Guidance for Day Care/Out of School Care (Child Care)
This protocol provides guidance to help childcare operators reduce the risk of transmission of COVID-19 among participants, workers, volunteers and children. Operators are required to adhere to these Guidelines for reopening Licensed Child Care Centers see annex A. Please note that child care settings have to be inspected by the Environmental Health Department and Department of Education prior to opening. All settings should consider reducing the number of children they would normally accommodate in order to permit social distancing. These additional considerations are intended to provide guidance for a range of child care programs, including:
- Family child care programs, also known as home-based child care
- Pre-K (Pre-kindergarten) programs at private and public schools
- Head Start and Early Head Start programs
- Private child care centers
Prevent the Spread of COVID-19
Plan ahead to ensure adequate supplies to support hand hygiene behaviors and routine cleaning of objects and surfaces.
Encourage staff to take everyday preventive actions to prevent the spread of respiratory illness.
- Wash hands often with soap and water. If soap and water are not readily available, use an alcohol-based hand sanitizer with at least 70% alcohol.
- Always wash hands with soap and water if hands are visibly dirty.
- Remember to supervise young children when they use hand sanitizer to prevent swallowing alcohol.
- Clean and disinfect frequently touched surfaces.
- Cover cough and sneezes.
- Cover your mouth and nose with a cloth face covering when you have to go out in public.
- Cloth face coverings should NOT be put on babies and children under age two because of the danger of suffocation.
Require sick children and staff to stay home.
- Communicate to parents the importance of keeping children home when they are sick.
- Communicate to staff the importance of being vigilant for symptoms and staying in touch with facility management if or when they start to feel sick.
- Establish procedures to ensure children and staff who come to the child care center sick or become sick while at your facility are sent home as soon as possible.
- Keep sick children and staff separate from well children and staff until they can be sent home.
- Sick staff members should not return to work until they have met the criteria to discontinue home isolation.
Have a plan if someone is or becomes sick.
- Plan to have an isolation room or area (such as a cot in a corner of the classroom) that can be used to isolate a sick child.
- Be ready to follow Environmental Health Department (EHD) guidance on how to disinfect your building or facility if someone is sick.
- If a sick child has been isolated in your facility, clean and disinfect surfaces in your isolation room or area after the sick child has gone home.
- If COVID-19 is confirmed in a child or staff member:
- Close off areas used by the person who is sick.
- Open outside doors and windows to increase air circulation in the areas.
- Wait up to 24 hours or as long as possible before you clean or disinfect to allow respiratory droplets to settle before cleaning and disinfecting.
- Clean and disinfect all areas used by the person who is sick, such as offices, bathrooms, and common areas.
- If more than 7 days have passed since the person who is sick visited or used the facility, additional cleaning and disinfection is not necessary.
- Continue routine cleaning and disinfection.
Monitor and Plan for Absenteeism Among Your Staff
- Develop plans to cover classes in the event of increased staff absences. Coordinate with other local child care programs and reach out to substitutes to determine their anticipated availability if regular staff members need to stay home if they or their family members are sick.
- Recommend that individuals at higher risk for severe illness from COVID-19 (older adults and people of any age who have serious underlying medical conditions) consult with their medical provider to assess their risk and to determine if they should stay home if there is an outbreak in their community.
Review plans for implementing social distancing strategies
- Social distancing focuses on remaining out of congregate settings, avoiding mass gatherings, and maintaining distance from others when possible. Detailed guidance for implementing social distancing strategies in child care centers and schools is found here.
Assess Group Gatherings and Events
- Follow current guidance about gatherings and events.
- Plan to limit nonessential visitors and postpone or cancel use of classroom volunteers.
Ensure the following strategies are implemented:
- Implement social distancing strategies.
- Intensify cleaning and disinfection efforts.
- Modify drop off and pick up procedures.
- Implement screening procedures upon arrival.
Risk Reduction Measures:
- Child care programs should operate in cohorts of 10 people during this phase. This should include both staff and children.
- A cohort is defined as a group of children and staff members assigned to them who stay together throughout the day.
- Staff members, parents and guardians and children must not attend the program if they are sick, even if symptoms resemble a mild cold.
- Symptoms to look for include: fever, cough, shortness of breath, sore throat, runny nose, nasal congestion, headache, and a general feeling of being unwell.
- Staff must ask parents and guardians to check the temperatures of their children daily before coming to the program.
- Parents and guardians should be reminded of this requirement when children are first registered for the program and through visible signage at the entrances and drop off areas.
- Staff must conduct active symptom screening of each child every day with their parent or guardian during drop off.
- Programs must keep daily records of anyone entering attending the facility who stays for 15 minutes or longer (e.g. staff working each day, children.). Records must be kept up-to-date and available to facilitate contact tracing in the event of an outbreak.
- Any program connected to a confirmed or probable case of COVID19 will be required to close for a minimum of 72 hours to allow contact tracing, and then adhere to recommendations from Ministry of Health.
- If a child develops symptoms while at the program, the child should be isolated away from other children and the parent or guardian should be notified to come and pick up the child immediately. If a separate room is not available, the child needs to be kept at least 2 metres (6) away from other children.
- If the child is young and requires close contact and care, staff can continue to care for the child until the parent is able to pick the child. Staff should wear a mask during all interactions with the child and should avoid contact with the child’s respiratory secretions.
- Staff should wash their hands before putting on a mask and after removing the mask (as per mask guidance), and before and after touching any items used by the child.
- All items, used by the child while isolated should be cleaned and disinfected as soon as the child has been picked up. Items that cannot be cleaned and disinfected (e.g. paper, books, cardboard puzzles) should be removed from the program and stored in a sealed container for a minimum of 10 days.
- Social (Physical) Distancing
- Cohorts cannot mix with other cohorts or be within in the same room/space at the same time, including pickups and drop-offs, meal times, playtime, outdoor activities, staff rooms, etc.
- Limit the mixing of children by staggering playground times and keeping groups separate for special activities.
- Shared spaces and structures that cannot be cleaned and disinfected between cohorts should not be used.
- If possible, at nap time, ensure that children’s naptime mats (or cribs) are spaced out as much as possible, ideally 6 feet apart. Consider placing children head to toe in order to further reduce the potential for viral spread.
- More than one program can be offered per building as long as separation between programs is maintained (separate entrances/exits, washrooms) and all health requirements are followed.
- Where possible, physical distancing practices should occur.
- Avoid close greetings like hugs or handshakes and encourage physically-distant greetings such as “air fives” and waves.
- Plan for physically-distant activities such as shadow tag and where possible, avoid activities that require clustering around a particular item or small area.
- Consider staggering arrival and drop off times and/or have child care providers come outside the facility to pick up the children as they arrive. Your plan for curb side drop off and pick up should limit direct contact between parents and staff members and adhere to social distancing recommendations.
- If possible, arrange for administrative staff to telework from their homes.
- Drop off and Pick Up Procedures
- Management should develop appropriate procedures for drop off and pick up that support physical distancing and separate cohorts to the greatest extent possible. Possible strategies should include separate cohort entrances, having one designated parent or guardian pick up and drop off each child, staggering entry, or limiting the numbers of people in entry areas.
- There should be no non-essential visitors at the program. Parents or guardians are able to attend the program when needed, but should minimize the time spent there.
- Childcare operators and staff should use telephone or video conferencing when possible to meet with staff and parents.
- Parents picking up children from more than one cohort at the centre should not be allowed to intermingle with children in the cohorts.
- Alcohol-based sanitizer containing at least 70% alcohol should be placed in all entrances to the program area for use by staff, parents doing pickups/drop-offs, and other essential visitors. Dispensers should not be placed in locations that can be accessed by young children as alcohol-based hand sanitizer is not generally recommended for use by young children.
- Signs should be posted reminding persons not to enter if they are sick (even if symptoms resemble a mild cold).
- Use of shared spaces
- Play structures that are to be used by more than one group, should only be used by one cohort at a time and must be cleaned and disinfected thoroughly before and after use by each cohort.
- Only one cohort at a time may use the same outdoor play space. Follow physical distancing practices when possible. Each cohort should have designated equipment (e.g. balls, loose equipment) or clean and disinfect equipment between cohort uses.
- The program should establish a plan to prevent mingling of cohorts in washrooms and to minimize the number of shared surfaces in washrooms.
- Programs that utilize a space that has other user groups (e.g. programs in museums, community centres, etc.) must ensure the space is cleaned before and after using the space. It is recommended that cleaning be done by one person within the cohort directly before the group enters the space and after it exits the space. A cleaning log must be posted and used to track cleaning.
- Program Planning
- When planning activities, staff should conduct an assessment using the following questions in order to determine the risk of the activities and whether they are allowed to proceed:
- Does the activity violate a public health measures?
- Does the activity involve shared surfaces or objects frequently touched by hands?
- Can an activity be modified to increase opportunities for physical distancing?
- Food Services
- No self-serve or family-style meal service.
- Food provided by the family should be stored with the child’s belongings or, if refrigeration is required, should be kept in an area designated for the child’s cohort and should not be handled by other cohorts’ staff.
- No activities involving child participation in food preparation are allowed.
- Ensure that food handling staff practice hand hygiene and are excluded from work if they are symptomatic.
- Where possible, children should practice physical distancing while eating.
- There should be no common food items (e.g., salt and pepper shakers).
- Meals should be served in individual portions by a designated staff member to each child.
- Utensils should be used to serve food items (not fingers).
- Caregivers should ensure children wash hands prior to and immediately after eating.
- Caregivers should wash their hands before preparing food and after helping children to eat.
- Programs should engage in frequent, thorough cleaning and disinfecting each day.
- Clean and disinfect frequently touched objects and surfaces as per Environmental Health Department Guidelines for Environmental Cleaning of Public Facilities during COVID-19.
Intensify cleaning and disinfection efforts:
- Facilities should develop a schedule for cleaning and disinfecting.
- Routinely clean, sanitize, and disinfect surfaces and objects that are frequently touched, especially toys and games. This may also include cleaning objects/surfaces not ordinarily cleaned daily such as doorknobs, light switches, classroom sink handles, countertops, nap pads, toilet training potties, desks, chairs, cubbies, and playground structures. Use the cleaners typically used at your facility.
- Use all cleaning products according to the directions on the label. For disinfection, most common EPA-registered, fragrance-free household disinfectants should be effective.
- If surfaces are dirty, they should be cleaned using a detergent or soap and water prior to disinfection. Follow the manufacturer’s instructions for concentration, application method, and contact time for all cleaning and disinfection products.
- If possible, provide EPA-registered disposable wipes to child care providers and other staff members so that commonly used surfaces such as keyboards, desks, and remote controls can be wiped down before use.
- All cleaning materials should be kept secure and out of reach of children.
- Cleaning products should not be used near children, and staff should ensure that there is adequate ventilation when using these products to prevent children from inhaling toxic fumes.
Clean and Sanitize Toys
- Toys that cannot be cleaned and sanitized should not be used.
- Toys that children have placed in their mouths or that are otherwise contaminated by body secretions or excretions should be set aside until they are cleaned by hand by a person wearing gloves. Clean with water and detergent, rinse, sanitize with an EPA-registered disinfectant, rinse again, and air-dry. You may also clean in a mechanical dishwasher. Be mindful of items more likely to be placed in a child’s mouth, like play food, dishes, and utensils.
- Machine washable cloth toys should be used by one individual at a time or should not be used at all. These toys should be laundered before being used by another child.
- Do not share toys with other groups of infants or toddlers, unless they are washed and sanitized before being moved from one group to the other.
- Set aside toys that need to be cleaned. Place in a dish pan with soapy water or put in a separate container marked for “soiled toys.” Keep dish pan and water out of reach from children to prevent risk of drowning. Washing with soapy water is the ideal method for cleaning. Try to have enough toys so that the toys can be rotated through cleanings.
- Children’s books, like other paper-based materials such as mail or envelopes, are not considered a high risk for transmission and do not need additional cleaning or disinfection procedures.
Clean and Disinfect Bedding
- Use bedding (sheets, pillows, blankets, sleeping bags) that can be washed. Keep each child’s bedding separate, and consider storing in individually labeled bins, cubbies, or bags. Cots and mats should be labeled for each child. Bedding that touches a child’s skin should be cleaned weekly or before use by another child.
Caring for Infants and Toddlers
When diapering a child, wash your hands and wash the child’s hands before you begin, and wear gloves. Follow safe diaper changing procedures. Procedures should be posted in all diaper changing areas. Steps include:
- Prepare (includes putting on gloves)
- Clean the child
- Remove trash (soiled diaper and wipes)
- Replace diaper
- Wash child’s hands
- Clean up diapering station
- Wash hands
After diapering, wash your hands (even if you were wearing gloves) and disinfect the diapering area with a fragrance-free bleach that is EPA-registered as a sanitizing or disinfecting solution.
If other products are used for sanitizing or disinfecting, they should also be fragrance-free and EPA-registered. If the surface is dirty, it should be cleaned with detergent or soap and water prior to disinfection.
Washing, Feeding, or Holding a Child
It is important to comfort crying, sad, and/or anxious infants and toddlers, and they often need to be held. To the extent possible, when washing, feeding, or holding very young children: Child care providers can protect themselves by wearing an over-large button-down, long sleeved shirt and by wearing long hair up off the collar in a ponytail or other up do.
- Child care providers should wash their hands, neck, and anywhere touched by a child’s secretions.
- Child care providers should change the child’s clothes if secretions are on the child’s clothes. They should change the button-down shirt, if there are secretions on it, and wash their hands again.
- Contaminated clothes should be placed in a plastic bag or washed in a washing machine.
- Infants, toddlers, and their providers should have multiple changes of clothes on hand in the child care center or home-based child care.
- Child care providers should wash their hands before and after handling infant bottles prepared at home or prepared in the facility. Bottles, bottle caps, nipples, and other equipment used for bottle-feeding should be thoroughly cleaned after each use by washing in a dishwasher or by washing with a bottlebrush, soap, and water.
Healthy Hand Hygiene Behaviour
- All children, staff, and volunteers should engage in hand hygiene at the following times:
- Arrival to the facility and after breaks.
- Before and after preparing food or drinks.
- Before and after eating or handling food, or feeding children.
- Before and after administering medication or medical ointment.
- Before and after diapering.
- After using the toilet or helping a child use the bathroom
- After coming in contact with bodily fluid.
- After handling animals or cleaning up animal waste.
- After playing outdoors or in sand.
- After handling garbage.
- Wash hands with soap and water for at least 20 seconds. If hands are not visibly dirty, alcohol-based hand sanitizers with at least 70% alcohol can be used if soap and water are not readily available.
- Supervise children when they use hand sanitizer to prevent ingestion.
- Assist children with handwashing, including infants who cannot wash hands alone.
- After assisting children with handwashing, staff should also wash their hands.
As the COVID-19 situation continues to develop, the Ministry of Health will provide updates if any additional precautions are recommended.