Fort Worth, TX,
12:20 PM

Curious About Health and Safety Requirements at Day Care? We Have Answers

Here's a look at a few key requirements that licensed day cares in Texas must follow.

By Jean Yaeger

Enrolling a child in day care might raise a few concerns or unknowns about the steps the facilities take to protect the kids they serve from illness and injury. 3

It’s important for parents to know that the Texas Health and Human Services Commission (HHSC) sets rules that state-licensed day care operators, including in-home day cares, must follow. Those rules aim to minimize the risks for infants, toddlers and older children while playing, eating and sleeping at day care. The goal is to make the settings as sanitary and hazard-free as possible.

Across the state, there are about 8,300 licensed child care centers and in-home day cares with a combined capacity for more than 997,000 children. Sharon Evans, trauma injury prevention coordinator at Cook Children’s, advises parents to make sure the facility they choose is licensed and subject to the regulations.

“Day care regulations are in place to keep your child as safe as possible. However, Cook Children’s still sees broken bones and head injuries from day cares due to kids playing,” Evans said.  1

The HHSC requirements are published in Minimum Standards for Child-Care Centers, which was revised in March 2023. You’ll find specifics on many topics – from food allergies and first aid to fever and fire drills – in the updated manual. Sections cover illness protocol, required immunizations, playground equipment and much more in 294 pages.

Here’s a shorter and simplified look at a few key requirements.

Parents will need to provide:

Medical information at admission: Name, address and phone number of the child’s physician; authorization for emergency medical care; an emergency plan for any severe allergic reactions; a statement of any special care needs.   

Health statement: Signed by a health care professional who has examined the child in the past year. It says the child can participate in the day care’s program.

Routine vaccinations: Immunize by 3 months old for diseases including polio, hepatitis B and diphtheria, tetanus and pertussis (DTaP). Booster shots are due for older children. The day care must keep a copy of every child’s up-to-date shot record on file.  Learn more here. 2

Licensed day cares are required to provide:

Caregiver training: Before they start the job, with 24 hours of additional training each year. Certification in pediatric first aid and pediatric cardiopulmonary resuscitation (CPR) is also required. “Ongoing training provides caregivers an opportunity to learn the newest techniques for addressing children’s behaviors, to discover the latest findings on what children need as they develop, and to refresh and re-energize their skills,” the manual says.

Communication for any injuries: The day care will let you know about minor scratches and cuts when you pick up your child. An Incident/Illness Report must be filled out for injuries.

Infant safe sleep practices: Infants are always placed on their backs, by themselves, in a crib that meets federal regulations. Bean bags, waterbeds and foam pads may not be used. No pillows, blankets or soft toys can be in the sleep space. If your infant falls asleep in their car seat on the way to day care, they’ll be moved out of the seat and into a crib.

Sanitization: Toys that have been in a child’s mouth; potty chairs; sleeping spaces; table tops; anything soiled or contaminated. 

Proper handwashing: For employees upon arrival for the day; before handling food or medication; before feeding a child; after a diaper change or assisting a child with toileting; after wiping a child’s nose, mouth or sores; after their own trips to the bathroom. The children also must wash their hands frequently throughout the day.  

Guidelines for illness: Don’t bring your child to day care with an oral temperature above 101 degrees or ear temperature above 100 degrees. Other exclusions include lethargy, abnormal breathing, uncontrolled diarrhea, vomiting twice or more in 24 hours, rash with fever, or mouth sores with drooling.  A child may return after being symptom-free for 24 hours.

Safeguards on the premises: Childproof covers on electrical outlets; televisions anchored so they can’t tip over; heaters out of children’s reach; no access to firearms. Smoke detectors, carbon monoxide detectors, fire extinguishers and sprinkler systems are required. No use of alcohol, drugs, tobacco products or e-cigarettes is permitted by anyone on the property. 

Medication: In the original container, labeled with your child’s name, and not past the expiration date. The employee who administers the medicine will record the date, time and dosage given.

Safe handling for food allergies: Employees who prepare and serve food will be made aware of the known food allergies. Foods listed on a child’s emergency plan will be posted wherever food is prepared and where the child spends time.

Stock - Baby and momStarting day care is a big milestone, and Cook Children’s is here to help if your child needs routine immunizations or a signed health statement prior to get started. Our neighborhood clinics and pediatric offices are located across Fort Worth and much of the North Texas region. Find the closest site by visiting Primary Care Offices/Neighborhood Clinics (

Search the official state of Texas child care database to make an informed decision when choosing a child care provider. Inspection and compliance history can be found at Search Texas Child Care, which includes the details of all minimum standards cited as a deficiency.