Medication administration in family child care homes: A comparison of state regulations with national recommendations

Background: Approximately 11 million children under age five years have mothers in the workforce, and about 6% are cared for by a non-relative in a family child care home. Among the 9% of young children with a special health care need, 86% require medication therapy. State childcare regulations play an important role in ensuring the inclusion, health, and safety of children in these settings. Method: This cross-sectional study compared the 50 state and D.C. family child care home regulations with standards on medication administration in Caring for Our Children (CFOC)– National Health and Safety Performance Standards: Guidelines for Out-of-Home Child Care Programs, 3rd ed (CFOC). A data collection instrument, which included seven CFOC standards on medication administration and was developed by a team of national experts, was used to measure compliance of state regulations with the standards. Results: None of the states' regulations (N=51) met the criteria for all seven standards. Most of the states (98%) met some criteria for standards on medication administration (94%), labeling, storage, disposal (94%), contents of medication record (88%), and maintenance of records (73%). However, only the regulations in a few states included some of the criteria for training of caregivers (27%), a medication policy (35%), and records of injury (12%). Conclusion: Most state regulations for medication administration in family child care homes do not meet CFOC standards, thus failing to ensure safe medication administration practices and optimal health outcomes for children in these settings. Implications for child health, safety, and policy will be discussed.