Caring for Our Children

National Health and Safety Performance Standards

Guidelines for Early Care and Education Programs

Caring for Our Children, (CFOC) is a collection of national standards that represent the best practices, based on evidence, expertise, and experience, for quality health and safety policies and practices for today's early care and education settings.

CFOC Online Standards Database

(Most up-to-date source)

Search the CFOC Online Standards Database by health and safety topic, search term, chapter, or standard number.

COVID-19 Modifications:

COVID-19 modifications to CFOC standards are based on current evidence and guidelines. Some COVID-19 modifications may not be adequate for individual programs based on local community transmission levels. COVID-19 modifications are meant to supplement local, tribal, and/or territorial requirements for decreasing transmission and exposure to COVID-19. Programs are encouraged to check with their local public health departments for additional guidance. 

Suggested Citation for CFOC Standards Online Database:
American Academy of Pediatrics, American Public Health Association, National Resource Center for Health and Safety in Child Care and Early Education. CFOC Standards Online Database. Aurora, CO; National Resource Center for Health and Safety in Child Care and Early Education; 2020. [URL of Standard/Chapter]. Accessed [date].

See CFOC Table of Contents

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Standard included in Stepping Stones (SS)

Most recent revision date

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Updates to CFOC Standards 

*NEW! Updates to CFOC Appendices!*

APPENDIX L: Cleaning Up Body Fluids

APPENDIX JJ: Breastfeeding/Chestfeeding Support in Early Care and Education Programs

APPENDIX G: Recommended Childhood Immunization Schedule

APPENDIX H: Recommended Adult Immunization Schedule

APPENDIX I: Recommendations for Preventative Pediatric Health Care

APPENDIX W: Sample Food Service Cleaning Schedule

APPENDIX J: Selection and Use of a Cleaning, Sanitizing or Disinfecting Product

APPENDIX K: Routine Schedule for Cleaning, Sanitizing or Disinfecting

COVID-19 Modifications to CFOC Standards

Standard Child Care Health Consultants (Last Updated May 21, 2021)

Standard Infant and Early Childhood Mental Health Consultants (Last Updated October 10, 2022)

Standard Daily Staff Health Check (Last Updated July 28, 2023)

Standard Parent/Guardian Visits (Last Updated July 28, 2023)

Standard Conduct of Daily Health Check (Last Updated July 28, 2023)

Standard Situations that Require Hand Hygiene (Last Updated August 10, 2022)

Standard Inclusion/Exclusion/Dismissal of Children (Last Updated July 28, 2023)

Standard Staff Exclusion for Illness (Last Updated July 28, 2023)

Standard Socialization During Meals (Last Updated July 28, 2023)

Standard Ensuring Access to Fresh Air Indoors (Last Updated March 20, 2023)

Standard Heating and Ventilation Equipment Inspection and Maintenance (Last Updated August 10, 2022)

Standard Storage and Labeling of Personal Articles (Last Updated July 28, 2023)

Standard Drop-Off and Pick-Up (Last Updated October 10, 2022)

Standard Child Behavior During Transportation (Last Updated July 28, 2023)

Chapter 7.1 Introduction: How Infections Spread (Last Updated July 28, 2023)

Complete Standard Revisions

September 21, 2023

Standard Handwashing Procedure

Standard Handwashing Sink in Food Preparation Areas

Standard: Handwashing Sinks 

Standard Handwashing Sinks Prohibited Uses

Standard Handwashing Sinks for Diaper Changing Areas in Centers

Standard Handwashing Sinks for Diaper Changing Areas in Homes

September 14, 2023

Standard Food Preparation Sinks

June 16, 2023

Standard Dishwashing in Centers

Standard Dishwashing in Small and Large Family Child Care Homes

Standard Method for Washing Dishes by Hand

April 12, 2023

Standard Drinking Fountains

March 30, 2023

Standard Cleaning Food Areas and Equipment

Standard Cutting Boards

Standard Attendance of Children with Respiratory Syncytial Virus Infection (RSV)

March 20, 2023

Standard Cleaning and Sanitizing Toys

Standard Cleaning and Sanitizing Objects Intended for the Mouth

Standard Cleaning Individual Bedding

Standard Cleaning Crib and Other Sleep Surfaces

February 9, 2023

Chapter 4.1 Introduction

Standard Responsive Feeding of Infants by a Consistent Caregiver/Teacher

Standard Introduction of Age-Appropriate Solid Foods to Infants

Standard Encouraging Self-Feeding by Older Infants and Toddlers

January 31, 2023

Standard Use and Storage of Toxic Substances

Standard Sleeping Equipment and Supplies 

Standard Water Play Tables 

January 3, 2023

Standard Microfiber Cloths and Mops Used for Cleaning

December 20, 2022

Standard Parent and Guardian Visits

Standard Toilet Learning and Training Equipment

Standard Diaper Changing Tables

Standard Labeling, Cleaning, and Disposal of Waste and Diaper Containers

September 27, 2022

Standard Stress Management for Staff

Standard Routine Cleaning, Sanitizing, and Disinfecting

Standard Construction and Remodeling

Standard Maintenance of Exterior Surfaces

Standard Structure Maintenance

Standard Unimmunized/Underimmunized Children

Standard Maintenance and Display of Inspection Reports

September 13, 2022

Standard Infant and Early Childhood Mental Health Consultants

Standard Guidelines for Taking Children’s Temperatures

Standard Indoor and Outdoor Equipment, Materials, and Furnishing

Standard Staff Education and Policies on Enteric (Diarrheal) and Hepatitis A Virus (HAV) Infections

Standard Reporting Requirements for Diarrheal Infections

Standard Maintenance of Records

July 05, 2022

CFOC Subchapter 7.1: Infections in Early Care and Education Programs

Standard Exclusion for Group A Streptococcal (GAS) Infections

Standard Informing Caregivers/Teachers of Group A Streptococcal (GAS) Infection

Standard Reporting Requirements for Haemophilus Influenzae Type B Infections

Standard Prophylactic Treatment for Pertussis (Whooping Cough) 

Standard Exclusion for Pertussis (Whooping Cough)

Standard Impetigo

Standard Exclusion of Children with Varicella-Zoster (Chickenpox) Virus 

March 22, 2022

Standard Written Plan and Training for Handling Urgent Medical or Threatening Incidents

Standard Emergency and Evacuation Drills Policy

February 25, 2022

Standard Health and Safety Education Topics for Staff

Standard Immunization of Staff

Standard Influenza Immunizations for Children and Staff

Standard Influenza Control

Standard Influenza Prevention Education

Standard Policy Development for Care of Children and Staff Who Are Ill

Appendix B: Major Occupational Health Hazards

February 4, 2022

Standard Staff Health Guidelines for Return to Work

Standard On-Site Occupational Hazards

Standard Basic Benefits for Staff 

Standard Staff Corrective Improvement Plan

Standard Handling Official Complaints About Early Care and Education Staff

Standard Written Human Resource Management Policies for Centers and Large Family Child Care Homes

Standard Written Human Resource Management Policies for Small Family Child Care Homes

April 27, 2021

Standard Inspection of Buildings

Standard Structurally Sound Facility

Standard Testing for and Remediating Lead Hazards


Current CFOC Standard-based Resources

Other NRC Resources

Related External Resources

Get CFOC 4 (Last updated June 2019)

Download Free PDF Version of CFOC4 
Copyright 2019

Please note: The 4th Edition of CFOC does not contain the most up to date information. Updates to CFOC are made on this website and users are encouraged to use the online version for current information.

Purchase CFOC4 Print Version 
Copyright 2019


This resource is supported by the Administration for Children and Families (ACF) of the United States (U.S.) Department of Health and Human Services (HHS) as part of a financial assistance award totaling $7,600,000 with 100% funded by ACF. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement by, ACF/HHS or the U.S. Government.


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