(a)  All staff working with the mildly sick children shall complete all requirements in this Chapter pertaining to preservice training in 10A NCAC 09 .0704, .0710 and .0711, orientation in 10A NCAC 09 .1101, health and safety training requirements in 10A NCAC 09 .1102, on-going training in 10A NCAC 09 .1103, and staff records in 10A NCAC 09 .0701. In addition, the requirements for staff who care for children with Level One symptoms as described in Rule .2404, Paragraphs (a)(1)(A) and (B) of this Section shall be as follows:

(1)           Each group of children shall have a lead teacher present who has the North Carolina Early Childhood Credential or its equivalent prior to assuming care giving responsibilities.

(2)           In addition to staff orientation requirements in 10A NCAC 09 .1101 of this Chapter prior to assuming care giving duties all caregivers shall complete 10 hours of training on the following:

(A)          storage and administration of medication;

(B)          infection control procedures;

(C)          aspiration of nasal secretions;

(D)          positioning for sleeping and eating;

(E)           temperature and respiratory rate taking;

(F)           documentation of signs, symptoms, physical appearance, intake and output, and communication with family and physicians;

(G)          recognizing when to stop, increase, or decrease oral intake of fluids;

(H)          recognizing signs and symptoms associated with the increased severity of illness including behavioral changes, changes in bowel movements, increased sluggishness, etc.;

(I)            developing individualized plans of care;

(J)            special dietary requirements and maintaining hydration; and

(K)          emergency procedures, including notification of a parent, should a child's condition worsen.

(3)           Any caregiver caring for a child whose illness requires special knowledge, skills, or equipment shall have training and equipment prior to caring for the child.

(4)           Completion of the training required by Subparagraph (a)(2) of this Rule shall count toward meeting one year's annual on-going training requirements in 10A NCAC 09 .1103.

(5)           When a center cares for mildly sick children as a component of a child care center, the administrator shall meet the education requirements for administrators as required by G.S. 110-91(8).

(b)  In addition to the staffing requirements listed in Subparagraphs (a)(1) through (a)(4) of this Rule, if children with Level Two symptoms as described in Parts (a)(2)(A) through (a)(2)(E) of Rule .2404 of this Section are in care, the following number of medical staff shall be on site based upon the total number of children in care:


No. of Children    Type of Medical Staff

1 to 10                   an RN, or a LPN with a health care professional in the immediate vicinity

10 to 20                 an RN

20 to 40                 an RN and an additional LPN


Each medical staff shall have one year of full-time pediatric nursing experience, and may count in staff/child ratio. Medical staff may also act as lead teachers if they have the North Carolina Early Childhood Credential or equivalent.


History Note:        Authority G.S. 110-88(11); 143B-168.3;

Eff. April 1, 2003;

Readopted Eff. October 1, 2017;

Amended Eff. February 1, 2021; September 1, 2019.