In Know What to Expect at Your Child’s K- 12 School or Child Care Program, 8/4/21, the Centers for Disease Control and Prevention (CDC) offer helpful information to consider and suggest, "To maximize protection from the Delta variant and prevent possibly spreading it to others, wear a mask indoors in public if you are in an area of substantial or high transmission.  

The American Academy of Pediatrics (AAP) updated COVID-19 Guidance for Safe Schools - as of July 18, 2021.

The AAP strongly advocates that all policy considerations for school plans should start with the goal of keeping students safe and physically present in school. It is critical to use science and data to guide decisions about the pandemic and school COVID-19 plans. All school COVID-19 policies should consider the following key principles and remember that COVID-19 policies are intended to mitigate, not eliminate, risk. Because school transmission reflects (but does not drive) community transmission, it is vitally important that communities take all necessary measures to limit the community spread of SARS-CoV-2 to ensure schools can remain open and safe for all students.

  • The implementation of several coordinated interventions can greatly reduce risk. See the guidance from the American Academy of Pediatrics (AAP) as of July 18, 2021.

Review the Pennsylvania Office of Child Development and Early Learning (OCDEL)'s suggestions COVID-19 Best Practices for Early Childhood Education (ECE) 9-6-21.

To view OCDEL's policy update posted previously 8-31-21, click Announcement C-21-07: COVID-19 Policy Updates or visit the Pennsylvania Department of Education's website

The Pennsylvania Office of Child Development and Early Learning (OCDEL), Bureau of Early Learning Policy and Professional Development and Bureau of Certification has released the Announcement C-21-07: COVID-19 Policy Updates. The purpose of this Announcement is to communicate the release of an Order of the Acting Secretary of the Pennsylvania Department of Health Directing Face Coverings in School Entities (Order) and expectations for compliance by certified child care facilities as well as provide clarification of ongoing reporting requirements related to COVID-19. The Order applies to all child care providers licensed by the Department of Human Services.

This announcement replaces announcement C-21-04 Best Practices for Child Care Facilities Operating During the Novel Coronavirus in its entirety.

The Acting Secretary of Health’s Order will be effective Sept. 7, 2021. School entities should comply with the Order on or before that date. Effective Sept. 7, 2021, child care certification representatives (reps) conducting inspections or complaint investigations will cite child care facilities operating out of compliance with the Order. The citations for non-compliance with the Order will be issued under 55 Pa. Code §3270.14, 3270.21, §3280.14, 3280.20, and §3290.18, all pertaining to compliance with “pertinent laws and regulations” and “general health and safety.” 

For additional details, please see the Announcement C-21-07: COVID-19 Policy Updates or visit the Pennsylvania Department of Education's website

The Pennsylvania Office of Child Development and Early Learning (OCDEL) has released the Guidance for Tuberculin Skin Testing (TST) and COVID-19 Vaccinations: Frequently Asked Questions (FAQs) which provides information for those within the child care setting relating to TST requirements and COVID-19 vaccinations.

See the Guidance for TST and COVID-19 Vaccinations: FAQs for additional details.

The Pennsylvania Office of Child Development and Early Learning (OCDEL), Bureau of Certification has released the Summer 2021 Newsletter. This printable newsletter contains information about:

•    Coronavirus updates
•    Meet the Certification Bureau director
•    New Regulation changes
•    Swimming and lifeguard requirements
•    Where's Baby? Look before you lock campaign
•    Field trip information
•    Exposure to bees and bugs in child care settings
•    Plant safety
•    Summer child care programs and summer camps
•    Safety in the sun
•    Summer treats

Child care directors are encouraged to discuss any questions with their certification representative and then share the information with their staff and families.

Archived Bureau of Certification E-News and Newsletters

Don’t miss important information; Sign up for the Certification eNews

Promote healthy nutrition with children, families and staff at your program. Examine the Academy of Nutrition and Dietetics’ website. Use their toolkit with individual files such as 20 Health Tips. See Smart Snacking Tips for Kids.

The Early Childhood Education Linkage System (ECELS) websiteoffers resources to promote healthy nutrition. Explore valuable options in the Child Care Health Consultant Toolkit- Obesity Prevention, for example: Tips for Feeding Picky Eaters (one minute video and resources). Use Model Child Care Health Policies, 5th Ed. to revise/develop policies and practices to support improved nutrition, breastfeeding, physical activity and screen time. Contact ECELS at This email address is being protected from spambots. You need JavaScript enabled to view it..

Use the Healthy Kids, Healthy Future resources. Review the Nutrition and Physical Activity Self- Assessment for Child Care (Go NAP SACC). Based on your assessment, develop an action plan to make improvements. Share these nutrition tips for infants, toddlers and preschoolers with families from the Early Childhood Learning & Knowledge Center (ECLKC). Encourage small changes to improve healthy eating and habits. 

Help fight hunger in PA. Visit DHS’ Ending Hunger webpages - a resource for food security in Pennsylvania. Click on the link to find a food pantry or view the network of food banks in PA. 5/21 

Do you know someone buying a car seat? Want to know the best one?


The best car seat is the one that fits the child, fits the vehicle, and the caregiver can use it correctly every time. See details in the "Gift Giving Guide for Car Seats." The many products sold as car seat accessories that are non-approved products, which are not recommended by car seat manufacturers, are addressed. Counterfeit car seats are being advertised and sold online and are found on many ecommerce platforms. These car seats do not meet Federal Motor Vehicle Safety Standard 213 (FMVSS 213) and are potentially dangerous for children. For more information, read “Counterfeit Car Seats."

 The Pennsylvania Key Infant Early Childhood Mental Health Consultation (IECMHC) Program Consultants worked collaboratively to create the social story and tips and resources to support re-entering into Early Education Centers after COVID-19. The social story, We are back in school!, can be used by early childhood education staff as a resource for support social and emotional as children and staff start the process of re-entering the child care setting. Each page in this social story contains Teacher Tips, Prompts, Resources and Activities which can help with discussions with children in child care. There are clickable links and even spots where staff can jot down their own notes! The Tip and Resource Guide provides additional information. 7/8/21

Nebulizers, Asthma and COVID-19

Do you have children in your care with asthma? Parents/caregivers of children with asthma who use nebulizers should contact their child’s health care provider about using a metered dose inhaler (MDI) instead of a nebulizer. Use of inhalers with spacers instead of nebulizers involves decreased close exposure time during the medication administration. According to The Centers for Disease Control’s (CDC), people with asthma should use inhalers with spacers (with or without a face mask, according to each student’s personal treatment plan) instead of nebulizer treatments whenever possible during the COVID-19 pandemic. Children’s medical records/care plans should be reviewed to see who may require nebulizer treatments. Care plans should be updated as per the health care provider’s recommendations. K-12 Schools and Child Care Programs FAQs for Administrators, Teachers, and Parents offers important guidance to consider and precautions to take.

Increased cleaning and disinfecting is necessary because of the pandemic. Disinfecting products maybe a trigger for some children so care should be taken to prevent exposure to them:

If you have asthma:
    •  Ask an adult without asthma to clean and disinfect surfaces and objects for you.
    •  Stay in another room when cleaners or disinfectants are being used and right after their use.
    •  Use only cleaning products you must use. Some surfaces and objects that are seldom touched may need to be cleaned only with soap and water.
    •  Make a list of the urgent care or health facilities near you that provide nebulizer/asthma treatments. Keep it close to your phone.
    •  If you have an asthma attack, move away from the trigger such as the disinfectant or the area that was disinfected. Follow your Asthma Action Plan. Call 911 for medical emergencies. 7/8/21

The American Academy of Pediatrics Parenting website has many COVID-19 resources to support families.  These include: Parenting in a Pandemic; Working and Learning; Getting Outside; Masks for Kids; New Baby Challenges; Disinfectant Safety and Breastfeeding.  

Asthma is one of most common chronic illnesses among children in the United States. Most people know at least one child with asthma. Asthma is different for each child, so it’s important to know each child’s triggers, symptoms, and treatment plan. Changes in the seasons as well as an increase of allergens in our environment can cause an increase in asthma symptoms. Symptoms range from mild coughing or wheezing to chest tightness, sometimes causing shortness of breath, or worse – a severe asthma attack. The National Heart, Lung, and Blood Institute’s Learn More Breathe Better national health education program provides information and resources on asthma, Chronic Obstructive Pulmonary Disease (COPD), and other lung diseases and conditions to those who are managing these diseases, their caregivers and the health care providers who help treat them.

What is Asthma?

Reducing Allergens in your home

Monitoring your Asthma

Asthma Action Plan

Source: National Heart, Lung, and Blood Institute; National Institutes of Health; U.S. Department of Health and Human Services.

Many children in child care need assistance with managing their asthma (even during COVID). Here is a good resource for those who care for children in early learning settings - Caring for Children with Asthma during the COVID-19 Pandemic 7/8/21

Every 3 Minutes a food allergy reaction sends someone to the emergency room and over 60 percent of food allergy reactions at school take place in preschools and child care facilities, notes the Food Allergy Research & Education’s (FARE) website. Keeping children with food allergies safe and healthy can present a special challenge in early care and education programs if you are not prepared.

  • Learn to modify early learning and school-age programs for a child with a food allergy. Plan for handling a food allergy response by reviewing the training presentations from Food Allergy Research & Education (FARE) such as Save a Life: Recognizing and Responding to Anaphylaxis”, “Keeping Students Safe and Included”, and “Navigating Early Childhood and Food Allergies”.
  • Use FARE’s Food Allergy & Anaphylaxis Emergency Care Plan, formerly the Food Allergy Action Plan, that outlines recommended treatment in case of an allergic reaction, is signed by a physician and includes emergency contact information. PA Keystone STARS Performance Standards LM.2.5 specifies policies relating to care plans for children with special needs including food allergies. Resources available include – “Tips for Managing Students with Food Allergies During a Shelter-in-Place Emergency”, “Tips for Field Trips”, “Tips for Cleaning”, “Tips for Non-Food Treats and Rewards”.
  • See the Centers for Disease Control and Prevention (CDC)’s Voluntary Guidelines for Managing Food Allergies in Schools and Early Care and Education Programs for additional recommended plans, practices, and procedures. 5-2021

Children die in hot vehicles every year. Heatstroke begins when the core body temperature reaches about 104 degrees and the ability to maintain or control body temperature is overwhelmed. Vehicles heat up quickly – even with a window rolled down two inches.   If the outside temperature is in the low 80°s Fahrenheit, the temperature inside a vehicle can reach deadly levels   in only 10 minutes! Children’s bodies overheat easily, and infants and children under four years of age are among those at greatest risk for heat-related illness. When left in a hot vehicle, a young child’s body temperature may increase three to five times as fast an adult. High body temperatures can cause permanent injury or even death.

Warning signs of heatstroke include:

  • Red, hot, and moist or dry skin
  • No sweating, even though the child is warm
  • Strong rapid pulse or slow weak pulse
  • Throbbing headache
  • Dizziness
  • Nausea
  • Confusion, or acting strangely

If a child exhibits any of these signs after being in a hot vehicle, call 911 or your local emergency number immediately! Cool the child rapidly. Spray the child with cool water - do NOT place child in an ice bath.


  • Always check the back seat before you lock the vehicle and walk away.
  • Get in the habit of always opening the back door to check the back seat before leaving a vehicle. Put something you will need like your cell phone, handbag, or briefcase, etc., in the back seat to create a reminder to open the back door to retrieve that item every time you park.
  • Keep a large stuffed animal in the child’s car seat. When the child is placed in the car seat, put the stuffed animal in the front passenger seat as a visual reminder that the child is in the back seat.
  • Distractions and/or a change in routine increase the risk of forgetting a child in a back seat. If someone else is driving your child, or your daily routine is altered, always check to make sure your child has arrived safely.
  • Have a strict policy in place with the childcare provider about morning drop-off.
    • If your child will not be attending childcare as scheduled, the parent’s responsibility is to call and inform the childcare provider.
    • If the child does not show up as scheduled, and the child care provider did not receive a call, the childcare provider pledges to contact the parent immediately to ensure the safety of your child.
  • Never leave a child alone in a car.
  • Never let children play in an unattended vehicle. Teach children that a vehicle is not a play area.
  • Never leave a child in a parked vehicle, even if the windows are partially open.
  • Observe and Report: If you see a child alone in a car, call 911, especially on warm days!

Resource: National Highway Traffic Safety Administration

It’s unsafe and bad practice to leave a child unattended in a car for any reason, even for a quick stop – e.g. in a parking lot or elsewhere to pick up food from a restaurant. In PA, it is a summary offense as specified in PA Statute Title 75 3701.1 Leaving an unattended child in a motor vehicle.

For heatstroke prevention information cited above, click here. For other traffic injury prevention information, contact the PA Traffic Injury Prevention Project of the PA Chapter of the American Academy of Pediatrics (PA-TIPP) at      1-800-CARBELT, 484-446-3008 or see their website and resource page. 6/2021

Q: What is the guidance regarding embedded tick removal for ECE providers?
A: It is recommended that removal of a tick from a child should be completed by the parent/guardian or medical professional as soon as possible. According to Dr. Brittany Massare, ECELS Advisor and Pediatrician, “The more time a tick is attached to a child increases the risk of Lyme disease transmission. In general, the CDC says it takes at least 36-48 hours of the tick being attached before Lyme is spread to the person. If a parent did a thorough tick check before bed the night before and did not see a tick, this is reassuring. But because attached ticks can be missed even with thorough checks and the CDC can’t say for sure there is no transmission of Lyme until at least 36 hours of attachment, prompt removal of any tick is recommended.”
OCDEL Certification recommends that if a childcare provider finds an embedded tick, they should immediately contact the child’s parent or guardian so that next steps can be determined quickly. This is consistent with regulation 132(a). While it is not recommended for a provider to remove an embedded tick, there is no regulation that states that they cannot do so. With that being said, it is advised that a provider not remove a tick unless there is written authorization by the parent and the provider has received the appropriate health and safety training to do so. Following proper technique for tick removal can be challenging; even with proper technique, heads can stay attached and need to be dug out, which can be difficult.

Tick Removal and Prevention:

  • The Centers for Disease Control and Prevention ( provides information on prevention, removal and symptoms of tickborne diseases. Helpful resources include:
  • Caring for our Children (CFOC) standard includes information on protection from ticks and how to remove a tick.
  • Pediatric First Aid for Caregivers and Teachers (2nd ed.) First Aid Care for tick bites section states: “Don’t grab a tick by the rear of its body. The body might rupture. Then the infectious contents can enter the wound. If the ticks head breaks off in the skin, use tweezers as you would remove a splinter. Wash area with soap and rinse with Inform the parent or guardian that you have removed a tick from the child. Alert them to watch the bite area for appearance of a rash. If a rash appears, or the child becomes ill, the child needs medical care.”
  • Managing Infectious Diseases in Child Care and Schools (5th ed.) includes a section on the roles of the teacher/caregiver and family, and states that a child does not need to be excluded from a group setting for a tick bite unless the child is ill with a tickborne illness and is unable to participate. Staff members determine whether they are able to care for the child without compromising their ability to care for the health and safety of the other children in the group.

For More information see Health Advisory - 571 - Lyme Disease and Other Tickborne Diseases in Pennsylvania
For questions, please call 1-877-PA-HEALTH (1-877-724-3258) or your local health department for more information.

Shared by ECELS, Healthy Child Care PA/PA Chapter, American Academy of Pediatrics 484/446-3003
Reviewed by Amy Requa: Senior Health Manager, The Pennsylvania Key 6/2021