Caring for Our Children (CFOC)

Chapter 1: Staffing

1.1 Child:Staff Ratio, Group Size, and Minimum Age

1.1.1 Child:Staff Ratio and Group Size Ratios for Facilities Serving Children with Special Health Care Needs and Disabilities

COVID-19 modification as of May 21, 2021 

After reading the CFOC standard, see COVID-19 modification below (Also consult applicable state licensure and public health requirements).


Facilities enrolling children with special health care needs and disabilities should determine, by an individual assessment of each child’s needs, whether the facility requires a lower child:staff ratio.

COVID-19 modification as of May 21, 2021 

In response to the Centers for Disease Control and Prevention’s COVID-19 Guidance for Operating Early Care and Education/Child Care Programs, it is recommended that early childhood programs:

  • Follow guidance from your state and local health department as well as your state licensing agency to make decisions on appropriate group sizes
  • Keep the same group of children (cohort) and staff together each day
  • Ensure that everyone two years old and older wears a well-fitted mask except when eating or sleeping
    • Wearing a mask maybe difficult for children with special needs
    • Prioritize wearing mask when it is difficult to separate children and/or staff
  • Limit the contact children have in large groups
  • Allow direct service providers into the program to provide individual services for children with special needs
  • Allow additional square footage if possible during naptime, as children are unmasked and need to be further apart 
    • Place children head to toe on alternating mats (or cribs)
  • Use outdoor environments for activities and meals as much as possible
  • Increase ventilation by bringing in as much outdoor air as possible
    • Open windows and doors, when safe to do so
    • Use child-safe fans to increase the airflow from open windows
  • Avoid use of cleaning, sanitizing and disinfecting products near children with sensory or respiratory issues 

Additional Resources:

Centers for Disease Control and Prevention. Ventilation in Schools and Childcare Programs

American Academy of Pediatrics. Guidance Related to Childcare During COVID-19

Environmental Protection Agency. Ventilation and Coronavirus (COVID-19)

The child:staff ratio must allow the needs of the children enrolled to be met. The facility should have sufficient direct care professional staff to provide the required programs and services. Integrated facilities with fewer resources may be able to serve children who need fewer services, and the staffing levels may vary accordingly. Adjustment of the ratio allows for the flexibility needed to meet each child’s type and degree of special need and encourage each child to participate comfortably in program activities. Adjustment of the ratio produces flexibility without resulting in a need for care that is greater than the staff can provide without compromising the health and safety of other children. The facility should seek consultation with parents/guardians, a child care health consultant (CCHC), and other professionals, regarding the appropriate child:staff ratio. The facility may wish to increase the number of staff members if the child requires significant special assistance (1).

These ratios do not include personnel who have other duties that might preclude their involvement in needed supervision while they are performing those duties, such as therapists, cooks, maintenance workers, or bus drivers.

Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home
RELATED STANDARDS Ratios for Small Family Child Care Homes Ratios for Large Family Child Care Homes and Centers
  1. University of North Carolina at Chapel Hill, FPG Child Development Institute. The national early childhood technical assistance center.

COVID-19 modification as of May 21, 2021