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Commonly Asked Questions about
Child Care Centers and Coverage
Does the Americans with Disabilities Act -- or "ADA" --
apply to child care centers?
Yes. Privately-run child care centers -- like other public
accommodations such as private schools, recreation centers, restaurants,
hotels, movie theaters, and banks -- must comply with Title III of
the ADA. Child care services provided by government agencies,
such as Head Start, summer programs, and extended school day programs,
must comply with Title II of the ADA. Both titles apply to
a child care center's interactions with the children, parents, guardians,
and potential customers that it serves. A child care center's
employment practices are covered by other parts of the ADA and are
not addressed here.
Which child care centers are covered by title III?
Almost all child care providers, regardless of size or number of
employees, must comply with Title III of the ADA. Even small,
home-based centers that may not have to follow some State laws are
covered by Title III. The exception is child care centers that
are actually run by religious entities such as churches, mosques,
or synagogues. Activities controlled by religious organizations
are not covered by Title III. Private child care centers that
are operating on the premises of a religious organization, however,
are generally not exempt from Title III. Where such areas are
leased by a child care program not controlled or operated by the
religious organization, Title III applies to the child care program
but not the religious organization. For example, if a private
child care program is operated out of a church, pays rent to the
church, and has no other connection to the church, the program has
to comply with Title III but the church does not.
How do I decide whether a child with a disability belongs in my program?
Child care centers cannot just assume that a child's disabilities
are too severe for the child to be integrated successfully into the
center's child care program. The center must make an individualized
assessment about whether it can meet the particular needs of the
child without fundamentally altering its program. In making
this assessment, the caregiver must not react to unfounded preconceptions
or stereotypes about what children with disabilities can or cannot
do, or how much assistance they may require. Instead, the caregiver
should talk to the parents or guardians and any other professionals
(such as educators or health care professionals) who work with the
child in other contexts. Providers are often surprised at how simple
it is to include children with disabilities in their mainstream programs. Child
care centers that are accepting new children are not required to
accept children who would pose a direct threat or whose presence
or necessary care would fundamentally alter the nature of the child
care program.
My insurance company says it will raise our rates if we accept children
with disabilities. Do I still have to admit them into my program?
Yes. Higher insurance rates are not a valid reason for excluding
children with disabilities from a child care program. The extra
cost should be treated as overhead and divided equally among all
paying customers.
Our center is full and we have a waiting list. Do we have
to accept children with disabilities ahead of others?
No. Title III does not require providers to take children
with disabilities out of turn.
Our center specializes in "group child care." Can we reject
a child just because she needs individualized attention?
No. Most children will need individualized attention occasionally. If
a child who needs one-to-one attention due to a disability can be
integrated without fundamentally altering a child care program, the
child cannot be excluded solely because the child needs one-to-one
care. For instance, if a child with Down Syndrome and significant
mental retardation applies for admission and needs one-to-one care
to benefit from a child care program, and a personal assistant will
be provided at no cost to the child care center (usually by the parents
or though a government program), the child cannot be excluded from
the program solely because of the need for one-to-one care. Any
modifications necessary to integrate such a child must be made if
they are reasonable and would not fundamentally alter the program. This
is not to suggest that all children with Down Syndrome need one-to-one
care or must be accompanied by a personal assistant in order to be
successfully integrated into a mainstream child care program. As
in other cases, an individualized assessment is required. But
the ADA generally does not require centers to hire additional staff
or provide constant one-to-one supervision of a particular child
with a disability.
What about children whose presence is dangerous
to others? Do
we have to take them, too?
No. Children who pose a direct threat -- a substantial risk
of serious harm to the health and safety of others -- do not have
to be admitted into a program. The determination that a child
poses a direct threat may not be based on generalizations or stereotypes
about the effects of a particular disability; it must be based on
an individualized assessment that considers the particular activity
and the actual abilities and disabilities of the individual. In
order to find out whether a child has a medical condition that poses
a significant health threat to others, child care providers may ask
all applicants whether a child has any diseases that are communicable
through the types of incidental contact expected to occur in child
care settings. Providers may also inquire about specific conditions,
such as active infectious tuberculosis, that pose a direct threat.
One of the children in my center hits and bites other children. His
parents are now saying that I can't expel him because his bad behavior is
due to a disability. What can I do?
The first thing the provider should do is try to work with the parents
to see if there are reasonable ways of curbing the child's bad behavior. He
may need extra naps, "time out," or changes in his diet or medication. If
reasonable efforts have been made and the child continues to bite
and hit children or staff, he may be expelled from the program even
if he has a disability. The ADA does not require providers
to take any action that would pose a direct threat -- a substantial
risk of serious harm -- to the health or safety of others. Centers
should not make assumptions, however, about how a child with a disability
is likely to behave based on their past experiences with other children
with disabilities. Each situation must be considered individually.
One of the children in my center has parents who are deaf. I
need to have a long discussion with them about their child's behavior and development. Do
I have to provide a sign language interpreter for the meeting?
It depends. Child care centers must provide effective communication
to the customers they serve, including parents and guardians with
disabilities, unless doing so poses an undue burden. The person
with a disability should be consulted about what types of auxiliary
aids and services will be necessary in a particular context, given
the complexity, duration, and nature of the communication, as well
as the person's communication skills and history. Different
types of auxiliary aids and services may be required for lengthy
parent-teacher conferences than will normally be required for the
types of incidental day-to-day communication that take place when
children are dropped off or picked up from child care. As with
other actions required by the ADA, providers cannot impose the cost
of a qualified sign language interpreter or other auxiliary aid or
service on the parent or guardian. A particular auxiliary aid
or service is not required by Title III if it would pose an undue
burden, that is, a significant difficulty or expense, relative to
the center or parent company's resources.
We have a "no pets" policy. Do I have to allow a child with
a disability to bring a service animal, such as a seeing eye dog?
Yes. A service animal is not a pet. The ADA requires
you to modify your "no pets" policy to allow the use of a service
animal by a person with a disability. This does not mean that
you must abandon your "no pets" policy altogether, but simply that
you must make an exception to your general rule for service animals.
If an older child has delayed speech or developmental disabilities,
can we place that child in the infant or toddler room?
Generally, no. Under most circumstances, children with disabilities
must be placed in their age-appropriate classroom, unless the parents
or guardians agree otherwise.
Can I charge the parents for special services provided to a child with
a disability, provided that the charges are reasonable?
It depends. If the service is required by the
ADA, you cannot impose a surcharge for it. It is only if you go beyond
what is required by law that you can charge for those services. For
instance, if a child requires complicated medical procedures that
can only be done by licensed medical personnel, and the center does
not normally have such personnel on staff, the center would not be
required to provide the medical services under the ADA. If
the center chooses to go beyond its legal obligation and provide
the services, it may charge the parents or guardians accordingly. On
the other hand, if a center is asked to do simple procedures that
are required by the ADA -- such as finger-prick blood glucose tests
for children with diabetes -- it cannot charge the parents extra
for those services. To help offset the costs of actions or
services that are required by the ADA, including but not limited
to architectural barrier removal, providing sign language interpreters,
or purchasing adaptive equipment, some tax credits and deductions
may be available (Tax Credit Line).
Personal Services
Our center has a policy that we will not give
medication to any child. Can I refuse to give medication
to a child with a disability?
No. In some circumstances, it may be necessary
to give medication to a child with a disability in order to make
a program accessible to that child. While some state laws may
differ, generally speaking, as long as reasonable care is used in
following the doctors' and parents' or guardians written instructions
about administering medication, centers should not be held liable
for any resulting problems. Providers, parents, and guardians
are urged to consult professionals in their state whenever liability
questions arise.
We diaper young children, but we have a policy that
we will not accept children more than three years of age who need
diapering. Can we reject
children older than three who need diapering because of a disability?
Generally, no. Centers that provide personal
services such as diapering or toileting assistance for young children
must reasonably modify their policies and provide diapering services
for older children who need it due to a disability. Generally
speaking, centers that diaper infants should diaper older children
with disabilities when they would not have to leave other children
unattended to do so. Centers must also provide diapering services
to young children with disabilities who may need it more often than
others their age. Some children will need assistance in transferring
to and from the toilet because of mobility or coordination problems. Centers
should not consider this type of assistance to be a "personal service."
We do not normally diaper children of any age who are
not toilet trained. Do
we still have to help older children who need diapering or toileting assistance
due to a disability?
It depends. To determine when it is a reasonable
modification to provide diapering for an older child who needs diapering
because of a disability and a center does not normally provide diapering,
the center should consider factors including, but not limited to,
(1) whether other non-disabled children are young enough to need
intermittent toileting assistance when, for instance, they have accidents;
(2) whether providing toileting assistance or diapering on a regular
basis would require a child care provider to leave other children
unattended; and (3) whether the center would have to purchase diapering
tables or other equipment. If the program never provides toileting
assistance to any child, however, then such a personal service would
not be required for a child with a disability. Please keep in mind
that even in these circumstances, the child could not be excluded
from the program because he or she was not toilet trained if the
center can make other arrangements, such as having a parent or personal
assistant come and do the diapering.
Issues Regarding Specific Disabilities
Can we exclude children with HIV or AIDS from
our program to protect other children and employees?
No. Centers cannot exclude a child solely because
he has HIV or AIDS. According to the vast weight of scientific
authority, HIV/AIDS cannot be easily transmitted during the types
of incidental contact that take place in child care centers. Children
with HIV or AIDS generally can be safely integrated into all activities
of a child care program. Universal precautions, such as wearing
latex gloves, should be used whenever caregivers come into contact
with children's blood or bodily fluids, such as when they are cleansing
and bandaging playground wounds. This applies to the care of
all children, whether or not they are known to have disabilities.
Must we admit children with mental retardation and include them in
all center activities?
Centers cannot generally exclude a child just because
he or she has mental retardation. The center must take reasonable
steps to integrate that child into every activity provided to others. If
other children are included in group sings or on playground expeditions,
children with disabilities should be included as well. Segregating
children with disabilities is not acceptable under the ADA.
What about children who have severe, sometimes life-threatening
allergies to bee stings or certain foods? Do we have to take
them?
Generally, yes. Children cannot be excluded on
the sole basis that they have been identified as having severe allergies
to bee stings or certain foods. A center needs to be prepared
to take appropriate steps in the event of an allergic reaction, such
as administering a medicine called "epinephrine" that will be provided
in advance by the child's parents or guardians.
What about children with diabetes? Do we have to admit them to
our program? If we do, do we have to test their blood sugar levels?
Generally, yes. Children with diabetes can usually
be integrated into a child care program without fundamentally altering
it, so they should not be excluded from the program on the basis
of their diabetes. Providers should obtain written authorization
from the child's parents or guardians and physician and follow their
directions for simple diabetes-related care. In most instances,
they will authorize the provider to monitor the child's blood sugar
-- or "blood glucose" -- levels before lunch and whenever the child
appears to be having certain easy-to-recognize symptoms of a low
blood sugar incident. While the process may seem uncomfortable or
even frightening to those unfamiliar with it, monitoring a child's
blood sugar is easy to do with minimal training and takes only a
minute or two. Once the caregiver has the blood sugar level,
he or she must take whatever simple actions have been recommended
by the child's parents or guardians and doctor, such as giving the
child some fruit juice if the child's blood sugar level is low. The
child's parents or guardians are responsible for providing all appropriate
testing equipment, training, and special food necessary for the child.
Do we have to help children take off and put on their leg braces and
provide similar types of assistance to children with mobility impairments?
Generally, yes. Some children with mobility impairments
may need assistance in taking off and putting on leg or foot braces
during the child care day. As long as doing so would not be
so time consuming that other children would have to be left unattended,
or so complicated that it can only done by licensed health care professionals,
it would be a reasonable modification to provide such assistance.
Making the Child Care Facility Accessible
How do I make my child care center's building, playground,
and parking lot accessible to people with disabilities?
Even if you do not have any disabled people in your
program now, you have an ongoing obligation to remove barriers to
access for people with disabilities. Existing privately-run
child care centers must remove those architectural barriers that
limit the participation of children with disabilities (or parents,
guardians, or prospective customers with disabilities) if removing
the barriers is readily achievable, that is, if the barrier removal
can be easily accomplished and can be carried out without much difficulty
or expense. Installing offset hinges to widen a door opening, installing
grab bars in toilet stalls, or rearranging tables, chairs, and other
furniture are all examples of barrier removal that might be undertaken
to allow a child in a wheelchair to participate in a child care program.
Centers run by government agencies must insure that their programs
are accessible unless making changes imposes an undue burden; these
changes will sometimes include changes to the facilities.
We are going to build a new facility. What architectural standards
do we have to follow to make sure that our facility is accessible to people
with disabilities?
Newly constructed privately-run child care centers
-- those designed and constructed for first occupancy after January
26, 1993 -- must be readily accessible to and usable by individuals
with disabilities. This means that they must be built in strict
compliance with the ADA Standards for Accessible Design.
Tax Provisions
Are there tax credits or deductions available to help offset
the costs associated with complying with the ADA?
To assist businesses in complying with the ADA, Section 44 of the
IRS Code allows a tax credit for small businesses and Section 190
of the IRS Code allows a tax deduction for all businesses. (Tax
Credit Line)
Additional Resources
Are there any reference books or video tapes that might
help me further understand the obligations of child care providers
under Title III?
Through a grant from the Department of Justice, The Arc published
All Kids Count: Child Care and the ADA, which addresses the ADA's
obligations of child care providers. Copies are available for a nominal
fee by calling The Arc's National Headquarters in Arlington, Texas:
800-433-5255 (voice)
800-855-1155 (TTY)
Under a grant provided by the Department of Justice, Eastern Washington
University (EWU) produced eight 5-7 minute videotapes and eight accompanying
booklets on the ADA and child care providers. The videos cover
different ADA issues related to child care and can be purchased as
a set or individually by contacting the EWU at:
509-623-4246 (voice)
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