Caring for Our Children (CFOC)

Chapter 9: Administration

9.2 Policies

9.2.3 Health Policies Documentation of Exemptions and Exclusion of Children Who Lack Immunizations

For children who have been exempted from required, up-to-date immunizations, these exemptions should be documented in the child’s health record as a cross reference, (acceptable documentation includes a statement from the child’s primary provider, a legal exemption with notarization, waiver, or other state-specific required documentation signed by the parent/guardian). See Standard for more information.

Within two weeks of enrollment the parent/guardian should provide documentation to the child care program regarding progress in obtaining immunizations. The parent/guardian should receive written notice of exclusion if noncompliance or lack of progress is evident. If more than one immunization is needed in a series, time should be allowed for the immunizations to be obtained at the appropriate intervals. Exemptions from the requirement related to compliance with the federal McKinney-Vento Homeless Assistance Act for children experiencing homelessness are documented and include a plan for obtaining available documents within a reasonable period of time.

National surveys document that child care has a positive influence on protection from vaccine-preventable illness (1). Immunizations should be required for all children in child care and early education settings. Facilities must consider the consequences if they accept responsibility for exposing a child who cannot be fully immunized (because of immaturity) to an unimmunized child who may bring disease to the facility. Although up to two weeks after the child starts to participate in child care may be allowed for the acquisition of immunizations for which the child is eligible, parents/guardians should maintain their child’s immunization status according to the nationally recommended schedule to avoid potential exposure of other children in the facility to vaccine-preventable disease.
An updated immunization schedule is published annually near the beginning of the calendar year in the AAP’s Pediatrics journal and in the CDC’s MMWR and should be consulted for current information. In addition to print versions of the recommended childhood immunization schedule, the “Recommended Immunization Schedules for Persons Aged 0 through 18 Years – United States” is posted on the Websites of the CDC at and the AAP at

When a child who has a medical exemption from immunization is included in child care, reasonable accommodation of that child requires planning to exclude such a child in the event of an outbreak. Caregivers/teachers should check the Website for specific state-mandated immunization requirements and exemptions.

Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home
RELATED STANDARDS Unimmunized/Underimmunized Children
  1. Aronson, S. S. 1986. Maintaining health in child care settings. In Group care for young children, ed. N. Gunzenhauser, B. M. Caldwell. New Brunswick, NJ: Johnson and Johnson Baby Products Company.