Child Care Guidance

The playbook is provided for Greater Des Moines (DSM) home-based child care, pre-K programs at private and public schools, head start and early head start programs, private child care centers, temporary child care centers operated by municipalities for the children of essential service providers, and child care centers that partner with healthcare facilities to support healthcare workers who need child care.

Child Care Risk Profile

This risk profile has been determined for child care centers in DSM. The profile shows frequency, or how many people in a day; duration, or length of typical interaction; and variety, or the number of different people.*

Current Impact

Future Trends

Recommended Practices

Community Partnerships

Additional Resources

Current Impacts

The public health crisis of COVID-19 has had a devastating effect on the child care industry. In the spring of 2020, many child care providers closed their programs to follow public health guidance, leading to lost revenue for weeks and months at a time. In Iowa, 829 centers and 171 home providers reported temporary closure by mid-April. While most providers have now re-opened, they are operating with increased operational costs. The pandemic has further exposed Iowa families' issues with gaining access to good, affordable child care. Earlier this year, Governor Reynolds launched the Child Care Taskforce to develop a comprehensive strategy to address the child care shortage and barriers to work in Iowa.

Future Trends

	Health and Safety Efforts In child care settings, the legacy of the pandemic will likely be a continued focus on health, safety and hygiene. Parents who have become used to continuously washing their hands and staying at a safe distance from others are unlikely to suddenly abandon this protocol after vaccination. Providers will continue to focus on health and safety efforts and go to additional lengths to keep their facilities clean.
	Virtual Care The flexibility of virtual child care makes it appealing to many children and parents who will need child care in a post-pandemic future. Although most schools and child care providers are returning to an in-person setting, some degree of virtual or hybrid child care will remain to serve those that prefer greater flexibility than in-person services can offer.
	Increased Tech Mobile apps help parents stay informed of their child's preschool activities and helps child care centers communicate with parents. After a year of living through incredibly uncertain times, parents are going to want and need peace of mind when it comes to their little ones more than ever before.

Recommended Practices

Health & Sanitation

• Conduct a health screening with all employees before their shifts in accordance with the most up to date recommendations from your local public health department.
• Screen children upon arrival for fever or other COVID-19 symptoms. Detailed CDC screening methods for child care providers can be found in the resource section below.
• Encourage employees who feel sick to stay home. Employees who have had close contact with someone with COVID-19 should consult CDC guidance on when to self-quarantine.
• Have a plan if someone is or becomes sick, including an isolation room or area that can be used to isolate a sick child.
• Appropriate PPE should be worn in accordance with the most up-to-date recommendations from your local public health department.
• When feasible, staff members and older children should wear face coverings within the facility.
• Cloth face coverings should not be placed on babies and children under two.
• Train all employees on appropriate cleaning and disinfection, hand hygiene and respiratory etiquette.
• Assist children with handwashing, including infants who cannot wash hands alone.
• All children and staff should wash their hands with soap and water at the following key times:
  • Arrival to your facility
  • Before and after preparing food or drinks
  • Before and after eating or handling food or feeding children
  • Before and after helping a child put on or adjust their mask
  • Before and after administering medication or medical ointment
  • Before and after diapering a child
  • After using the bathroom or after helping a child use the bathroom
  • After having contact with bodily fluids
  • After handling garbage
• To the extent possible when holding, washing or feeding young children, protect yourself by:
  • Washing your hands frequently
  • Washing your hands, neck and anywhere you have been touched by a child’s bodily fluids
  • Avoiding touching your eyes while holding, washing or feeding a child
• If bodily fluids get on the child’s clothes, change them right away, whenever possible, and then your hands should be rewashed.
• Wash your hands before and after handling infant bottles prepared at home or in the facility.
• Develop a schedule for increased frequency of routine cleaning of high-touch surfaces such as door handles, tables, sink faucets and drinking fountains.
• Clean more frequently or clean AND disinfect surfaces and objects if certain conditions apply:
  • High transmission of COVID-19 in your community
  • Low number of people wearing masks
  • Infrequent hand hygiene
  • The space is occupied by people at increased risk for severe illness from COVID-19
• All cleaning materials should be kept secure and out of reach of children.
• If possible, provide EPA-registered disposable wipes to staff so that commonly used surfaces such as keyboards, desks and remote controls can be wiped down before use.
• 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.
• Toys that can be put in the mouth should be sanitized between uses or not used if they cannot be cleaned and sanitized.
• Set aside toys that children have placed in their mouths or that are otherwise contaminated through contact or other bodily fluids until they can be cleaned by hand by a person wearing gloves. Clean with water and detergent, rinse and sanitize with an EPA-registered disinfectant, rinse again and air-dry. You can 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 person 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 paperback books, like other paper-based materials such as mail or envelopes, are not considered a high risk for transmission and do not need additional procedures for cleaning or disinfection.
• Use child bedding (sheets, pillows, blankets, sleeping bags) that can be washed and keep each child’s bedding separate. Label cots and mats for each child. Clean bedding that touches a child’s skin weekly or before use by another child.
• Offer modified job responsibilities for your staff at higher risk for severe illness (including older adults and people of all ages with certain underlying medical conditions or disabilities) that limit their exposure risk.
• Encourage staff to talk to their healthcare providers to assess their risk and to determine if they should stay home and to get a vaccine when it is offered.
• Consistent with applicable laws, put in place policies to protect the privacy of people at higher risk for severe illness regarding underlying medical conditions.

Process & Space Modifications

• Discourage sharing of items that are difficult to clean or disinfect (for example, stuffed animals, electronics, games, puzzles).
• Keep each child’s belongings separated from others’ and in individually labeled containers, cubbies or areas.
• Ensure adequate supplies to minimize sharing of high touch materials to the extent possible (for example, assigning each child their own art supplies, equipment) or limit use of supplies and equipment (for example, physical activity equipment) by one group of children at a time and clean and disinfect between use.
• Physically distance child seating areas when possible.
• Turn your tables to face in the same direction (rather than facing each other), or have your children sit on only one side of your tables, spaced apart, particularly at mealtimes.
• Modify your learning stations and activities to keep children physically distanced, when possible.
• Provide physical guides, such as tape on floors or sidewalks and signs on walls, to ensure that staff and children maintain six feet physical distance from other “classrooms” or cohorts in common areas (for example, guides for creating “one-way routes” in hallways). Recognizing that for very young children, lining up physically distanced may be developmentally difficult and may need to be modified.
• Install physical barriers, such as sneeze guards and partitions, particularly in settings where it is difficult for people to remain physically distanced (for example, child care center reception desks and entryways). Ensure barriers are regularly cleaned and disinfected.
• Family child care providers can use physical barriers and guides where it is difficult to remain physically distanced.
• If your child care program does have communal spaces that are used by multiple different groups of children throughout the day such as dining halls, multi-purpose rooms and playgrounds, stagger their use and properly clean and disinfect between groups. Ensure proper hand hygiene is practiced by children and staff before and after each use. Closing communal spaces may be considered if you are unable to maintain cleaning and disinfection.
• Communal outdoor spaces, such as playgrounds (play structures, jungle gyms, swing sets) and play spaces with shared toys or equipment (for example balls, tricycles, toy cars) are important for healthy child development, but can pose a risk for spreading COVID-19. Even though outdoor spaces reduce risk of spreading COVID-19, the virus can still spread when young children touch contaminated objects and then touch their eyes, nose or mouth. Preventive behaviors such as wearing a mask, handwashing and cohorting are needed.
  • Keep readily available your supplies, such as hand sanitizer with at least 60% alcohol, disinfectant wipes, paper towels, tissues and no-touch trash cans in outdoor areas for staff and children.
  • Outdoor areas generally require normal routine cleaning and do not require disinfection. Do not spray disinfectant on sidewalks and in outdoor play areas as it is not an efficient use of disinfectant supplies and has not been proven to reduce the risk of COVID-19. You should continue existing cleaning and hygiene practices for outdoor areas.
  • The targeted use of disinfectants can be done effectively, efficiently and safely on outdoor hard surfaces and objects frequently touched by multiple children and staff (for example, handrails, benches); make sure disinfectant has thoroughly dried before allowing children to play.
  • Routinely clean high touch surfaces made of plastic or metal, such as grab bars and railings.
  • Do not clean and disinfect wooden surfaces (play structures, benches, tables) or groundcovers (mulch, sand).
  • Consider restricting your use of play structures or equipment that position children close by one another (for example facing each other on a tire swing, crawling close together in tunnels or enclosed with one another in fort-type structures.)
  • Stagger your use of playgrounds and play spaces by reducing the group size in the play area at one time or remaining in cohort groups while sanitizing shared objects and high-touch surfaces between groups.
  • If multiple cohort groups need to be in your play area at the same time, consider using fencing or another barrier to designate separate areas for each cohort.
• If possible, your child care groups should include the same children each day, and the same child care providers should remain with the same group of children each day.
• Limit the mixing of classes, such as staggering playground times separate groups for special activities such as art, music and exercise.
• The number of cohorts or groups may vary depending on child care program type (centers versus homes) and size, with smaller programs having fewer cohorts than larger ones.
• Limit the mixing of your children, such as staggering your playground times and keeping groups separate for special activities such as art, music and exercising.
• If possible, at nap time, ensure that children’s naptime mats (or cribs) are spaced out as much as possible. Consider placing children (or infants in cribs) head to toe in order to further reduce the potential for viral spread.
• Stagger child arrival, drop-off and pickup times or locations by group, or put in place other plans to limit contact between groups and to limit staff’s direct contact with parents, guardians and caregivers.
• Consider going outside your child care center or family child care home to pick up children as they arrive. A plan for curbside drop-off and pickup should limit direct contact between parents/guardians and staff members and ensure six feet distance between adults. You can transport infants in their car seats and then store car seats out of children’s reach. If curbside, outdoor or staggered pickup and drop-off are not feasible, consider how you limit or decrease direct contact between parents, guardians and caregivers to ensure physical distancing when possible.
• Handwashing stations should be set up at the entrance of the child care center or family child care home, so that staff and children (over age 2) can use hand sanitizer before they enter. If a sink with soap and water is not available, provide hand sanitizer with at least 60% alcohol next to parent sign-in sheets or the door to the home. Keep hand sanitizer out of children’s reach and supervise use for children under six years old. If possible, place sign-in stations outside and provide sanitary wipes for cleaning pens between each use.
• As feasible, have children and staff eat meals outdoors or in well-ventilated classrooms or spaces within the family child care home while maintaining distance as much as possible. Masks should be stored in a space designated for each child that is separate from others when not being worn (for example, in individually labeled containers, bags, or cubbies) and put back on when not eating.
• If cafeterias or communal dining halls will be used, ensure separate “classrooms” or cohorts remain six feet apart while eating and faced in the same direction. Consider staggering when classrooms eat, so children can maintain their small groups. Clean and disinfect tables, chairs and highchairs between each use. Surfaces that come in contact with food should be washed, rinsed and sanitized before and after meals.
• Avoid offering any self-serve food or drink options. Instead, serve individually plated or pre-packaged meals and snacks while ensuring the safety of children with food allergies.
  • If your meals are typically served family-style, identify one employee to place food on plates so that multiple staff and children are not handling serving utensils.
• Use disposable food service items (for example, utensils, trays).
  • If using disposable items is not feasible or desirable, ensure that all non-disposable food service items and equipment are handled by staff with gloves and washed, rinsed and sanitized to meet food safety requirements.
• Everyone should wash their hands after removing their gloves or after directly handling used food service items.
• Drinking fountains should be cleaned and sanitized. Encourage staff and families to bring their own water to minimize use and touching of water fountains or consider installing no-touch activation methods for water fountains.
• Consider how you can bring in as much fresh air into your child care center or family child care home as possible. Bringing fresh, outdoor air into your center or home helps keep virus particles from concentrating inside.
  • If it’s safe to do so, open doors and windows as much as you can to bring in fresh, outdoor air. While it’s better to open them wide, even having a window cracked open slightly can help.
  • If you can, open multiple windows and doors to allow more fresh air to move inside.
  • Do not open windows and doors if doing so is unsafe for you or others (for example, risk of falling, triggering asthma symptoms, high levels of pollution).
  • If opening windows or doors is unsafe, consider other approaches for reducing the amount of virus particles in the air, such as using air filtration and exhaust fans.
  • Consider running your HVAC system at maximum outside airflow for two hours before and after the center or home is occupied.
  • Ventilation considerations are also important on your transport vehicles such as buses or vans. Open windows to increase airflow from outside when safe to do so.
• Ensure restroom exhaust fans are functional and operating at full capacity when the center or home is occupied. Clean and change filters as recommended by manufacturer.
• Inspect and maintain your local exhaust ventilation in areas such as restrooms, kitchens, cooking areas, etc.
• Use child-safe fans to increase the effectiveness of open windows. Placing a fan by an open window to blow inside air out is a good way to encourage air flow throughout the room. Even without an open window, fans can improve air flow and keep virus particles from staying concentrated in one place.
• Ensure your ventilation systems operate properly and provide acceptable indoor air quality for the current occupancy level for each space.
• If your child care center or family child care home does not have an HVAC system or wants extra filtration, consider using a portable high-efficiency particulate air (HEPA) cleaner.
• Do not open windows and doors if doing so is unsafe for you or others (for example, risk of falling, triggering asthma symptoms, high levels of pollution).
• If transport vehicles (for example, buses or vans) are used by your child care program, drivers should practice all safety actions and protocols as indicated for other staff (for example, hand hygiene, masks). Clean and disinfect frequently touched surfaces.
• Create distance between children on transport buses (for example, seat children one child per row, skip rows) when possible. However, children from the same home can be seated together.

Provide accommodations, modifications and assistance for children with disabilities and special needs:

• Your child care program should remain accessible for children with disabilities.
• Physical distancing can be difficult for young children with disabilities.
• Wearing masks may be difficult for young children with certain disabilities (for example, visual or hearing impairments) or for those with sensory, cognitive or behavioral issues. For children who are only able to wear masks some of the time for these reasons, prioritize having them wear masks during times when it is difficult to separate children and/or staff (for example, during carpool drop off or pick up, or when standing in line).
• If interacting with people who rely on reading lips, consider wearing a clear mask or a cloth mask with a clear panel.
• Many children require assistance or visual and verbal reminders to cover their mouth and nose with a tissue when they cough or sneeze, throw tissues in the trash and wash their hands.
• Where service or therapy animals are used, use guidance to protect the animal from chemical disinfectants and from COVID-19 (even though the number of dogs and other pets who have contracted COVID-19 from humans remains low).
• Cleaning and disinfecting procedures might negatively affect children with sensory or respiratory issues. Avoid overuse, use safer products, and clean and disinfect when these children are not nearby, if possible.
• Behavioral techniques (such as modeling and reinforcing desired behaviors and using picture schedules, timers, and visual cues for positive reinforcement) can help all children adjust to changes in routines and take preventive actions but may be especially beneficial for some children with disabilities.
• Organizations that support people with disabilities have information and resources to help child care programs with these behavioral techniques. In addition, behavioral therapists or local mental health or behavioral health agencies may be able to provide consultation for specific concerns.

Communication

• Designate someone to be responsible for responding to COVID-19 concerns. Make sure staff and families know who their designated person is and how to contact them. In a family child care home, the provider is the designated contact person.
• Post signs in visible locations (entrances and restrooms) that promote everyday protective measures and describe how to stop the spread of germs (such as by properly washing hands and properly wearing a mask). Signs should be clear, be easy to understand, use pictures, be at appropriate reading and literacy level and be in primary languages spoken by your staff and families.
• Use various communication methods to ensure accessibility for all, including those with disabilities and vision impairments.
• 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.
• Post procedures for safe diaper changing in all diaper changing areas.
• Place posters describing hand-washing steps near sinks.
• Encourage workers to report any safety and health concerns immediately.

Strategic Partnerships

Investing in Iowa's Child Care (IICC) Program

Iowa's Child Care (IICC) is a funding program intended to increase availability of child care throughout the State. The program is administered by Child Care Resource and Referral (CCR&R) with funds from the Coronavirus Response and Relief Supplemental Appropriations Act of 2021. Funding is available for programs that are licensed or registered by DHS or are seeking to be licensed or registered by DHS. More information and application materials for the IICC program can be found on the Iowa CCR&R website here.

Child Care Task Force

Governor Reynolds launched the Child Care Taskforce on March 10, 2021, to develop a comprehensive strategy to address the child care shortage and barriers to work in Iowa. The Task Force will develop a roadmap to reduce both short- and long-term challenges to affordable and reliable child care throughout the state.

Additional Resources

• CDC Guidance for Child Care
• CDC COVID-19 Vaccine Toolkit for School Settings and Childcare Programs
• Iowa Child Care Task Force
• Iowa Child Care Guidance: Infection Control in Child Care Settings
• National Association for Family Child Care 
• Child Care Aware of America
• Child Care Trends

Recommended Playbooks

The business function playbooks include takeaways that are specific to professional functions that could be present in any business, regardless of industry.

*We note that these assessments are qualitative and based on expert-led judgment (Johns Hopkins, 2020). Currently, there are not enough detailed data available to enable quantitative risk stratification. Businesses will need to make decisions about re-initiating business activities before there are validated data to know the precise levels of risk.

Legal Disclaimer

The Greater Des Moines Partnership's DSM Forward playbook is not intended to constitute legal advice or provide specific direction. The preparation of a business continuity or preparations plan should be undertaken with the advice and direction of appropriate specialists and personnel, in consideration of the unique circumstances impacting each business. Third-party websites or material linked to or referenced in DSM Forward are for informational purposes only and do not constitute a recommendation of The Partnership of that material or its authors.
Last updated: 5/14/2021