As a licensed Family Day Home provider with more than thirty years of experience and MAT certification, my primary focus has always been the safety and well-being of children. Although I am committed to taking every reasonable measure to protect children and respond swiftly to medical emergencies, I have significant reservations about the safety, financial, and legal challenges this mandate presents, especially for home-based providers.

In the absence of a confirmed allergy or physician’s diagnosis, symptoms such as choking, asthma attacks, anxiety, or viral illnesses can closely resemble anaphylaxis. Expecting child care providers—who often work independently—to distinguish among these conditions in emergency situations places a heavy medical responsibility on non-medical personnel. This increases the risk of accidental or inappropriate epinephrine administration.

While MAT training equips providers to administer medication as directed, it does not train providers to diagnose anaphylaxis independently. Administering epinephrine without a clear allergy history or medical guidance exposes providers to considerable legal liability and poses risks to children’s health.

An additional concern in culturally diverse and multilingual settings is the risk associated with administering English as a second language (ESL). In many home-based child care settings, providers and families may not share a common primary language. Communication barriers—especially in high-stress emergencies—can lead to misunderstandings about a child’s medical history, parental consents, or the nature of the allergic reaction. This can result in delayed or inappropriate administration of epinephrine and further complicate post-incident communication with families and emergency responders. It is crucial to recognize that cultural differences and limited English proficiency may heighten the risk of errors and increase anxiety for both providers and families during critical moments.

Additionally, the recurring expense of purchasing and replacing expired auto-injectors—currently estimated at $290 to $850 per device—places a significant financial strain on small or part-time providers, particularly without designated state or federal funding. This requirement may also complicate insurance coverage and amplify legal exposure.

Rather than further medicalizing child care environments, I urge the Commonwealth to focus on allergy education, preventive measures, and clear emergency response protocols. In situations where no diagnosed allergy exists, calling 911 and relying on trained emergency medical professionals to assess and treat suspected anaphylaxis is the safest and most responsible approach.

I respectfully request that the Virginia Department of Education reconsider this mandate and actively involve providers—particularly those from Family Day Homes—in developing safer and more practical solutions.

Respectfully,

Monica Jackson

Policy Recommendations for Consideration

• Make the stocking of undesignated epinephrine voluntary rather than mandatory for child care providers.
• Provide dedicated funding or reimbursement for the purchase, replacement, and proper storage of epinephrine auto-injectors if required.
• Establish clear liability protections for providers who administer undesignated epinephrine in good faith.
• Restrict administration to children with documented allergies and prescriptions whenever possible.
• Invest in allergy awareness education, prevention strategies, and emergency preparedness training for all providers.
• Reinforce 911-first emergency response protocols for situations involving undiagnosed severe reactions.

Key References Supporting Safety & Liability Concerns

1. American Academy of Pediatrics (AAP) – Guidance on Anaphylaxis Management https://publications.aap.org
2. CDC – Anaphylaxis Overview
3. National Association of School Nurses (NASN) https://www.nasn.org
4. FDA – Epinephrine Auto-Injector Safety Information https://www.fda.gov
5. Insurance & Risk Management Analyses (Child Care Law Center)