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Children's Medical Services - Special services for children with special needs
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Infant Toddler Development Training
Module 6, Lesson 2

Child Care and Group Settings

3 kids drawingChild care and group settings are where most toddlers and many infants spend their days. Infants and toddlers with special needs are also served in child care centers or in family child care homes. The Division for Early Childhood (DEC) of the Council for Exceptional Children recommends that young children with disabilities have access to learning opportunities in their community (Sandall, 2000).

The ITDS has an opportunity to ensure the safety and health of young children with special needs, as well as helping to provide guidance on development, when a child is in a child care center. Can you think of some ways the ITDS can assist the family in ascertaining the safety of a center?

Bacterial Infections in Child Care

Physicians and other health care professionals are concerned about bacterial infections that infants and young children can acquire in child care settings. Bacterial infections are more prevalent when children are cared for in group settings. Good hand-washing techniques and a clean environment are essential to the overall health of the children and the adults in the center. Encourage the family to inquire about infection control policies. As an example of the higher risk for infection, the National Association of Child Care Professionals provide documentation that children in child care are at high risk for antibiotic resistant ear infections and are also at significantly higher risk for repeat ear infections. Further information can be obtained through Kid Source.

Choosing Child Care Settings

The family has several options when choosing a child care setting. They may opt for a small or a large family child care home, a large center or a drop-in child care facility. The need for child care is a discussion that can take place with the team.

If the ITDS is the primary provider, what considerations should be made in regards to helping a family access child care?

Adult-Child Ratios

mother holding babyLow adult-child ratios that meet the standards of the National Association for the Education of Young Children (NAEYC) tend to be associated with more developmentally appropriate interactions between the adult caregivers and the children. For infants, the NAEYC recommended practice for adult-child ratio is 1:3; however, licensing allows for 1:4 in most Florida counties. For toddlers, the NAEYC recommended practice for adult-child ratio is no more than 1:6. Lower adult-child ratios contribute to the safety at a center.

Specialized Child Care

There are child care agencies that serve sick children and agencies that serve children with chronic health care needs such as Prescribed Pediatric Extended Care (PPEC) facilities. Children need a physician's prescription to attend a PPEC. PPECs are considered as alternative to home nursing or prolonged hospitalization. Children served in PPECs need very low adult-child ratios because non-ambulatory children and children with special equipment require a greater amount of time to exit for fire safety and also for the provision of routine care giving.


The ITDS assesses the child with special needs in the child care setting and creates a Plan of Care and a Daily Activity Plan. This is done in collaboration with the child care provider to support the individual development of the child. The plan is based on the behavioral observations of the child's interactions with peers, adults, and materials in the environment (e.g. toys, books). The ITDS, who is often the Special Instruction Consultant (SIC) for the child, serves as a mentor/coach for the child care provider who may be a paraprofessional. The ITDS provides examples of ways that teachers can integrate developmental strategies into the everyday routines of the child.


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