While the intent of the proposed amendments to the Child Care Program regulation (8VAC20-790) is to enhance child safety, the action may not be beneficial for Child Day Centers due to several operational, financial, and practical concerns.

First, the requirement for Child Day Centers to procure, store, and maintain stock epinephrine creates an unfunded mandate. Many centers, particularly small or nonprofit providers, operate on limited budgets and may struggle with the recurring costs associated with purchasing epinephrine auto-injectors, replacing expired doses, maintaining proper storage, and ensuring compliance with documentation and oversight requirements. Without dedicated funding or reimbursement, this requirement could place a significant financial burden on centers and potentially threaten their continued participation in the Child Care Program.

Second, the proposed amendments increase administrative and regulatory complexity. Centers would be required to develop and regularly update detailed policies related to epinephrine possession, administration, staff authorization, training verification, storage access, and parental notification. These additional compliance responsibilities may divert staff time and resources away from core caregiving and educational functions, particularly in centers with limited administrative capacity.

Third, staffing and training requirements present practical challenges. Requiring authorized and trained personnel to have continuous access to epinephrine during all operating hours may be difficult to implement given staff turnover, absenteeism, and varying levels of medical training among child care employees. Centers may face challenges ensuring consistent coverage, especially in rural areas or during early morning and late afternoon hours when staffing levels are typically reduced.

Additionally, liability concerns may deter centers from fully embracing the policy. Despite training and authorization, the administration of epinephrine involves medical risk, and centers may be concerned about increased exposure to legal liability if an adverse outcome occurs. These concerns may necessitate additional insurance coverage or legal consultation, further increasing operational costs.

Finally, the action does not sufficiently account for the diversity of child day center settings and existing health practices. Many centers already rely on individualized health care plans coordinated with families and health care providers. A one-size-fits-all requirement for stock epinephrine may duplicate existing safeguards without clearly demonstrating added benefit, particularly in centers with no history of severe allergic reactions.

For these reasons, while the goal of protecting children is commendable, the proposed amendments may impose disproportionate burdens on Child Day Centers without adequate support, flexibility, or demonstrated benefit. Consideration should be given to alternative approaches, such as optional participation, phased implementation, funding assistance, or enhanced guidance, to ensure child safety objectives are met without negatively impacting the viability and quality of child day care services.