Preventing infection in early childhood centers

As you drop your child off at day care, you are probably thinking: Will they eat enough? Will they take a nap? Will she miss me? How will he get along with the other children?

These are all important questions, but your overwhelming concern is likely that your infant or toddler is safe and healthy. We know kids share a lot of germs. Respiratory and gastrointestinal infections spread quickly in early childhood facilities. According to the Centers for Disease Control and Prevention, an average of 20,000 children younger than 5 years of age are hospitalized each year because of flu-related complications.

So how can you reduce your child’s chance of getting sick, whether they go to a small home day care or a center caring for more than 15 children?

Here are four key areas to be aware of to help reduce the spread of germs to you and your child.

1. Infection prevention.

Infection prevention is everybody’s business – including child care staff, children, and families. An important question to ask is, are the staff and children healthy enough to come to the center, i.e., not contagious? 

  • For staff members, this means being up to date on immunizations including Tdap (tetanus, diphtheria, and pertussis), MMR (measles, mumps, and rubella), and seasonal flu. 
  • For children and parents, the center should have criteria for when someone might be contagious and shouldn’t be at the day care. These might include: rashes with fever, strep throat, and infectious diarrhea. Ask the care providers what criteria they use. As a parent, know when your child should stay home too. If your day care center accepts potentially contagious children, find out how those children and assigned staff are physically separated from others. 

2. Hand hygiene. 

Keeping your hands clean is the number one way to prevent the spread of infection. Clean your hands after using the bathroom; after sneezing, blowing your nose, or coughing; before eating; when visiting someone who is sick; or whenever your hands are dirty.

  • Staff should be observed performing hand hygiene before and after diapering, assisting with toileting, before food preparation, after touching body fluids (including runny noses), and countless more times throughout the day. Children, too, should be washing their hands, especially after eating, after using the bathroom, and after playing outdoors. Visit for a list of when to perform hand hygiene.
  • Hands should be rinsed with warm soapy water for at least 20 seconds. Alcohol hand sanitizers are a convenient and effective product for hand hygiene for children older than 24 months of age. 
  • Take a look around. Are there enough sinks or sanitizers throughout the center and in close proximity to the diaper changing areas? Are there separate sinks for food preparation and toileting? Are hand hygiene posters in the facility? If not, speak up and request more hand washing stations and posted information about proper hand hygiene.

3. Cleaning and disinfection. 

It is important to clean and disinfect frequently touched surfaces on a regular basis. There should be a schedule for when each item is cleaned with an Environmental Protection Agency (EPA)-registered disinfectant or a bleach solution (according to the manufacturers’ recommendations). Certain items need specific attention. 

For example:

  • Diaper changing areas should have new paper liner for each diaper change, and then be wiped with a disinfectant.
  • Toys must have washable surfaces. Items that cannot be cleaned (e.g., stuffed animals) should be dedicated to one child. 
  • Bottles, caps, and nipples must be disposable or sanitized between uses (dishwasher or boiled for one minute).
  • Cribs and sleeping mats need a cover sheet and must be regularly disinfected. 

4. Food safety. 

Proper handling and preparation of food are important to prevent and avoid foodborne illnesses (food poisoning). A significant part of a child’s day involves eating. 

  • Food and beverages should not be prepared in the same areas as the bathroom, diapering area or playrooms. 
  • Reusable utensil and plates must be sanitized between uses. 
  • Food, including breast milk, should be stored at safe temperatures. 
  • Leftover food should be well labeled and stored accordingly.

In addition to local or state regulations, the American Academy of Pediatrics, The National Resource Center, and the American Public Health Association developed Caring for Our Children: National Health and Safety Performance Standards- Guidelines for Early Care and Educational Programs. Access it here.