Dear Virginia Department of Education,

Thank you for the opportunity to provide public comment on the proposed fast-track regulations regarding stock or undesignated epinephrine for child day programs.

I am a licensed family day home provider, and I fully support efforts to keep children safe. However, I am concerned about several aspects of the proposed requirements as they relate specifically to small, home-based programs like mine:

1. The cost of stock epinephrine is prohibitive.
   With devices ranging from $290 to $850 each and no available federal or state funding, this places a disproportionate financial burden on small programs that operate with narrow margins. Providers should not be required or pressured to absorb the cost of medical devices that expire annually without state financial support.
2. Clarification is needed on liability.
   If family day home providers store epinephrine or administer it to a child without a prescription, we need clear guidance on liability protections, documentation requirements, and emergency procedures to ensure we are acting safely and legally.
3. Training timelines and accessibility must be clear.
   While I appreciate that training will be offered at no cost, small providers need training delivered in formats that are accessible around our operating hours, such as virtual modules or flexible scheduling.
4. The requirement to notify parents about whether epinephrine is stored is reasonable, but providers should not face penalties for choosing not to store stock epinephrine due to cost.

I respectfully request that the Department consider:

• Providing funding or negotiated reduced-cost devices for small programs
• Clarifying liability protections
• Creating flexible, accessible training options
• Ensuring that providers who choose not to store stock epinephrine are not disadvantaged in licensure or compliance

Thank you for considering the viewpoint of family day home providers as you finalize this regulation. I am committed to maintaining a safe, healthy environment for children and appreciate thoughtful, practical guidance that supports programs of all sizes.

Sincerely,

Cimbria Peterson

Licensed Family Day Home Provider

Fairfax, VA

We strongly oppose these new revisions.  It creates a huge liability issue, and unnecessary financial burden. Standards are already in place to protect children. Unnecessary government overreach!  

This is not a safe option to be required of all childcare facilities.  It is a much higher risk/liability to have stock epinephrine on site and making the determination if a CHILD (most of which cannot express their symptoms due to younger age) needs it.  

Opposed:  I am opposed to the proposed requirements to stock the epi pens and have my teachers administer the epi pens.  I think that these proposed requirements deserve more time for consideration in regards to the liabilities of storing and maintaining epi pens, administering those epi pens and what the requirements will be for the center to notify parents about these policies.  

I am strongly opposed to the requirement to stock and administer epi pens at my center.  The cost alone is devastating to small business owners and should not be a requirement.  

I do not believe it is safe for child care centers to purchase and use Epi-pens that have not been prescribed by a doctor for a specific child. Therefore, I don't think Family Day Homes should be required to have someone trained to use them.

RE: Opposition to Mandatory Stock EpiPen Requirement

I am a licensed Virginia child care provider, and I oppose this mandate for the following reasons:

• Financial burden of purchasing and maintaining EpiPens plus training costs

• Lack of medical training to diagnose anaphylactic shock or determine need for epinephrine

• Fear of causing serious harm through accidental injection or unnecessary administration

• Concern about dosing errors with children of different ages and sizes

• Unclear liability insurance coverage and risk of lawsuits

• Better alternatives exist, such as requiring prescribed EpiPens from parents with known allergies

I support child safety but ask that you work with providers on practical, sustainable solutions.

The Problem:

Stock epinephrine auto-injectors (EpiPens) are expensive pharmaceutical products with limited shelf life. Unlike one-time purchases, this represents an ongoing operational cost that providers must budget for indefinitely.

Specific Cost Factors:

• EpiPen Junior (for children 33-66 lbs): Approximately $300-650 for a 2-pack

• EpiPen Regular (for children over 66 lbs): Approximately $300-650 for a 2-pack

• Most facilities would need both sizes to cover different age groups

• EpiPens expire after 12-18 months and must be replaced

• Annual replacement costs even if never used

Additional Financial Considerations:

• Small family-based providers often operate with minimal profit margins

• Many providers are already struggling with rising costs (food, supplies, insurance)

• State reimbursement rates for subsidized care haven't kept pace with costs

• Passing costs to families makes child care less affordable in an already expensive market

• Some providers may be forced to close rather than absorb these costs

Impact on Families:

• Increased tuition rates across the board

• Reduced access to affordable child care

• Particular burden on working families already struggling with costs

Do not fast track this. This should be left up to the doctor's. We would call 911 and they would be here quickly. They are trained to administer this medication.

This should not be required by Family Day Homes. This creates an additional expense and we already do not receive enough money to cover this expense. 

As a Virginia child care provider, I am writing to express serious concerns about the proposed mandatory stock EpiPen requirement. This mandate would impose substantial costs for purchasing EpiPens and training staff, expenses that many small providers cannot absorb. More importantly, I am deeply uncomfortable being required to make complex medical decisions about administering epinephrine to children without medical training or knowledge of their full medical history. I fear the liability exposure and the potential for accidentally harming a child. I support child safety but believe this mandate is not the right approach. Please work with providers to develop practical alternatives.

Dear Members of the Virginia Department of Education,

I am writing on behalf of child care providers throughout Virginia to express serious concerns regarding the proposed requirement that all child care facilities maintain stock epinephrine auto-injectors (EpiPens) for emergency use. While we share the Department's commitment to child safety, we believe this mandate presents significant practical, financial, and liability challenges that warrant reconsideration.

Our concerns include the following:

Financial Burden: The cost of purchasing and maintaining stock EpiPens represents a substantial financial burden for child care providers, particularly small family-based operations. EpiPens require replacement before expiration dates, creating an ongoing expense that many providers cannot absorb without passing costs on to families already struggling with child care affordability.

Training Requirements and Associated Costs: The specialized training required to properly administer epinephrine represents an additional financial and time burden. Providers must not only pay for initial training but also ensure all staff members are trained and maintain current certifications, multiplying both the cost and logistical complexity.

Lack of Medical Expertise: Child care providers do not possess medical training to accurately diagnose anaphylactic shock, particularly in children without known allergies. The symptoms of anaphylaxis can overlap with other medical emergencies, and providers fear making critical errors in judgment that could have serious consequences. This places an unreasonable medical responsibility on individuals who are educators, not healthcare professionals.

Dosage Concerns: Providers are deeply concerned about the potential for administering incorrect dosages. EpiPens come in different strengths for different age groups and weights, and the risk of administering the wrong dose to a child could result in serious harm. This concern is particularly acute when dealing with children who have no documented allergy history.

Liability and Insurance Coverage: There is significant uncertainty about whether existing liability insurance policies will cover claims arising from the administration of stock epinephrine. Providers need clear assurance that they will be protected from litigation if a child experiences an adverse reaction or if the epinephrine is administered in a situation where it was not needed. Without adequate liability protection, this mandate could expose providers to devastating financial risk.

We respectfully suggest that alternative approaches may better serve the goal of child safety while addressing these concerns. These might include:

- Requiring parents of children with known severe allergies to provide EpiPens specifically prescribed for their child

- Ensuring emergency medical services can respond rapidly to child care facilities

- Providing comprehensive training on recognizing allergic reactions and when to call 911

- Creating a voluntary program with state funding and liability protection for providers who wish to maintain stock epinephrine

We appreciate the Department's dedication to protecting Virginia's children and welcome the opportunity to engage in further dialogue about this important issue. We believe that working together, we can develop policies that enhance child safety while remaining practical and sustainable for child care providers.

Thank you for your consideration of these concerns.

Respectfully,

The Virginia Alliance of Family Child Care Associations

Dr. Regina Washington- President

Strongly oppose 

Strongly oppose

strongly oppose-this will open us up to more liability-but the most worrisome issue is the costs of these pens-and they expire-luckily-we have never had this issue and while I never know when we may-I have been doing daycare for 40 years in January 2026-so the actual need for this in all daycares seems excessive unless there is a child present with a known need for one at which time the parent would have to supply it and administer it..unless these can be made available for free and the training can easily be gotten -but we are not even MAT trained for liability reasons too. 

My name is Gabriela Santos, and I am a licensed family child care provider in Virginia. I am writing to respectfully oppose the proposal requiring all child care programs to purchase, stock, and administer epinephrine auto-injectors (EpiPens) for children without known allergies. While I fully support measures that enhance child safety, this mandate creates significant financial, medical, legal, and operational challenges for family child care providers.

Financial Impact

Family child care homes operate with very limited margins, especially those serving subsidy-supported families. Stock EpiPens cost several hundred dollars per set, expire annually or every two years, and must be replaced even if never used. Without guaranteed state funding, this becomes an unfunded and recurring expense that many small programs simply cannot absorb.

In addition to purchasing the medication, providers would face costs for required training, retraining for assistants or substitutes, secure storage, and likely increased insurance premiums. Without full financial support from the Virginia Department of Education or the Department of Planning and Budget, this mandate is not feasible for most family child care programs.

Medical and Safety Concerns

Epinephrine is a powerful medication intended for emergency use under clear medical guidance. The proposal shifts clinical decision-making onto educators who are not trained medical professionals. Identifying anaphylaxis in a child with no known allergies is not a simple task. Symptoms can resemble asthma, choking, panic responses, viral illness, or febrile reactions. Asking child care providers to diagnose a life-threatening condition without medical history or parental guidance places children and providers at risk.

Administering epinephrine unnecessarily can cause serious complications, including elevated heart rate, high blood pressure, and cardiac side effects. These decisions should not be made by non-medical staff without a doctor’s plan.

Liability and Insurance Exposure

This proposal dramatically increases legal exposure for child care providers. Most insurance policies do not cover medical decision-making or medication errors involving prescription-level medication administered without a doctor’s order. A provider who administers epinephrine without clear indication risks malpractice-like claims, uncovered incidents, legal conflict with families, and possible licensure issues. Without strong liability protections, this mandate places child care providers in an unsafe and unfair position.

Operational Challenges

Many family child care homes operate with one provider or one assistant. During an emergency, one adult would need to assess symptoms, administer medication, call 911, supervise the rest of the children, and contact parents—simultaneously. This is not realistic or safe. These environments are not staffed or equipped like medical facilities, and the expectations of this proposal exceed what is feasible in small home-based programs.

Conflicts With Existing Medication Policies and Parental Rights

Current regulations appropriately require parental consent and a physician’s plan for any medication given in a childcare setting. This proposal contradicts those protections by requiring providers to administer a powerful medication without parent permission, without a medical diagnosis, and without individualized instructions. Parents must retain the right to make medical decisions for their children.

Recommendations

I urge the Virginia Department of Education to consider safer and more reasonable alternatives, such as:

• Requiring stock epinephrine only when a child with a documented allergy is enrolled
• Fully funding all medication, replacement cycles, and training if the mandate is kept
• Providing state-funded training conducted by medical professionals
• Offering voluntary participation rather than mandatory implementation
• Establishing strong liability protections for providers

While the intention behind this proposal is understandable, mandating stock epinephrine for all childcare programs—without medical need, parental consent, or state funding—creates significant risks and burdens. Providers are already navigating rising operational costs, staffing challenges, and increased regulatory demands. This mandate, as written, threatens the stability of family child care programs and does not reflect medical best practices.

For these reasons, I respectfully oppose the regulation in its current form.

Thank you for the opportunity to share my concerns.

Gabriela Santos
Licensed Family Child Care Provider
Virginia

Kim’s Home Daycare

Centreville, VA 20121

11/26/2025

RE: Public Comment on Proposed Mandatory Stock Epinephrine Requirement

To Whom It May Concern,

My name is Kim, and I am a licensed child care provider in Fairfax County, Virginia. I am writing to express my concerns regarding the proposed requirement that all child care programs maintain stock epinephrine auto-injectors (EpiPens) for emergency use.

I have been providing child care for 30 years and currently care for five children ranging in age from 16 months to 5 years old in a small, family-based program. I am deeply committed to the safety and well-being of every child in my care. While I fully support measures that protect children, I have serious concerns about this proposed mandate that I believe must be addressed before implementation.

FINANCIAL CONCERNS

The cost of purchasing and maintaining stock EpiPens is a significant burden for a small child care program like mine. As a small provider, I operate on an extremely tight budget, and stock epinephrine would likely expire before ever being used.

For my facility, this requirement would cost approximately $800 per year. I would have no choice but to raise tuition by about $150 per family to cover the expense. Families are already struggling with rising costs, and this additional financial burden would be unfair to both providers and parents.

LACK OF MEDICAL TRAINING

I am an educator—not a medical professional. Although I have received basic EpiPen training through Medication Administration Training (MAT) and CPR/First Aid, I have never been required to use one. I do not feel confident diagnosing anaphylaxis without clear, documented symptoms from a doctor.

Expecting child care providers to make a split-second life-or-death medical decision without advanced medical training puts both providers and children at risk. I am uncomfortable being placed into a role that requires medical judgment beyond our training and licensing.

FEAR OF CAUSING HARM

I am genuinely worried about unintentionally harming a child who does not have a known allergy or who is not under a doctor’s care.

What if an auto-injector accidentally injects into a child’s finger?

What if I administer epinephrine to a child who does not need it and cause heart complications?

What if a child has an underlying heart condition that a provider is unaware of?

These are real medical risks that could occur when administering medication without a prescription and without a doctor’s direction.

DOSAGE UNCERTAINTY

EpiPens come in different strengths based on age and weight. I care for children of various sizes—from toddlers to preschoolers. Without a prescription for a specific child, how would I know which dose is correct?

As a licensed provider, I am not permitted to administer medication like an EpiPen unless it is prescribed for that specific child and accompanied by proper medical authorization forms. This mandate contradicts existing medication regulations and places providers in a legally and medically unsafe situation.

LIABILITY CONCERNS

I contacted my insurance company for guidance. They could not confirm whether I would be covered for administering stock epinephrine and indicated that my premiums would likely increase. They also could not provide clear information about liability protection.

I cannot afford the financial risk of a lawsuit—one incident could destroy my business and end my ability to care for families. The legal uncertainty alone is frightening.

SUGGESTED ALTERNATIVES

I believe the same child-safety goals can be met through approaches that are safer, more practical, and more financially reasonable:

Require parents of children with known allergies to provide prescribed EpiPens specific to their child

Improve emergency response times in our area

Provide additional training for providers on recognizing allergic reactions and when to call 911

Create a voluntary program with state funding, full liability protection, and optional participation

COMMITMENT TO SAFETY

I want to emphasize that I take children’s safety extremely seriously. I work closely with families when introducing new foods. Parents must introduce all new foods at home before I serve them at daycare. Families of children with allergies review recipes and weekly menus in advance to ensure safety.

I am fully committed to preventing emergencies before they happen. However, I respectfully ask that you reconsider making stock epinephrine mandatory for all providers.

REQUEST

I urge the state to:

Delay implementation until concerns around cost, training, and liability are addressed

Provide adequate funding, clear legal protection, and insurance guidance

Make participation voluntary, not mandatory

Work collaboratively with child care providers to create practical, safe solutions

Thank you for considering my concerns. I appreciate the opportunity to provide input on this important issue and am happy to discuss this further.

Sincerely,

Kim

Licensed Family Child Care Provider

Centreville, VA

My name is Jamie White, and I am a family day home provider in Loudoun County. I have been providing licensed child care since 2005 and currently care for children ages 3 to 5.

I am writing to share my concerns about requiring all programs to purchase and maintain stock EpiPens. The financial cost of this mandate is significant. Stock EpiPens cost $300 to $650 per two-pack and must be replaced every 12 to 18 months. In addition, eMAT certification is expensive and difficult to schedule, since it requires finding an available RN instructor.

Licensed providers are already managing increased expenses, including fingerprinting, lead water testing, CPR and First Aid training, and annual professional development. Adding stock EpiPens to the list makes it harder to stay open. For many small programs like mine, repeated new costs create real pressure to close.

We already maintain prescribed EpiPens for children with diagnosed allergies, and that system works well. If the state believes stock epinephrine is necessary, I ask that it be limited to programs that are not close to emergency medical services or made voluntary with funding and support.

Thank you for considering how this mandate would affect licensed family day homes. I appreciate the opportunity to share my perspective.

Sincerely,
Jamie White
Play to Learn Preschool
Leesburg, VA

Willing to comply if Epipens are provided free of charge. As more and more regulations come in like this, it makes me want to close my business. It is becoming too much of a headache and too expensive to small home daycares especially. We should be exempt and not treated like a large center.

I oppose this due to the extra cost and training that would come with it. Childcare providers already have an abundance of expenses that makes operating difficult. I understand the thought behind the idea, however I do not feel it is the responsibility of the provider to do this. 

Strongly oppose buying and carrying epiphany. I will close my business if it needs. It’s already been difficult and expensive maintaining and staying open. I will not agree and risky and facing liability as parents do not approve. Please No No No 

As a medical professional and a parent in Northern Virginia, I am very concerned about the proposed law requiring childcare providers to carry and administer epinephrine to children they *believe* may be experiencing anaphylaxis.

While I understand the intention is to protect children with severe allergies, this proposal raises significant safety and practical concerns:

1. Medical Risk: Administering epinephrine carries serious risks if given unnecessarily or incorrectly. Non-medical personnel are not trained to assess whether a child is truly in anaphylactic shock, and misuse could result in severe complications, including hypertensive crisis, arrhythmias, or other life-threatening outcomes.

2. Training Limitations: A single demonstration or two on using an auto-injector does not prepare someone to recognize anaphylaxis or manage complications that may arise from inappropriate use. It is not a course on anatomy and physiology and does not prepare the provider to respond if an adverse even occurs. 

3. Financial Burden: This would shift additional costs onto already overburdened childcare providers and families in Virginia, where childcare costs are already among the highest in the country.

4. Liability Concerns: Providers may face legal exposure if an epinephrine injection causes harm, despite good intentions.

I urge lawmakers to consider alternatives that prioritize both safety and practicality, such as:

-Allowing only medically trained personnel to administer epinephrine.

-Requiring individualized emergency action plans for children with known severe allergies.

-Providing funding or support for professional medical oversight in childcare settings.

While protecting children from anaphylaxis is critically important, this proposal could unintentionally put children at risk and impose unsustainable costs on families and providers.

Thank you for considering these concerns.

-Concerned mom, EMS provider and RN

If you want, I can also help you **condense this into a shorter, punchy version** that is more likely to be read and noticed on the public comment board while keeping the key points. Do you want me to do that?

Oppose to EpiPen

I think safety is utmost importance when it comes to children. I think we can provide options.

If this is mandated, then their should be vouchers from health Dept for Family daycares with less then a certain amount of children. OR waivers for small daycare facilities. Perhaps point system as they do for other rules. There could also be waivers needing to be signed by patients if they want to enroll their children in certain day care OR day care facility can provide top allergen free environment as an alternative.

The main message being - there should be options for different facilities. Not one size fits all.

Please make adjustments that take in to consideration the nuances in different child-care settings. 

thank you

3 Reasons a Daycare Should Not Owned EpiPen

1. Prescription Medication: EpiPens are prescription drugs and must be assigned to a specific child. A daycare cannot legally keep or use a “generic” EpiPen for anyone.

2. Individual Allergy Plans: Each child with allergies must have their own doctor-approved Allergy Action Plan and their own EpiPen. Using one that doesn’t belong to the child goes against medical guidelines.

3. Liability Risk: Administering an EpiPen not prescribed for that child can create legal and licensing issues for the daycare, exposing the center to unnecessary liability.

Epi-pen is very expensive, If the parent will provide that, why not! But me providing the epi-pen. It's a Big NO!

 I am writing to oppose the mandatory stock EpiPen requirement due to serious liability concerns. My insurance company cannot confirm coverage for claims arising from stock epinephrine use. If I incorrectly administer or fail to administer epinephrine, I could face devastating lawsuits that would destroy my business and financial security. Without clear liability protection, this mandate exposes providers to unacceptable legal risk. Please provide comprehensive liability protection or make this program voluntary rather than mandatory.

Additionally As a child care provider with no medical background, I am deeply concerned about the proposed EpiPen requirement. I am not qualified to diagnose anaphylactic shock or make split-second medical decisions about when to administer epinephrine. I fear accidentally harming a child through incorrect diagnosis, improper injection technique, or unnecessary administration. This mandate places medical responsibilities on educators that should remain with healthcare professionals. Please reconsider requiring providers without medical training to make these critical medical decisions.

I am opposed to this proposed mandate because it places an unreasonable medical and financial burden on small child care providers. Stocking and maintaining EpiPens—along with the required specialized training—not only adds significant ongoing costs, but also forces providers into medical decision-making and liability risks that go far beyond our role. Child care educators are not medical professionals, and being required to diagnose and administer emergency medication to children without known allergies creates unnecessary legal exposure and the potential for accidental harm. While I fully support keeping children safe, this proposal shifts critical medical responsibilities onto providers in a way that is neither practical nor appropriate.

I am writing as a licensed child care provider in Sterling to share my concerns about the
proposed requirement to stock epinephrine auto-injectors. While I am committed to child safety, I have serious reservations about this mandate.

First, the financial burden is significant. EpiPens are expensive and must be replaced regularly. Training requirements for all staff members add additional costs. For small providers like myself, these expenses are difficult to manage without raising tuition rates for families.

Second, I do not have medical training to diagnose anaphylactic shock or determine when
epinephrine is needed, especially for children without known allergies. I fear making incorrect medical decisions that could harm a child. The potential complications from accidental injection or unnecessary administration are frightening. The liability exposure could end my business.

I ask that you reconsider this mandate and instead work with providers on practical alternatives, such as requiring parents of children with known allergies to provide prescribed EpiPens and ensuring rapid emergency response. Thank you for considering my perspective.

I think its beneficial to have daycare workers trained in epipen administration, just as they are trained in CPR.  I would make it something optional, not mandatory, and parents can choose whether to send their kids to a daycare with trained workers or not. 

I think there should be a release form provided to daycares that parents can sign releasing the daycare from epipen administration and any entailed liabilities for daycares who do not want to train workers or use epipens. However, by providing free training, it would be silly for daycares not to take advantage of that service.  

I think parents should provide the epipens and the government should not take on that burden.  Maybe they can use the money to provide free training to daycare workers and maybe even have monetary incentives for daycares who participate. 

Daycares usually avoid meals that are allergenic, and Id say once a kid is over the age of 2.5, the parents know if they have specific food allergies.  Maybe daycares that have older kids dont need the training. But I dont know the statistics, some research numbers would help. 

The decision to administer an EpiPen without any background doctor's note or a parent's directions on the Child Record Form about known allergies is a risk no child care provider would like to take. This is like requiring all teachers to carry guns to combat a killer in schools. This requirement of keeping an EPIPen ready to use in a first-time epipen-requiring situation is like rookies making mistakes and causing more harm based on their judgment, which may be totally skewed. Why not ban the common food items causing common allergies from childcare menus? It’s a big NO to this proposal. 

I am a longtime licensed VA child care provider and oppose the proposed mandatory stock EpiPen requirement. Even though I am MAT trained (Medicine Administration Trained), which includes EpiPen training, I am not comfortable making the complex decision to administer epinephrine to children unless under the instruction of a heath care provider; or the Epipen and allergy action plan has been prescribed by the child's doctor, which would include the parents consent. CPR/First Aid is mandatory for licensed providers and we are trained to observe and assess children upon arrival and throughout the day for any unusual symptoms, and to contact parents or 911 if needed. As a parent and grandparent myself, I would be opposed to non-medical staff making a medical decision for my child when it may of not been needed. Cost, liability, risk if the meds were not needed, dosage uncertainty as licensed providers often have children from infancy to 12 year olds enrolled, are some of the reasons to reconsider this mandate. Recently the 18 month old that I watch developed a substantial red rash after a meal. I immediately contacted the parent, who contacted their pediatrician, and was instructed to administer a small dose of Benadryl and to observe the child in case the rash did not subside; which it did. She hadn't had anything to eat that she hadn't had before. The child had a follow up appointment and no allergies were discovered. Even Benadryl, generally labeled for the use in children aged 6 and older, requires the supervision and explicit direction of a healthcare provider. As well as MAT requires us to have a form signed from the child's doctor to administer Benadryl. Better alternatives already exist. Is this a child that would potentially be unnecessarily injected with epinephrine by some provider? I urge you to please reconsider or fine tune this potential EpiPen mandate without these risks and costs. Thank you.

While I appreciate the intention to keep children safe, I am uncomfortable with the idea of child care providers, who are not medical professionals, making decisions about administering powerful medication to my child without a prescription or specific doctor's guidance. Epinephrine can cause serious side effects, and the risk of administering it unnecessarily or incorrectly worries me as a parent.

I am concerned that this mandate could force some providers to close or reduce enrollment due to the cost and liability risk. Losing quality child care providers will be devastating for working families in our community. The child care shortage is already a crisis - policies that might reduce availability should be carefully considered. 

I’m strongly opposed to the proposed mandatory stock EpiPen requirement. As a parent, I’m very uncomfortable with non-medical staff giving my child such a powerful medication without a prescription or my explicit guidance. I’m also concerned that this mandate will raise childcare costs for my family, which would create an added burden for us.

I can’t support the proposed mandatory stock EpiPen requirement. I’m uncomfortable with non-medical staff administering such a strong medication to my child without a prescription. I’m also worried about the added childcare costs this could bring for my family. I would really prefer that the state consider alternative options.

I am a licensed family day home provider in Virginia, and I oppose the proposed requirement for all childcare providers to purchase and maintain stock EpiPens.

This mandate creates financial strain for small programs like mine. Stock EpiPens are expensive, expire quickly, and would need to be replaced regularly. Requiring additional specialized training that I would have to pay for adds another burden.

This proposal also places medical responsibility and liability on providers who are not medical professionals. Diagnosing anaphylaxis and administering medication to children without known allergies or prescriptions is unsafe and puts providers at legal risk.

I am committed to keeping children safe, but this requirement is not practical, not affordable, and not appropriate for family day homes. I respectfully ask that this mandate be reconsidered.

Thank you for reviewing my comment.

First off, the financial burden and liability are top items to consider. How can we administer an Epi-pen to a daycare child when they have not been diagnosed with an allergy in the first place. This clearly needs to have a doctor's diagnosis and prescription. I don't want to mistakenly give one of my daycare kids an epi-pen shot when perhaps they have a negative reaction or the symptoms they show were not allergy related. 

This is ridiculous to require any daycare to buy and stock epi-pens. We are an industry that is known for low pay, and now you want us to buy expensive epi-pens as well. Are all schools required to stock epi-pens? No!! Are there any other places that are required to stock epi-pens just to have them in case of an emergency? NO!! So why should we have to bear this burden.

We have had several added expenses in licensure requirements recently including water testing for homes on town and city water costing hundreds of dollars. Students with known allergies can send in an Epi Pen as they do in school. A requirement to keep Benedryl on hand for emergency use is more affordable and can be uses as directed with parental consent. 

The high cost of EpiPens, along with their relatively short shelf lives and high replacement costs, creates a significant and ongoing financial burden for organizations, especially small ones with limited budgets. Funds for buying and frequently replacing expired devices might be diverted from other critical needs.  It would also force providers to regularly bear the cost of replacing the medicine.

The state should provide these m we are struggling now as it is 

There is no good reason to add fringe requirements, making it harder to track all the more important item for small business owners.

where does this end?  A swimming pool of drinking water in case…?  A gas mask? 

My name is Soraya Fedayi, and I am a licensed child care provider in Gainesville, Virginia. I am writing to express my concerns about the proposed requirement that all child care facilities maintain stock epinephrine auto-injectors (EpiPens) for emergency use.

I have been providing child care for 14 years and currently care for 11 children ranging in age from one to three years old. My facility is a small home-based program. I am deeply committed to the safety and well-being of every child in my care.

While I absolutely support keeping children safe, I have serious concerns about this proposed mandate that I believe need to be addressed before implementation.

FINANCIAL CONCERNS:

The cost of purchasing and maintaining stock EpiPens is a significant burden for my business. As a small provider, I operate on a tight budget and I would have no choice but to increase tuition  for each child. 

LACK OF MEDICAL TRAINING:

I am an educator, not a medical professional. I have no medical training beyond basic first aid and I would not feel confident diagnosing anaphylactic shock. I fear making a life-or-death decision incorrectly and I am deeply uncomfortable being placed in a position where I must make complex medical decisions without proper medical expertise.

FEAR OF CAUSING HARM:

I am genuinely worried about accidentally harming a child. What if I inject epinephrine into a child's finger by mistake? What if I give epinephrine to a child who doesn't need it and cause heart problems? What if a child in my care has an underlying heart condition I don't know about? The potential medical complications from incorrect or unnecessary administration are frightening.

DOSAGE UNCERTAINTY:

EpiPens come in different strengths, and I care for children of varying ages and sizes. Without a prescription specific to each child, how do I know the correct dose? I'm concerned about using the wrong strength in an emergency situation. 

SUGGEST ALTERNATIVES

I believe there are better approaches that would protect children while being practical for providers:

• Requiring parents of children with known allergies to provide prescribed EpiPens for their specific child

• Improving emergency response times in our area

• Providing training on recognizing allergic reactions and when to call 911

• Creating a voluntary program with state funding and full liability protection

I want to emphasize that I take the safety of children very seriously . However, I respectfully ask that you reconsider this mandate and work with providers to develop solutions that are both effective and practical.

Please make this voluntary rather than mandatory. 

Thank you for considering my concerns. I am happy to discuss this further and appreciate the opportunity to provide input on this important issue.

I am a licensed Virginia child care provider, and I oppose this mandate for the following reasons:

• Financial burden of purchasing and maintaining EpiPens plus training costs
• Lack of medical training to diagnose anaphylactic shock or determine need for epinephrine
• Fear of causing serious harm through accidental injection or unnecessary administration
• Concern about dosing errors with children of different ages and sizes
• Unclear liability insurance coverage and risk of lawsuits
• Better alternatives exist, such as requiring prescribed EpiPens from parents with known
allergies

I support child safety but ask that you work with providers on practical, sustainable solutions.

Not only will this place a greater financial burden on an already unsupported field of work, but this is a waste of EPIPens as MOST children haven known allergies by the time they are in daycare/preschool. At a time when the federal government is already attacking education by cutting funding and creating restrictions, placing a greater unnecessary financial burden on child care providers is egregious. It is the states responsibility to protect it's people and create work opportunities as well as supporting childcare workers who are essential to keeping our economy and social welfare in good standing. To assume that childcare providers should assume liability for administering medication that the state is requiring us to mandate is again an attack on our field of work. Aside from private and state funded childcare providers, I do not know a single institute that would be able to survive a legal battle in court. To even propose this for ALL childcare workers is an attack on Virginia's quality and affordable childcare. For parents concerned that their child may have an unknown allergy: send your child to a school licensed to administer medication. The responsibility for individual welfare falls on the individual, the responsibility for the greater wellbeing of our state as a whole falls on our elected officials. Shame on you Virginia Department of Education for this attack. It is crucial we make policy based off of widespread fact and evidence, NOT anecdotal accounts. 

This proposed change is saving no one, helping no one, only creating more obstacles for childcare providers. All parens that we have spoken to would prefer that childcare providers call 911 in case of an emergency and NOT assume medical responsibility considering child care providers are not medical professionals. 

Please, support families and childcare providers and DO NOT stoop to the level of fear mongering. 

Tara Ford

Sterling, VA 20164

December 3, 2025

RE: Public Comment on Proposed Mandatory Stock Epinephrine Requirement

     My name is Tara Ford, and I am a licensed child care provider in Sterling (Loudoun County), Virginia. I am writing to express my concerns about the proposed requirement that all childcare facilities maintain stock epinephrine auto-injectors (EpiPens) for emergency use.

     I have been providing childcare for 22 years and currently care for 11 children, ages 2 to 11. My facility is a small family/home-based childcare facility. I am deeply committed to the safety and well-being of every child in my care.

     While I absolutely support keeping children safe, I have serious concerns about this proposed mandate that I believe need to be addressed before implementation.

     My serious concerns are as follows:

• Financial burden of purchasing and maintaining EpiPens plus training costs

• Lack of medical training to diagnose anaphylactic shock or determine the need for epinephrine

• Fear of causing serious harm through accidental injection or unnecessary administration

• Concern about dosing errors with children of different ages and sizes

• Unclear liability insurance coverage and risk of lawsuits

     Better alternatives exist, such as requiring prescribed EpiPens from parents with known allergies.  I support child safety but ask that you work with providers on practical, sustainable solutions.  I believe there are better approaches that would protect children while being practical for providers:

• Requiring parents of children with known allergies to provide prescribed EpiPens for their specific child.

• Improving emergency response times in our area.

• Providing training on recognizing allergic reactions and when to call 911.

• Creating a voluntary program with state funding and full liability protection!

     I want to emphasize that I take the safety of children very seriously. However, I respectfully ask that you reconsider this mandate and work with providers to develop solutions that are both effective and practical.

     Thank you for considering my concerns. I am happy to discuss this further and appreciate the opportunity to provide input on this important issue.

Sincerely,

Tara Ford

I am writing as a licensed child care provider in Herndon, VA to share my concerns about the proposed requirement to stock epinephrine auto-injectors. While I am committed to child safety, I have serious reservations about this mandate.

First, the financial burden is significant. EpiPens are expensive and must be replaced regularly. Training requirements for all staff members add additional costs. For small providers like myself, these expenses are difficult to manage without raising tuition rates for families.

Second, I do not have medical training to diagnose anaphylactic shock or determine when epinephrine is needed, especially for children without known allergies. I fear making incorrect medical decisions that could harm a child. The potential complications from accidental injection or unnecessary administration are frightening. The liability exposure could end my business.

I ask that you reconsider this mandate and instead work with providers on practical alternatives, such as requiring parents of children with known allergies to provide prescribed EpiPens and ensuring rapid emergency response. Thank you for considering my perspective.

 I’m  a childcare provider, and I strongly oppose being required to purchase EpiPens. Many of us are already struggling to afford basic necessities, including food. Adding the cost of EpiPens is simply impossible. If this requirement moves forward, I will have no choice but to close my daycare. This mandate puts an unfair and overwhelming burden on small providers like me.

This epi idea sounds good but is not actually financially feasible for these day cares. If a child has an allergy that is anaphylactic they will bring the Epi Pen with them. The cost for the day care would be too high and will make more daycares close. Please don’t go forward with this