Caring for Our Children: National Health and Safety Performance Standards
xvii Introduction
Every day millions of children attend early care and educa-
tion programs. It is critical that they have the opportunity to
grow and learn in healthy and safe environments with caring
and professional caregivers/teachers. Following health and
safety best practices is an important way to provide quality
early care and education for young children. The American
Academy of Pediatrics (AAP), the American Public Health
Association (APHA), and the National Resource Center for
Health and Safety in Child Care and Early Education (NRC)
are pleased to release the 3rd edition of Caring for Our Chil-
dren: National Health and Safety Performance Standards;
Guidelines for Early Care and Education Programs. These
national standards represent the best evidence, expertise,
and experience in the country on quality health and safety
practices and policies that should be followed in today’s
early care and education settings.
In 1992, the American Public Health Association (APHA) and
the American Academy of Pediatrics (AAP) jointly pub-
lished Caring for Our Children: National Health and Safety
Performance Standards; Guidelines for Out-of-Home Child
Care Programs (1). The publication was the product of a
five year national project funded by the U.S. Department of
Health and Human Services, Health Resources and Services
Administration, Maternal and Child Health Bureau (MCHB).
This comprehensive set of health and safety standards was
a response to many years of effort by advocates for quality
child care. In 1976, Aronson and Pizzo recommended devel-
opment and use of national health and safety standards as
part of a report to Congress in association with the Federal
Interagency Day Care Requirements (FIDCR) Appropriate-
ness Study (2). In the years that followed, experts repeatedly
reaffirmed the need for these standards. For example, while
the work to prepare Caring for Our Children was underway,
the National Research Council’s report, Who Cares for
America’s Children? Child Care Policy for the 1990s, called
for uniform national child care standards (3). Subsequently
a second edition of Caring for Our Children was published
in 2002 addressing new knowledge generated by increas-
ing research into health and safety in early care and educa-
tion programs. The increased use of the standards both in
practical onsite applications and in research documents
the value of the standards and validates the importance
of keeping the standards up-to-date (4). Caring for Our
Children has been a yardstick for measuring what has been
done and what still needs to be done, as well as a technical
manual on how to do it.
Review Process
The Maternal and Child Health Bureau’s continuing fund-
ing since 1995 of a National Resource Center for Health
and Safety in Child Care and Early Education (NRC) at the
University of Colorado, College of Nursing supported the
work to coordinate the development of the second and third
The revision of the standards for the third edition of Caring
for Our Children was an extensive process. The third edition
benefited from the contribution of eighty-six technical ex-
perts in the field of health and safety in early care and edu-
cation. Reviews and recommendations were received from
184 stakeholder individuals - those representing consumers
of the information and organizations representing major
constituents of the early care and education community.
Caregivers/teachers, parents/guardians, families, health care
professionals, safety specialists, early childhood educators,
early care and education advocates, regulators, and federal,
military, and state agencies all brought their expertise and
experience to the revision process. A complete listing of the
Steering Committee, Lead Organizations’ reviewers, Techni-
cal Panel members, and Stakeholder contributors appears
on the Acknowledgment pages.
The process of revising the standards and the consensus
building was organized in stages:
1) Technical panel chairs recruited members to their panels
and reviewed the standards from the second edition. Us-
ing the best evidence available (peer reviewed scientific
studies, published reports, and best practice information)
they removed standards that were no longer applicable or
out-of-date, identified those that were still applicable (in
their original or in a revised form), and formulated many new
standards that were deemed appropriate and necessary.
2) Telephone conference calls were convened among
technical panel chairs to bring consensus on standards that
bridge several technical areas.
3) A draft of these revised standards was sent to a national
and state constituency of stakeholders for their comments
and suggestions.
4) This feedback was subsequently reviewed and consid-
ered by the technical panels and a decision was made to
further revise or not to revise a standard. It should be noted
that the national review called attention to many important
points of view and new information for additional discussion
and debate.
5) The edited standards were then sent to review teams of
the AAP, the APHA and the MCHB. Final copy was approved
by the Steering Committee representing the four organiza-
tions (AAP, APHA, NRC and MCHB).
In projects of this scope and magnitude, the end product is
only as good as the persons who participate in the effort. It
is hard to enumerate in this introduction the countless hours
of dedication and effort from contributors and reviewers.
The project owes each of them a huge debt of gratitude.
Their reward will come when high-quality early care and
education services become available to all children and their
Overview of Content and Format Changes
Caring for Our Children, 3rd Edition contains
ten chapters of 686 Standards and thirty-nine
Appendices. We have made the following significant
content and format changes in the third edition:
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