Facility: SECTION 12 / HEALTH AND MEDICAL

A. Immunization. Immunization records must be maintained to ensure proper medical treatment is determined and given in the event of a disease outbreak or public health emergency.

  1. All Children in care must meet the following requirements:
    a. The Child Care Facility must have a current record of immunization on file for each Child, which clearly documents each Child’s present immunization status based on the Department’s Day Care Immunization Standards (available at
    https://www.maine.gov/dhhs/mecdc/infectiousdisease/immunization/documents/Childcare%20Immunization%20Standards.pdf and published August 8, 2021), within 30 days of the Child’s first admission to the Child care and updated as needed thereafter or,
    b. A blood test documenting immunity to measles, mumps, rubella and varicella (chickenpox), placed in the Child’s record and updated in a timely manner.
    c. Pursuant to P.L. 2019, Ch. 154, § 11, effective September 1, 2021, Children must be immunized as set forth herein and exemption from immunization requirements are limited to medical reasons. The Child’s physician, nurse practitioner, or physician assistant must provide documentation that immunization is medically inadvisable.
  2. Unimmunized Children and Child Care Staff Members. The Child Care Facility must maintain a list of all unimmunized persons, regardless of age. In the event of a disease outbreak as defined by CDC reporting standards, a Child not immunized must be excluded from the Child Care Facility in accordance with CDC guidance or until the Child receives the necessary immunization or proof of
    immunity is on record.
  3. Immunization records. The Child Care Facility must make immunization records available to the Department of Health and Human Services, Maine Center for Disease Control and Prevention, upon request.
  4. Documentation of immunity against tetanus, pertussis, and diphtheria is required for all Child Care Staff Members.
    a. For Child Care Staff Members born after 1956, the Child Care Facility must obtain and have available a Certificate of Immunization for measles, mumps, rubella, tetanus pertussis, and diphtheria.
    b. Documentation of immunity against measles, mumps and rubella is not required for Child Care Staff Members born prior to 1957. A laboratory blood test proving immunity may also be accepted.
    c. Only written documentation from a physician that such immunization is medically inadvisable exempts a Child Care Staff Member from the requirement of Section 12(A)(4)(a) and (b).

B. Evaluation requirements. When the Department has reasonable cause to believe that an Applicant or Child Care Staff Member may be unable to provide safe care for Children, the Department may request a report from a qualified professional or an appropriate official that includes the evaluator’s determination of the person’s ability to safely care for Children.

  1. A physical examination or other evaluation is not required if the Applicant or Child Care Staff Member states in writing that it is contrary to the person’s religious teachings and practice.
  2. If the Applicant or Child Care Staff Member refuses to be evaluated, the Department shall determine whether sufficient evidence exists to ensure that the person can safely care for Children.

C. Health care consultation.

  1. For Child Care Facilities licensed for 3-12 Children:
    a. The Child Care Facility must have a manual of written guidelines for the prevention and control of communicable diseases and other appropriate health practices for Child Care Facilities of this size.
    b. The Child Care Facility must ensure that the manual be available to and read by all Child Care Staff Members
  2. For Child Care Facilities licensed for 13 or more Children:
    a. The Child Care Facility must have a written agreement with a physician, physician’s assistant, a nurse practitioner, or registered nurse with pediatric or Child care experience to serve as a health consultant. The agreement must be updated at the time of license renewal.
    b. The Child Care Facility must have a written plan approved by the health care consultant which must include:
    i. Plan for access to emergency medical services;
    ii. Prevention and control of communicable diseases;
    iii. Policy on administration of medication including identification of Child Care Staff Members permitted to dispense medication and procedures for documentation of the administration or dispensing of medication; and
    iv. Provision of training to all Child Care Staff Members in the Child Care Facilities’ health care plan.

D. Health monitoring. The Child Care Facility must observe the Child each day at the time of arrival and throughout the Child’s stay for obvious signs of illness such as fever, diarrhea, vomiting, or skin rashes.

  1. In the event of an apparent illness of a Child, the Child Care Facility must follow appropriate health practices.
    a. The Child Care Facility licensed for 3-12 Children must comply with the guidance in the manual described in Section 12(C)(1)(a) above.
    b. The Child Care Facility licensed for 13 or more Children must follow its written health care policy statement.
  2. When a Child Care Facility knows or suspects that a Child has contracted a notifiable communicable disease or condition the Child Care Facility must notify the Maine Center for Disease Control and Prevention (MECDC).
    a. The Child Care Facility must notify the MECDC immediately by phone for Category 1 conditions, and within 48 hours for Category 2 conditions. MECDC contacts: Phone: 1-800-821-5821 (24 hours a day); FAX: 1-800-293-7534 (24 hours a day); or TTY: Maine relay 711 (24 hours a day).
    b. For a list of Category 1 and 2 notifiable conditions, see 10-144 CMR Chapter 258, Rules for the Control of Notifiable Conditions, Chapter 2(I).
    http://www.maine.gov/sos/cec/rules/10/144/144c258.doc

E. Dismissal of Children due to illness. When a Child becomes ill, but does not require immediate medical help, the Child Care Facility must determine if the Child should be sent home. The Child Care Facility must notify the parent/guardian of the Child who has symptoms that require exclusion.

F. Illness, serious injury, incidents, and accidents.

  1. The Child Care Facility must immediately notify the Child’s parent or legal guardian of any illness, serious injury, or incident involving their Child. An adult designated by the parent or legal guardian must be notified immediately should the parent or legal guardian be unavailable.
  2. The Child Care Facility must document all accidents, injuries, incidents, or emergencies in the Child’s record on the day of the occurrence and the parent or legal guardian must review and sign the document within two business days.

G. First aid. The Child Care Facility must have a first aid kit and a current first aid manual.

  1. A complete first-aid kit must be readily available at a Child Care Facility serving 3 to 12 Children, during all field trips, and while transporting Children.
  2. Programs serving 13 or more Children must have a separate first aid kit and manual in each classroom.
  3. The first aid kit must be kept in a clean and sanitary condition, be stored in an easily accessible, designated location known to all Child Care Staff Members and be kept out of the reach of Children.
  4. A complete first aid kit includes, but is not limited to, adhesive tape, band aids, gauze pads, gauze roller bandage, disposable gloves, instant cold pack, scissors, tweezers, thermometer, and antiseptic wipes.
  5. The first aid kit must not contain any expired materials.

H. Medication administration. A Child Care Facility may give a Child prescription medication only when the Child Care Facility has written, signed, and dated permission from a Parent.

  1. The Child Care Facility must only give medication prescribed for the specified Child, according to the label instructions on the original container.
  2. The Child Care Facility must not give any nonprescription medications to a Child without written permission from the parent. Telephone, text, or email permission is allowed in emergencies, if the Child Care Facility documents giving the medication and obtains written permission from the parent as soon as possible.
  3. The Child Care Facility must keep a written record, noting each time a prescription and nonprescription medication is given to a Child.
  4. All medications, refrigerated or non-refrigerated, must be:
    a. Completely inaccessible to Children,
    b. Stored at the proper temperature, and
    c. Discarded upon expiration.
  5. The use of medical marijuana in Child Care Facilities is governed by 18-691 CMR Chapter 2, Maine Medical Use of Marijuana Program Rule.

I. Handwashing. Handwashing must be done with soap and running water. The Child Care Facility must ensure that all adults and all Children wash their hands in at least the following circumstances:

  1. Immediately before and after eating snacks and meals, including washing the hands of all infants and toddlers before all feedings;
  2. After each diaper change or toileting;
  3. Before and after handling food; and
  4. Before and after administering medication

J. Prevention of exposure to blood and bodily fluids. Child Care Staff Members must take measures to prevent potential exposure to blood and other potentially infectious fluids, which may include use of disposable gloves. When touching blood, body fluids, secretions, excretions, mucous membranes, or nonintact skin, Care Staff Members must:

  1. Wash their hands after contact, even if gloves are worn;
  2. Ensure safe waste management by immediately discarding contaminated single use items; and
  3. Immediately clean and disinfect surfaces and reusable equipment.

K. Emergency procedures. Facilities must have a procedure for responding to situations when an immediate emergency medical response is required. Staff-Child ratio must be maintained, and Child Care Staff Members will be called in to maintain the required ratio. All Child Care Staff Members should be trained to manage an emergency until emergency medical care becomes available.