Caring for Our Children: National Health and Safety Performance Standards
xxiv New and Signiﬁcant Changes
NEW AND SIGNIFICANT CHANGES IN Caring
for Our Children (CFOC) STANDARDS SINCE
THE 2ND EDITION
Most of the 3rd Edition CFOC Standards have had some
changes. Below are those standards and appendices that
are new in the 3rd Edition or have had signiﬁcant updates/
changes to the content since the 2nd Edition.
CHAPTER 1 STAFFING
Standard 18.104.22.168: Ratios for Large Family Child Care.
Lowered ratios for infants and toddlers to be more in line
with small family child care.
Standard 22.214.171.124: Minimum Age to Enter Child Care –
NEW. Recommends healthy full-term infants can be safely
enrolled in child care settings beginning at three months of
age. Reader’s Note: This standard reflects a desirable goal
when sufﬁcient resources are available; it is understood that
for some families, waiting until three months of age to enter
their infant in child care may not be possible.
Standard 126.96.36.199: Background Screening. Changed termi-
nology from background checks to background screening.
Standard 188.8.131.52: First Aid and CPR Training for Staff.
Updated to be in compliance with the American Health As-
sociation’s 2010 recommendations on CPR.
Standard 184.108.40.206: Early Childhood Mental Health Consul-
tants – NEW. Recommends consultants engage with a mini-
mum of quarterly visits, and outlines experience, knowledge
base, and role of the mental health consultant.
Standard 220.127.116.11: Early Childhood Education Consultants
– NEW. Recommends consultants engage with a minimum
of semi-annual visits, and outlines the experience, knowl-
edge base, and role of an education consultant.
CHAPTER 2 PROGRAM ACTIVITIES
Standard 18.104.22.168: Coordinated Child Care Health Pro-
gram Model – NEW. Provides guidelines for coordinating
care, including eight interactive components.
Standard 22.214.171.124: Monitoring Children’s Development/
Obtaining Consent for Screening – NEW. Deﬁnes the role
of caregivers/teachers in monitoring a child’s development,
and includes policies on developmental screening, and
sharing observation with parents/guardians.
Standard 126.96.36.199: Transitioning within Programs and
Indoor and Outdoor Learning/Play Environments – NEW.
Recommends ensuring positive transitions for children when
entering a new program and beginning new routines or
activities within existing program.
Standard 188.8.131.52: Limiting Infant/Toddler Time in Crib,
High Chair, Car Seat, etc. – NEW. Guidelines to speciﬁc
limit of time children should be conﬁned in equipment.
Standard 184.108.40.206: Limiting Screen Time - Media, Com-
puter Time – NEW. Provides speciﬁc limits outlined by age
group and recommends what screen time is allowed be free
of advertising. Also includes two exceptions.
Standard 220.127.116.11: Supervision Near Bodies of Water.
Adds concept that supervising adult is within an arm’s
length, providing, “touch supervision.”
Standard 18.104.22.168: Discipline Measures. Enhanced with
information on positive behavior management and very
limited use of time-out.
Standard 22.214.171.124: Handling Physical Aggression, Biting,
and Hitting. Enhanced with more guidance on biting.
Standard 126.96.36.199: Preventing Expulsions, Suspensions,
and Other Limitations in Services – NEW. Includes recom-
mends procedures and policies for handling challenging
behaviors to minimize expulsions.
Standard 188.8.131.52: Using Physical Restraint. Updates
language on what a care plan should cover for the rare ex-
ception of a child with a special behavioral or mental health
issue that may exhibit a behavior that endangers his/her
safety and others.
Standard 184.108.40.206: Staff Modeling of Healthy and Safe
Behavior and Health and Safety Education Activities.
Enhanced with examples in the area of nutrition and physi-
CHAPTER 3 HEALTH PROMOTION AND
Standard 220.127.116.11: Routine Health Supervision and Growth
Monitoring. Updated to include tracking BMI.
Standard 18.104.22.168: Active Opportunities for Physical Activ-
ity – NEW. Includes number, type, and frequency of physical
activity by age group.
Standard 22.214.171.124: Protection from Air Pollution while
Children are Outside – NEW. Recommends frequency of
checking air quality index.
Standard 126.96.36.199: Caregivers’/Teachers’ Encouragement
of Physical Activity – NEW. Recommends staff promotion
of children’s active play throughout the day.
Standard 188.8.131.52: Safe Sleep Practices and SIDS/Suffo-
cation Risk Reduction. Updated with new information on
inappropriate infant sleeping equipment, paciﬁer use and
Standard 184.108.40.206: Swaddling – NEW. Recommends that
swaddling is not needed in child care settings.
Standard 220.127.116.11: Paciﬁer Use – NEW. Follows current
American Academy of Pediatrics’ recommendations and
recommends written policy on use.
Standard 18.104.22.168: Toothbrushes and Toothpaste. Includes
addition that toothbrushes should be replaced at least every
three to four months.
Standard 22.214.171.124: Procedure for Changing Children’s
Soiled Underwear/Pull-Ups and Clothing – NEW. Outlines
procedure consistent with and complimentary to the diaper
Standard 126.96.36.199: Hand Sanitizers – NEW. Describes ap-
propriate use of hand sanitizers as alternative to traditional