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Safe and Healthy Child Care

When you’re choosing a child care provider, it is important to look for evidence that your child’s health and safety will be a priority. Looking for a licensed program is one step you can take to help choose a safe place for your child.

What rules and regulations do child care providers in your state follow to protect your child’s health and safety? Are child care providers screened for past criminal activity? What training should child care providers have before they begin caring for your child? Look for these questions and more in the pages below.

Safe and Healthy Child Care

Child Care Licensing and Regulations

The first step to choosing a child care provider is determining whether potential providers have a license from your state or local government. Licensing does not guarantee quality; however, it sets minimum requirements and ensures that programs are monitored for compliance with these requirements.

Child care licensing regulations cover many topics, including the following:

  • The number of children one adult can care for a time (child-staff ratio) and the number of children allowed in a class (group size)

  • Supervision of children

  • Safety of the building (such as emergency exits, cleanliness and repairs, and potential dangers)

  • Immunizations, hand washing, diapering, and other methods to stop the spread of disease

  • Nutrition of food served to children

  • Training, health, and other requirements for the adults working at the child care program

Child care licensing requirements vary from state to state. The National Database of Child Care Licensing Regulations includes contact information and websites for state licensing departments. You can choose your state and view, download, and search the child care licensing regulations that apply to child care centers, family child care homes, and other licensed child care programs. The National Database of Child Care Licensing Regulations is available at

You can also contact the government agency responsible for child care licensing to find out whether a provider has a license and view the provider’s licensing record. Most states include records of child care licensing inspections in the search results for each provider. States without records available on the web can give you this information over the phone or at the agency office.

Providers exempt from licensing

Most states allow some child care providers to be exempt from child care licensing laws. Often these providers are relatives of the children they care for, care for a very small number of children, or operate only a few hours a day. Your state licensing agency can provide information about which types of providers are exempt from licensing in your state. Providers who are exempt from licensing still need to meet health and safety requirements if any of the children they care for receive federal child care financial assistance.

What are the benefits to choosing licensed child care?

Choosing a licensed child care program means that your child care provider is regulated and monitored by a state licensing agency. Licensing regulations generally address:

  • Health and safety measures to help protect your child from injury and illness

  • Ratio and group sizes

  • Background checks of adults that work in the child care facility

  • Physical environment of the program

  • Education and ongoing required training

  • Program management

Background Checks

Your child deserves to be safe and well cared for at all times. One of your child care provider’s most important responsibilities is keeping your child safe from harm. One way your provider does this is by making sure that all adults with access to your child have had a comprehensive background check. Your child care provider should verify that this check shows that the adult does not have a history of child abuse or violence.

Who should have a comprehensive background check?

  • All adults living in a family child care home

  • All child care center staff members, including directors, teachers, caregivers, bus drivers, janitors, kitchen staff, and administrative employees

  • Every adult volunteering in the program who will have unsupervised access to your child

  • Other adults who may come into the program and will have unsupervised access to your child, such as sports, art, or dance instructors

What are the federal background check requirements for child care providers?

Federal law requires all states to implement state and federal criminal background checks that include fingerprints for child care providers. The comprehensive background check must include a fingerprint check of the Federal Bureau of Investigation (FBI) database to ensure that providers do not have a history of convictions that could put children’s health and safety at risk. Additionally, potential child care providers must be checked to ensure that they are not listed as a sex offender and have not been found to have committed child neglect or abuse.

The following list has more details about the specific checks that are required. Ask your child care provider if these criminal history checks are up to date for all adults that will have access to your children while they are in care.

  1. An FBI fingerprint check

  2. A search of the National Crime Information Center’s National Sex Offender Registry

  3. A search of the following registries, repositories, and databases in the state where the child care staff member lives and each state where the staff member has lived in the past 5 years:

  • State criminal registry or repository (fingerprints are required in the state where the staff member currently lives, and optional in other states)

  • State sex offender registry or repository

  • State-based child abuse and neglect registry and database

Learn more about your state’s implementation of the federal background check requirements by visiting the state resources section of this website.

How often must background checks be conducted?

Request(s) for background checks must be submitted before the provider is hired and at least once every 5 years.

How do I know whether the adults in my child care program have had comprehensive criminal background checks?

The federal law requires all child care providers to have a comprehensive background check. This includes providers who are not required to be licensed but care for children receiving federal child care assistance. Any individual who is employed by a child care provider and any individual who may have unsupervised access to children in care should have a comprehensive criminal background check. You can learn more about your state’s criminal background check requirements by contacting your state licensing agency.

If your child’s caregiver does not have a license, ask for proof of a completed comprehensive background check. If the caregiver does not have this proof, ask him or her to complete a check, or conduct a background check yourself (contact your state police for information about how to conduct a background check).

Ratio and Group Sizes

The number of adults who are present to teach and care for your child and the other children who are playing, eating, and sleeping together in a group is known as the child-to-adult ratio.

In a child care center, a group of children is usually considered to be the children who are in the same classroom. In a family child care home, the group is all the children who are receiving care at any one time. The maximum number of children in a group is called the group size. Ratio and group size are two factors that are critical to your child’s health, safety, and development.

Low child-to-adult ratios and small group sizes help ensure that your child gets enough one-on-one attention from an adult who is available to take care of each child’s unique needs. This responsive care giving is extremely important to your child’s social and emotional development, physical well-being, and overall learning.

This one-on-one attention helps children feel safe and secure and reduces feelings of being overwhelmed—for both children and adults. A smaller group size with enough trained adults present is easier to manage. Because adults are better able to watch and respond to a smaller group, children will be less likely to get injured or sick.

Nutrition and Physical Activity

You want your child to have the best possible start, and good nutrition and plenty of physical activity are an important part of that.

Many states require licensed child care providers to follow rules about nutrition, physical activity, and screen time. Contact your state licensing agency to find your state’s requirements. It is also important to ask potential providers about their policies and practices in these areas.

For young children, each meal is an opportunity to grow healthy and strong and develop good habits. Ask potential providers how they handle food and nutrition. Some provide meals and snacks, and others ask parents to pack food for their children. If meals and snacks are provided, confirm that healthy dietary guidelines are followed. Ask to see daily menus. You may want to check for evidence that healthy meals and snacks are being served. Look to see that the kitchen area is clean, well maintained, and stocked with food.

It is also important that your child have access to clean drinking water throughout the day. Ask how the provider makes sure that children have access to clean drinking water whenever they want it.

If you are breastfeeding, support from your child care provider is essential. Ask potential providers what steps they take to support breastfeeding. If your child takes a bottle, ask about how formula is prepared and stored. Make sure that bottles are labeled with each child’s name and date and that there are procedures in place for making sure that each child gets the correct bottle.

Required Health and Safety Training

One of the most important aspects of high-quality child care is provider education and training. All adults caring for children should receive training on key health and safety topics.

State child care licensing rules include health and safety training requirements for adults working with children. In addition, federal law requires specific health and safety training for providers who care for children receiving federal financial assistance.

The federal requirements include the following important topics for health and safety training, which apply to adults caring for children in all types of child care settings. Training's should be customized for the setting and the age of the children being cared for. Ask your provider if he or she has completed training in the following areas:

  1. Pediatric first aid and CPR

  2. Prevention and control of infectious diseases (including immunizations)

  3. Safe sleep practices and prevention of sudden infant death syndrome (SIDS)

  4. Prevention of shaken baby syndrome, abusive head trauma, and child mistreatment

  5. Recognition and prevention of child abuse and neglect

  6. Use of medication

  7. Prevention of and response to emergencies caused by food allergies

  8. Emergency preparedness and response for natural disasters and other events

  9. Handling, storage, and disposal of hazardous materials

  10. Indoor and outdoor safety (including protecting children from hazards, bodies of water, and traffic)

  11. Safety when transporting children (if applicable)

  12. Child development, physical activity, and nutrition

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