records on file at enrollment: Parents must provide official immunization records (usually from their pediatrician or state immunization registry) before or on the first day of attendance. These records become part of the child's enrollment file.

• Keeping records current: As children receive new vaccinations, their records at the center must be updated. Staff should track immunization due dates and follow up with families when records need to be refreshed.

• Exemption policies: Every state allows medical exemptions for children who cannot be vaccinated for health reasons. Most states also allow religious exemptions, and a smaller number allow philosophical or personal belief exemptions. The specific exemption process and documentation requirements vary by state. Centers must keep exemption documentation on file just as they would immunization records.

• State immunization schedules: While most states follow the CDC's recommended immunization schedule, some have additional requirements or different timelines. Always check your state's specific schedule to ensure compliance.

Connecting immunization tracking to your enrollment workflow helps prevent children from starting care with incomplete records. For more on building an efficient enrollment process, see our guide on the childcare enrollment process.

Allergy and dietary management

Food allergies are a serious safety concern in childcare settings. An estimated 5.6 million children under 18 in the United States have food allergies, according to the CDC. Centers must have clear policies and procedures for identifying, documenting, and managing allergies to prevent allergic reactions and respond quickly if one occurs.

• Written allergy action plans: For every child with a known allergy, parents and the child's healthcare provider should complete a written allergy action plan. This plan should describe the allergen, symptoms of a reaction, steps to take for mild reactions, and emergency steps for anaphylaxis, including when and how to administer an epinephrine auto-injector (EpiPen).

• Staff training: All staff who interact with children should be trained on allergen awareness, how to read food labels for hidden allergens, and how to administer an EpiPen. Training should be repeated at least annually and whenever a new child with a severe allergy enrolls.

• Posted allergy lists: Allergy information should be posted in each classroom and in the food preparation area where staff can reference it quickly. Lists must be kept current as children enroll, disenroll, or receive new diagnoses.

• Coordination with meal planning: If your center participates in the USDA Child and Adult Care Food Program (CACFP), allergy accommodations must be factored into menu planning. CACFP requires centers to provide substitutions for children with documented disabilities (including life-threatening allergies) that restrict their diet.

• Dietary restrictions and cultural preferences: Beyond allergies, centers should document and accommodate dietary restrictions based on medical conditions, religious observances, or family preferences. This information should be collected during enrollment and communicated to kitchen staff and classroom teachers.

Incident and accident reporting

Every childcare center must have a formal process for documenting and reporting incidents and accidents, no matter how minor they may seem. Consistent incident reporting protects children by creating a record that can reveal patterns, protects staff by documenting exactly what happened and what action was taken, and protects your program by demonstrating accountability and compliance.

• Written report for every incident: Any time a child is injured, experiences a health event (such as a seizure or allergic reaction), or is involved in a behavioral incident, a written report must be completed. Even minor bumps and scrapes should be documented.

• Required elements: Each incident report should include: what happened, when it happened (date and time), where it happened, which children and staff were involved, what first aid or other action was taken, and who was notified (parents, director, licensing agency if applicable).

• Parent notification: Parents must be notified of any incident involving their child on the same day it occurs. Most licensing agencies require written notification (a copy of the incident report) in addition to verbal communication at pickup. For serious injuries, parents should be contacted immediately by phone.

• Reporting to licensing agencies: Serious incidents, such as injuries requiring medical treatment beyond basic first aid, hospitalizations, allegations of abuse or neglect, or deaths, must be reported to your state licensing agency. Most states require these reports within 24 hours, though some require notification within as few as 2 hours for the most serious events.

• Pattern identification: Maintaining an incident log allows directors and staff to identify patterns, such as a particular piece of playground equipment causing repeated injuries, a time of day when incidents spike, or a classroom that may need additional supervision. Reviewing incident logs regularly is a best practice for continuous safety improvement.

Emergency preparedness

Every childcare center must have a written emergency preparedness plan that covers a range of potential emergencies. Staff must be trained on these procedures, and drills must be conducted regularly so that both adults and children know what to do in a real emergency.

• Fire drills: Most states require monthly fire drills. Every drill should be documented with the date, time, number of children and staff present, and the time it took to evacuate the building. Drills should be varied by time of day and exit route so that staff and children are prepared for different scenarios.

• Severe weather drills: Centers in areas prone to tornadoes, hurricanes, earthquakes, or other natural disasters should conduct weather-specific drills on a regular schedule. Most states require at least quarterly severe weather drills.

• Lockdown procedures: Your center should have procedures for situations that require locking down the building, such as an unauthorized person attempting entry or a dangerous situation in the surrounding area. Staff should know how to secure doors, move children to interior rooms, and communicate with law enforcement.

• Posted evacuation routes: Evacuation route maps must be posted in every classroom and common area. Routes should show primary and secondary exits, the outdoor assembly point, and the location of fire extinguishers and first aid kits.

• Emergency supply kits: Your center should maintain an emergency supply kit that includes first aid supplies, a flashlight, a battery-powered radio, water, non-perishable snacks, blankets, diapers, and copies of children's emergency contact information and allergy/medical information.

• Emergency contacts accessible at all times: Emergency contact information for every child must be readily accessible to staff at all times, including during evacuations and field trips. Staff should carry emergency contact lists whenever children leave the building.

• Reunification plans: If an emergency requires evacuating to an off-site location, your plan must include a reunification process for getting children safely back to their families. This includes a designated secondary location, a communication plan for notifying parents, and a check-out procedure to ensure every child is accounted for and released only to authorized individuals.

Handwashing and hygiene

Handwashing is the single most effective way to prevent the spread of infectious disease in childcare settings. Licensing regulations in every state include specific handwashing requirements for both staff and children. Your hygiene policies should clearly define when and how hands must be washed.

• When handwashing is required: Upon arrival at the center, before and after preparing or eating food, after using the toilet or assisting a child with toileting, after diaper changes, after coming in from outdoor play, after handling animals, after wiping noses or contact with bodily fluids, and after cleaning or handling garbage.

• Proper technique: Post handwashing procedure signs at every sink at both child and adult height. The recommended technique is to wet hands, apply soap, scrub all surfaces for at least 20 seconds, rinse under running water, and dry with a single-use towel or air dryer. Children need direct instruction and reminders.

• Sanitization schedules: In addition to handwashing, your center should maintain written sanitization schedules for toys, surfaces, and bathrooms. High-touch surfaces (doorknobs, light switches, tables) should be sanitized multiple times daily. Toys that children put in their mouths should be sanitized after each use. Bathrooms and diaper changing areas should be sanitized after every use.

• Diaper changing procedures: Most states require centers to follow a specific multi-step diaper changing procedure that includes sanitizing the changing surface before and after each change, using disposable gloves, and proper handwashing for both the caregiver and the child.

Safe sleep practices (infants)

If your center cares for infants, safe sleep policies are among the most critical health and safety requirements you must follow. Sudden Infant Death Syndrome (SIDS) and sleep-related infant deaths are preventable, and licensing agencies enforce strict safe sleep standards based on the American Academy of Pediatrics (AAP) guidelines.

• Back to sleep: Infants must always be placed on their backs to sleep. If an infant rolls over on their own, they may be left in that position, but they must always be placed on their back initially.

• Firm, flat sleep surface: Infants must sleep on a firm, flat mattress in a safety-approved crib. No inclined sleepers, car seats, swings, or bouncy seats for sleeping.

• Nothing in the crib: No blankets, pillows, stuffed animals, bumper pads, or loose bedding. A fitted sheet on the crib mattress is all that should be used. Wearable blankets (sleep sacks) may be used as an alternative to loose blankets.

• Individual cribs: Each infant must have their own crib. Sharing cribs or placing more than one infant in a crib at any time is prohibited.

• Regular checks: Staff must visually check sleeping infants at regular intervals. Many states specify a minimum frequency, commonly every 10 to 15 minutes. These checks should be documented.

All staff who work with infants should receive training on safe sleep practices during onboarding and annually thereafter. Your safe sleep policy should be shared with families at enrollment so parents and caregivers are following consistent practices.

Documenting and communicating policies

Having strong policies is only half the equation. Those policies must be documented, accessible, and actively communicated to staff and families. A policy that exists on paper but is not understood or followed offers no protection to anyone.

• Parent handbook: All health and safety policies should be included in your parent handbook, which families receive at enrollment. Many centers require parents to sign an acknowledgment that they have read and understood the policies.

• Enrollment orientation: Walk through key health and safety policies with families during the enrollment process. This is the time to discuss illness exclusion rules, medication procedures, allergy management, and emergency plans face to face.

• Posted in classrooms: Relevant policies and procedures should be posted where staff can reference them, including handwashing procedures at sinks, diaper changing steps at changing stations, allergy lists in classrooms, and evacuation routes by exits.

• Policy updates: When policies change, families need to know. Use announcements to communicate policy updates to all families at once so no one is left out. Childcare management software like Neztio includes an announcements feature that lets directors send policy updates to every enrolled family instantly through the parent app.

• Staff training: All staff should be trained on health and safety policies during onboarding and receive annual refresher training. Keep signed training acknowledgments in each staff member's personnel file as documentation for licensing inspectors.