Thank you for the opportunity to provide feedback on the proposed regulation requiring all child care centers to maintain a stock supply of epinephrine auto-injectors (EpiPens) and administer them in emergency situations. While I strongly support policies that protect children’s health and safety, I do not support this proposed mandate for several reasons:

1. Existing medication and health-plan regulations already cover children with known allergies.

Virginia licensing already requires centers to follow individualized health care plans, obtain physician-signed action plans, maintain emergency medications on site, and train staff according to each child’s medical orders. Children with diagnosed allergies are already fully protected through this established system.
A duplicative “stock” requirement adds regulatory burden without providing additional benefit for the children most at risk.

2. Mandating medical judgment and medication administration without diagnosis creates liability concerns.

Epinephrine is a life-saving medication—but it is also a prescription medication that requires clinical judgment to determine when administration is appropriate.
Requiring non-medical child care staff to administer prescription medication without a diagnosis or physician’s order places centers and staff in a legally vulnerable position and exceeds the scope of typical child-care training.

3. The cost burden is significant and recurring.

EpiPens have short shelf lives, high replacement costs, and require ongoing expiration monitoring. Mandating multiple sets for all classrooms or areas is financially burdensome for programs, especially small centers, nonprofit centers, and community-based early childhood programs.
Many programs already face tight margins, and this mandate would divert resources away from salaries, training, and quality improvements.

4. The proposed regulation shifts medical responsibility from licensed health professionals to child-care educators.

Child-care providers are not medical personnel. The proposed rule effectively converts early-childhood staff into first responders for a medical emergency they cannot diagnose with certainty.
This shift in responsibility is not aligned with best-practice boundaries between child-care services and healthcare services.

5. Universal stock epinephrine policies are better suited for K–12 settings, not early childhood programs.

Many K–12 districts use school nurses to oversee medication storage, training, and emergency protocols. Child care centers do not have medical staff on site, and their staffing structures are fundamentally different.
Regulations designed for K–12 environments do not translate directly to early childhood settings.

6. A collaborative, family-driven approach is safer and more appropriate.

For children with known allergies, families already partner with pediatricians and centers to provide required medications and safeguards.
For children without known allergies, emergency medical services are the proper mechanism for rapid response—staff are already required to call 911 immediately for any suspected anaphylactic event.

I am the director of a licensed center located in Bridgewater, VA. I have serious concerns regarding the potential regulation to store weight-based epinephrine at the center and administer "as needed." I am a MAT certified staff member, however I am uncomfortable with the notion that any staff member would be in a position to make medical decisions (aka deciding if a child is experiencing anaphylactic shock to administer the epinephrine). I am also concerned about how we are to know a child's weight in a moment of emergency. We have a 2 year old in our program that weights around 48 pounds but I would not know that weight for every child and have concerns for children that are outside of the "normal weight category" for their age. I do not have a nurse on staff (or medically trained staff member) and this feels like a huge risk of liability to make judgement calls of when to give epinephrine to a child that has never been administered the medication before without doctor's instructions. Also the cost to have enough weight based pens available is a cost to our company we are not prepared to take on. We serve children infant age through 12 years old. I am not entirely sure, but I imagine we would have to have 4-6 epinephrine pens on hand to serve those varied weights. These would expire annually (potentially) and would create an ongoing cost to our company. As a center Director, I am very opposed to such regulations and would create a system which requires educators to make medical decisions and take on a liability that I am not comfortable with. 

I am the owner of a licensed child day center that serves 57 children. My main concern here is cost. We have ages birth through 5 so that is a lot of EpiPens that expire yearly. My second concern is guessing a child’s weight in an emergency situation would be risky to say the least. Please do not put more expense on child care providers who are already struggling to stay afloat.

I am writing this comment in opposition to the proposed changes to required epinephrine to be available by the child care center. We are already in a time where the real costs of operating licensed facilities continue to rise for numerous reasons, where finding and retaining staffing is increasingly costly and challenging, and where the increased burdens on the child care providers is making the proposition of opening a child care center untenable. Our organization has lost money every single year since COVID hit, and we are projected to continue to do so. In order to break even we would need to increase fees to a level that would make child care unaffordable for anyone but the upper middle class. Affordability of child care is already a problem across the nation. These kinds of regulations increase the financial and administrative burden on child care organizations and add to the problem without providing a solution. For our organization this regulation would add upwards of $5,000 of annual cost. This coupled with the skyrocketing prices of liability insurance would force us to make a difficult decision to not hire an additional staff member in order to cover these administrative costs. If the state wants to solve a problem, there are other ways to do this than to increase the financial burdens on child care providers. 

Daycares have enough to cover in cost, how are we responsible for this as well.  This should be on the parent.

I am writing in opposition to the proposed amendment to the Standards for Licensed Child Day Centers (8VAC20-780) requiring centers to possess and administer stock epinephrine.

I am an Administrator at a childcare center in Bridgewater, Virginia, and I have significant concerns regarding the safety, training, and liability risks this amendment places on centers and their staff. Our educators and caregivers are not medically trained professionals, nor do they have the clinical expertise to assess and determine when a child—who does not have a known allergy or an epinephrine prescription—requires emergency administration of an epipen. This level of medical judgment goes far beyond the scope of training and responsibility appropriate for childcare staff.

The liability associated with administering epinephrine to a child without a documented need is astronomical. Even with training on how to administer the medication, staff cannot be expected to diagnose anaphylaxis, differentiate it from other medical conditions with similar symptoms, or make a high-stakes medical decision with potentially life-altering consequences. This creates significant risk for staff, centers, and, most importantly, the children in our care.

While I understand that Chapter 122 and Chapter 123 of the 2023 Acts of Assembly, as well as § 22.1-289.059 of the Code of Virginia, prompt these amendments, the requirement that any employee—rather than a licensed medical professional—administer epinephrine is deeply concerning. Childcare centers are not staffed like schools with full-time nurses. Many centers, including ours, do not have a school nurse on site. Requiring an employee to act in this medical capacity is unrealistic and unsafe.

Additionally, the mandate to maintain appropriate weight-based dosages of stock epinephrine accessible at all times introduces further logistical and financial burdens. Childcare centers already operate under strict regulatory requirements and tight budgets. Adding high-cost medical supplies, secure storage, documentation procedures, and ongoing staff training—without staffing medical personnel—creates significant strain.

In closing, I urge the Board to reconsider this amendment or revise it to ensure that only medically licensed personnel are permitted to administer stock epinephrine, or that an alternative approach be implemented that does not place childcare staff in positions requiring medical judgment beyond their training.

Thank you for the opportunity to provide input on this important matter. 

The state already requires providers to have someone trained at all times on site to administer epinephrine. If that state wants to revise and re-word that policy, great, but it's already there. 

But to require a provider to purchase and possibly administer a drug that has not been prescribed by a medical professional is irresponsible and a massive liability. Our programs are already struggling trying to find insurance coverage for typical things that happen in our setting, and now we are going to need a childcare version of medical malpractice insurance? We can't even administer tylenol without a doctor's note with specific instructions, but the state wants to allow us to administer an epi pen when we "think" someone is having a reaction? 

I fully understand wanting to have something on hand in the event a child has a reaction, as providers we of course would always want to help. But we do not have the structure, the medical training, the liability coverage, or the funding to take on such a task. Those epi pens expire every few years and we would have to have more than 1 on hand to span the weights of children that we service. 

At a time when SO much is being put on providers plates with little to no support, the state is playing a dangerous game and risking too much to keep high quality facilities in business. 

Thank you to the person who summed up my concerns so perfectly! 

Thank you for the opportunity to provide feedback on the proposed regulation requiring all child care centers to maintain a stock supply of epinephrine auto-injectors (EpiPens) and administer them in emergency situations. While I strongly support policies that protect children’s health and safety, I do not support this proposed mandate for several reasons:

1. Existing medication and health-plan regulations already cover children with known allergies.

Virginia licensing already requires centers to follow individualized health care plans, obtain physician-signed action plans, maintain emergency medications on site, and train staff according to each child’s medical orders. Children with diagnosed allergies are already fully protected through this established system.
A duplicative “stock” requirement adds regulatory burden without providing additional benefit for the children most at risk.

2. Mandating medical judgment and medication administration without diagnosis creates liability concerns.

Epinephrine is a life-saving medication—but it is also a prescription medication that requires clinical judgment to determine when administration is appropriate.
Requiring non-medical child care staff to administer prescription medication without a diagnosis or physician’s order places centers and staff in a legally vulnerable position and exceeds the scope of typical child-care training.

3. The cost burden is significant and recurring.

EpiPens have short shelf lives, high replacement costs, and require ongoing expiration monitoring. Mandating multiple sets for all classrooms or areas is financially burdensome for programs, especially small centers, nonprofit centers, and community-based early childhood programs.
Many programs already face tight margins, and this mandate would divert resources away from salaries, training, and quality improvements.

4. The proposed regulation shifts medical responsibility from licensed health professionals to child-care educators.

Child-care providers are not medical personnel. The proposed rule effectively converts early-childhood staff into first responders for a medical emergency they cannot diagnose with certainty.
This shift in responsibility is not aligned with best-practice boundaries between child-care services and healthcare services.

5. Universal stock epinephrine policies are better suited for K–12 settings, not early childhood programs.

Many K–12 districts use school nurses to oversee medication storage, training, and emergency protocols. Child care centers do not have medical staff on site, and their staffing structures are fundamentally different.
Regulations designed for K–12 environments do not translate directly to early childhood settings.

6. A collaborative, family-driven approach is safer and more appropriate.

For children with known allergies, families already partner with pediatricians and centers to provide required medications and safeguards.
For children without known allergies, emergency medical services are the proper mechanism for rapid response—staff are already required to call 911 immediately for any suspected anaphylactic event.

As an early childhood educator and a parent, I do not feel comfortable with early learning centers taking on this responsibility. This drug is a prescription and requires special training to prescribe and administer. Educators are there to educate and monitor overall well-being. We are not paid medical professionals. 

As a parent, I would not want a center making an educated guess that could endanger a child in this way. It is a guardian's responsibility to provide medical supplies. The fact that this particular type is extremely expensive is something that should be addressed, politically. But the solution is not to be put it on the shoulders of educators who already do so much.

Hello,

I am the Director over two Early Learning Centers in the state of Virginia. The Centers are Non-Profit Centers. This would be a costly hit to our program by paying for Epinephrine that most likely will sit and expire and have to be purchased again, over and over to remain in compliance. This reminds me of having to purchase the activated charcoal for years and not be able to use it as it was deemed only a medial professional could administer it. So in my opinion if only a medical professional can administer activated charcoal, which is not an actual medication, then why are we even thinking of allowing Early Learning Staff who have no medical background to have the authority to give an actual medication without direct medical instructions by a medical professional?

I do not feel comfortable with my staff taking on this task as we are not medical professionals and we do not have an RN or School Nurse on staff who has had multiple years of education to know how to detect reactions and be able to know for sure the proper dosage.

As others have said in opposition, if we do have a child in our care who has a true allergy then their pediatrician has prescribed the Epi pen, we have been provided the allergy action plan, and we have MAT trained staff who can administer it in the event that it is needed, and we will always call 911 weather they have an epi pen or not. 

We need to leave the medical side of things to the medical professionals and School Nurses in the Public Schools. 

Thank you for allowing me to give my opinion on this matter and I hope that you listen to those of us who are in the field and doing this job every single day.

I am the director of a non-profit organization in Harrisonburg, VA. I strongly oppose 

• Requiring each child day center to implement policies for the possession and administration of epinephrine that requires at least one school nurse, employee at the center, or employee of a local health department who is authorized by a prescriber and trained in the administration of epinephrine has the means to access at all times during regular facility hours any such appropriate weight-based dosage of epinephrine that is stored in a locked or otherwise generally inaccessible container or area. 

Childcare centers do not have the financial means and do not have the trained professionals on staff at all times incase epinephrine would need to be administered. This responsibility should not be placed on childcare programs. 

I strongly oppose the proposed action of this Fasttrack motion. This puts an undue burden on licensed centers, such as the one I work at to purchase potentially every year epinephrine which could be deadly. We are not medical professionals, we are teachers. It is wrong to expect us to have the appropriate knowledge to decide if a child with previous unknown allergies is having an allergic reaction to the point of needing a possibly life ending medication. We also have no medical knowledge to judge what amount would be appropriate for each child in an emergent situation. Teachers or center staff could easluly misjudge something as an anaphylactic reaction and cause more harm. I fully support epinephrine training for all daycare staff, but to expect centers to provide the drug and take on the risk of administering it to children who have no medical diagnosis is unwise and very dangerous. 

Response Opposing Mandatory Stock Epinephrine and Untrained Dosage Determination in Childcare Settings

We oppose the proposed amendments to the Child Care Program regulation (8VAC20-790) that mandate the stocking of epinephrine and delegate its administration and dosage determination to non-medical personnel. While the intent to protect children during anaphylactic emergencies is commendable, these regulations introduce significant safety hazards by requiring individuals without proper medical training to manage powerful emergency medications and make critical, high-stakes decisions regarding a child’s health.

Our primary objections center on two major concerns:

1. Significant Hazards of Non-Medical Personnel Stockpiling and Administering Medication

The regulations require childcare center employees or family day home providers—individuals whose primary expertise lies in early childhood education and care, not emergency medicine—to be trained in epinephrine administration. This approach raises several critical safety issues:

• Risk of Misdiagnosis and Inappropriate Administration: Anaphylaxis can mimic other conditions, some of which do not require epinephrine. Administering epinephrine to a child who does not need it can cause serious side effects, including dangerous spikes in blood pressure, heart palpitations, anxiety, and other cardiovascular complications. Childcare staff are not qualified to make a definitive differential diagnosis in a high-stress, emergency situation.
• Liability and Training Limitations: Standardized Medical Administration Training (MAT training) for staff cannot replicate the clinical judgment and expertise of a licensed medical professional. Staff turnover necessitates continuous, costly retraining, and the inherent stress of an anaphylactic emergency increases the likelihood of human error during administration, such as injection site errors or hesitation that delays care.

2. The Inherent Dangers of Determining Weight-Based Dosages Without Medical Training

A core component of the proposal requires providers to store "an appropriate weight-based dosage of epinephrine." This places an unacceptable burden and risk on non-medical personnel:

• Dosage Complexity: Epinephrine dosing for children is highly specific and depends entirely on the child's precise weight. The difference between a safe and a harmful dose is narrow. Childcare providers are not medical professionals trained to accurately weigh children, calculate dosages, and assess contraindications.
• The Problem of "Stock" Doses: Mandating "stock" epinephrine requires providers to guess the likely weight range of the children in their care or stock multiple dosages, further increasing the complexity and potential for error. A child’s weight changes rapidly, and relying on outdated information or estimations is inherently dangerous. Using an adult dose on a small child, or an infant dose on a larger child, could have fatal consequences.
• Undermining Medical Authority: Decisions regarding which medication a child should receive and at what dosage should remain solely within the purview of the child’s parents and their prescribing physician. These regulations effectively require non-medical staff to act as pharmacists and emergency physicians, a role they are neither trained nor legally qualified to assume.

Conclusion

While rapid response to anaphylaxis is vital, the solution should not introduce new, significant hazards. The current proposal shifts complex medical decision-making from trained professionals to laypersons, creating substantial risks of misadministration, incorrect dosing, and accidental exposure. The focus should remain on rapid access to emergency medical services (911) and clear communication protocols between parents and providers, rather than mandating the dangerous practice of non-medical individuals managing potent emergency drugs.

I respectfully submit this comment in strong opposition to the proposed amendments to the Standards for Licensed Child Day Centers (8VAC20-780) requiring centers to possess and administer weight-based stock epinephrine and requiring early childhood staff to identify and treat anaphylaxis during an emergency.

While the intent behind the regulation is understandable, these requirements are unrealistic, unsafe, and financially burdensome for child day centers.

First, the proposed amendments require that “any nurse at the center, employee at the center, or employee of a local health department” be trained to identify a child “believed to be having an anaphylactic reaction” and administer a weight-based dose of epinephrine. This expectation is far beyond the scope of practice for early childhood educators, the vast majority of whom are not medical professionals. Determining whether a child is experiencing anaphylaxis—especially when symptoms can resemble choking, asthma, vomiting, or panic—requires specialized clinical training. Calculating and administering a weight-specific dose in the midst of a medical emergency adds even greater risk of error.

Second, the proposal imposes substantial financial and operational burdens on child care centers. Maintaining stock epinephrine in multiple weight-based doses, replacing expired medication, securing and documenting storage, and providing specialized medical training for staff represent significant unfunded costs. Additionally, these requirements will lead to increased liability insurance premiums at a time when centers already struggle with staffing shortages and rising operational expenses.

Third, the proposed changes may actually decrease safety. Epinephrine auto-injectors exist precisely to eliminate the need for lay caregivers to calculate doses or make medical judgments under stress. Requiring early childhood staff to manage weight-based dosing contradicts established best practices for emergency allergy response and introduces avoidable opportunities for error.

Child day centers are designed to provide education, care, and supervision—not to function as clinical medical settings staffed by individuals making life-and-death medical decisions. These amendments exceed what is reasonable or feasible for early childhood programs and place both children and staff at greater risk.

For these reasons, I urge the Department of Education and the Board of Education to reconsider or revise the proposed amendments and engage stakeholders in developing a more practical, medically sound, and developmentally appropriate approach.

Thank you for the opportunity to speak. I want to begin by acknowledging the importance of protecting children during medical emergencies. Those of us who work closely with young children care deeply about their safety and well-being, and we share the same goal: ensuring every child has the best chance of surviving an anaphylactic reaction.

However, I respectfully oppose the proposed amendments to the Child Care Program regulation (8VAC20-790) that would require childcare programs to stock epinephrine and assign non-medical personnel the responsibility of determining and administering weight-based doses. While the intention behind this proposal is understandable, it introduces serious risks—both to children and to the educators tasked with carrying out these high-stakes responsibilities.

1. Safety Risks for Children When Medical Judgment Is Placed on Non-Medical Personnel

Childcare providers are trained, compassionate professionals whose expertise lies in nurturing children, supporting development, and maintaining safe environments—not practicing emergency medicine.

Requiring staff to diagnose a potential anaphylactic episode and determine if epinephrine is necessary places them in an impossible position. Symptoms of anaphylaxis often mimic other conditions, and administering epinephrine to a child who does not need it can cause significant medical complications. Even with MAT training, staff are not—and cannot be—equipped with the clinical judgment needed to reliably differentiate between these conditions under the pressure of an emergency.

Additionally, MAT training cannot mirror the skill, confidence, or decision-making of licensed medical professionals. High staff turnover means providers must constantly retrain new staff. And in the stress of a critical moment, even small errors—injecting into the wrong site, hesitating, or misinterpreting symptoms—could lead to harmful outcomes.

2. The Serious Dangers of Requiring Non-Medically Trained Staff to Determine Weight-Based Doses

The proposal’s requirement to maintain “an appropriate weight-based dosage of epinephrine” introduces another layer of significant risk.

Children’s weights vary greatly and change rapidly. Determining the correct dose is not simple—it requires accurate, current weights, clinical knowledge, and medical oversight. Expecting teachers to estimate weights, calculate dosages, or maintain multiple stock doses is unsafe and unfair.

A dose meant for an adult administered to a small child—or a dose too low to help a larger child—can have life-altering or fatal consequences. These decisions should remain strictly in the hands of medical professionals and parents in consultation with their child’s physician. Asking childcare providers to assume this responsibility effectively requires them to act as pharmacists and emergency clinicians, roles far outside their training and legal scope.

3. The Emotional and Psychological Toll on Childcare Providers

There is also a human element that must be acknowledged.

Childcare providers dedicate their lives to caring for young children. If a provider were required to administer epinephrine without proper medical training and something went wrong—even with the best intentions—the emotional impact would be devastating.

We must consider:

• The lifelong trauma a teacher would carry if a child were harmed or died because of an incorrect administration.

• The ripple effect this trauma could have on the teacher’s mental health, family, and career.

• The moral burden placed on individuals who simply want to nurture and protect children, not perform emergency medical interventions beyond their expertise.

We cannot overlook the psychological cost of transferring complex medical responsibilities onto educators who did not choose this path and are not prepared to bear its consequences.

Conclusion

Protecting children from anaphylaxis is critically important, but this proposal shifts complicated medical decision-making from trained professionals to well-meaning, untrained childcare staff—creating risks that may outweigh the intended safety benefits.

A safer, more appropriate approach would emphasize:

• Immediate activation of emergency medical services (911),

• Clear communication procedures between families and providers, and

• Ensuring that children with known allergies have physician-prescribed, child-specific medication plans on site.

We all want what is best for children. I respectfully urge you to reconsider these regulations and pursue solutions that protect children without placing childcare providers in medically and emotionally unsafe positions.

Thank you for allowing the opportunity to share my view. 

We strongly oppose the legislation that would force us to stock and administer epinephrine for the following reasons: 

1. Our staff are not medical professionals and might easily 'misjudge' a presumed anaphylactic reaction. The training you offer 'free of charge' only speaks about administration of epinephrine, not about recognizing the symptoms and how to differentiate from other symptoms or more common issues, e.g. hives, rashes, astma.
2. Staff might not feel comfortable providing a serious, complicated medical procedure, as they have chosen the education field, not a medical career. Not being comfortable might lead to mistakes and misjudgment. 
3. As someone needs to have access to the epipen at all times, we would need to have 5-6 'trained' staff, as they work at different times of the day. This is an administrative burden and takes time away from their regular tasks, if they need to be trained.
4. The cost burden is significant and recurring, with epipens having an expiration date of 2 years. With having to 'buy' a new supply of epipens every 2 years for multiple age/weight groups will put a financial burden on providers. If they are not used - which we hope- it will be a total waste of a medical provision that might have been used for someone who actually needed it.
5. The liability insurance will become more expensive, and we will probably need to add a malpractice insurance or a professional liability Insurance on top of the general liability insurance.
6. We assume we would need parental permission of our parents that they would approve of epinephrine administration for their child in the event of a 'presumed' anaphylactic shock. We are sure they will have questions on how we will diagnose and who will administer. This will create an administrative burden and hard to keep track of who opted in/out. 
7. We are missing a whole lot of clarification from the department:
   1. Is there a form for parents to opt in/out of administration of epinephrine.
   2. how would we get the epipens - has the VDOE secured a contract with pharmacies for a constant supply of epipens to be bought by all VA schools? Or are we supposed to call individual pharmacies to see if they are willing to 'sell' us some epipens. And who will determine the correct dose - do we need to weigh all children and keep a log of their weight??
   3. How will the data tracking take place - assuming that the VDOE would want to know - on how often used for undefined situations, how many correctly judged, how many misjudged, consequences and side effects of wrongly administered epipens..... etc.
8. This 'new' law is actually not new, as the Code was already finalized in 2022. So, the past 3 years, this was not an issue, and all of a sudden it is on the fast track to be pushed through without any additional information on procedures or logic. 

This revision would open up a whole new level of liability for our businesses.  We essentially become a pharmacy having to hold, monitor and dispense medication. While this issue could be critical, facilities have the ability to call EMS in extreme situations. The financial expense is also extreme, and completely unnecessary.  We strongly oppose.,

New Regulations requiring childcare centers to keep stock epinephrine creates both a liability issue for staff and centers while also putting undue pressure on educators and administrators.

The new regulations also create clear contradictions: All staff are trained either in AMAT or MAT training to safely and legally administer medications to students. We are taught that we need medication authorization paperwork signed by parents and healthcare providers, we must have allergy action plans and the ability to match medical labels with paperwork. These procedures are both mandated by licensing AND create systems that keep children with allergies and medical conditions safe. 

A regulation to keep stock epinephrine creates a contradiction in that staff are trained NOT to administer any medication to a student that does not have paperwork and authorization. Doing so creates liability issues for staff AND puts unfair expectation on educators who are NOT healthcare providers. 

VDOE licensing has not and will not provide clarity around how these contradictions are being addressed. We are not comfortable moving forward with implementation unless this clarity of procedure is created AND these liability issues and safety issues are addressed. 

Finally, there is the issue of implementation with regards to stocking epinephrine. This is not an OTC medication and needs to be purchased through a prescription from a healthcare provider. Having a stock epinephrine pen, not designated for a specific individual, is not feasible unless VDOE can provide some further guidance on how to address this. 

I am writing to oppose the fast-tracking of the proposed amendment requiring every child day center to implement policies for the possession and administration of epinephrine.

This requirement places childcare providers in direct conflict with both state and federal laws, which clearly prohibit administering prescription medication to anyone other than the individual for whom it is prescribed. Expecting daycare administrators—who are not licensed medical professionals—to determine when epinephrine should be used and at what dosage is unsafe and beyond the scope of our training and legal authority. Currently, we cannot administer over-the-counter medications such as Benadryl, nor can we apply basic items like diaper cream, without signed parental permission. Epinephrine is significantly more serious, can remain active in a child’s system for days, and carries far greater risks than the medications we are restricted from using.

Additionally, the financial burden this regulation would place on childcare centers is unrealistic. For my center, annual costs would range from $2,000 to $2,400, and the devices expire every year. Many childcare programs are already operating on thin margins, and this requirement would create added strain without offering a safe or practical solution.

For these reasons—legal concerns, medical risk, and unsustainable cost—I strongly oppose fast-tracking this amended regulation. A requirement of this magnitude should undergo full public consideration, stakeholder input, and careful evaluation before any further action is taken.

I respectfully submit this comment in opposition to the fast-tracking of the proposed regulation requiring all child day centers to maintain policies and procedures for the possession and administration of epinephrine.

This amendment creates significant legal and safety concerns for childcare providers. Under both state and federal law, prescription medication cannot be administered to anyone other than the individual for whom it is prescribed. This proposal essentially places childcare staff in a position where they could be expected to identify when epinephrine is needed and administer a specific dose—tasks that fall far outside our training, authority, and legal protections. The contradiction is clear: we are not permitted to give a child Benadryl or even apply diaper cream without written parental consent, yet this regulation would require us to handle a medication that carries far more serious risks and effects that can last for days.

There is also a substantial financial impact that has not been fully considered. For many centers, including my own, the annual cost of maintaining epinephrine devices would fall between $2,000 and $2,400, and these devices expire every year. Childcare programs are already facing staffing challenges, rising operating costs, and limited financial resources. Adding another unfunded mandate of this size is simply not feasible.

For these reasons—legal conflict, safety concerns, and significant financial burden—I strongly urge the Board not to fast-track this amendment. A requirement of this magnitude deserves a full review process that allows for careful analysis and meaningful stakeholder input.

I am submitting this comment as a grandparent who cares deeply about the safety and well-being of children in Virginia’s childcare programs. I am strongly opposed to the fast-tracking of the proposed regulation requiring all child day centers to possess and administer epinephrine.

This proposal places childcare providers in an impossible position. Both state and federal law prohibit giving prescription medication to someone other than the individual it was prescribed for. Yet this amendment would expect childcare staff—who are not medical professionals—to determine when epinephrine should be used and to administer a specific dose. As a grandparent, this deeply concerns me. These same caregivers cannot give a child Benadryl or even apply diaper cream without written parent permission. Epinephrine is far more serious, can remain active in a child’s system for days, and poses significant medical risks if used incorrectly.

The financial burden on daycare programs is also troubling. Centers would be forced to spend $2,000 to $2,400 every year on devices that expire annually. Many childcare programs are already struggling to stay afloat. Adding another costly, unfunded mandate will only make it harder for families to find affordable, safe care for their children and grandchildren.

For the safety of children, the legal protection of staff, and the sustainability of childcare centers, I strongly oppose fast-tracking this regulation. A proposal with such serious implications must go through the full regulatory process, allowing for proper review and public input.

I am submitting this comment as a childcare staff member who works directly with young children every day. I strongly oppose the fast-tracking of the proposed regulation requiring all child day centers to possess and administer epinephrine.

This amendment would put staff like me in a legally and medically risky position. Under state and federal law, we cannot administer prescription medication to anyone other than the person it was prescribed for. Yet this regulation would require us—non-medical personnel—to determine when epinephrine is needed and to deliver the correct dosage. Currently, we cannot give a child Benadryl or even apply diaper cream without written parental authorization. Expecting us to administer epinephrine, which carries significant risks and can affect a child’s system for days, is far beyond what our training and legal guidelines allow.

There is also a serious financial impact on the centers we work for. Many programs are already operating on tight budgets, and requiring epinephrine devices would add $2,000 to $2,400 in annual costs—for products that expire every year. These added expenses strain already-limited resources and ultimately affect the quality and availability of care for families.

For the safety of the children we serve, the legal protection of staff, and the financial stability of childcare programs, I strongly oppose fast-tracking this regulation. A change of this magnitude deserves full review and input from those directly impacted.

I am submitting this comment as a childcare staff member with professional responsibility for the daily care, supervision, and well-being of young children. Based on my experience and understanding of current childcare regulations, I strongly oppose the fast-tracking of the proposed amendment requiring all child day centers to maintain and administer epinephrine on site.

This proposal introduces significant legal, procedural, and safety implications for childcare personnel. Current state and federal regulations clearly prohibit the administration of prescription medications to individuals for whom they are not prescribed. Childcare staff are not licensed medical professionals, yet this amendment would effectively require us to evaluate symptoms, make medical judgments, and administer a prescription drug with potent and lasting effects. Under existing standards, staff cannot administer over-the-counter medications such as Benadryl, nor are we permitted to apply simple topical products like diaper cream without written parental consent. Epinephrine, which can remain active in a child’s system for an extended period and carries well-documented risks, exceeds the scope of what non-medical providers are trained or authorized to administer.

In addition to these concerns, the financial strain this requirement would place on childcare centers is substantial. Epinephrine devices expire annually, and for many programs—particularly those serving diverse or low-income communities—the annual cost of $2,000 to $2,400 represents a significant operational burden. Such unfunded mandates place considerable stress on already limited budgets and may ultimately reduce access to high-quality childcare for families across the Commonwealth.

For these reasons, including the legal conflicts, medical risks, and financial implications, I strongly oppose fast-tracking this amended regulation. A requirement of this magnitude warrants a full, deliberate regulatory review process that includes comprehensive stakeholder input, evidence-based evaluation, and thoughtful consideration of its impact on children, families, and the childcare workforce.

Strongly oppose the fast tracking

Strongly Opposed

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.  

Strongly opposed to stock EPI pens being a requirement for licensed child day centers. 

1. Liability and financial burden for centers.
2. No data indicates this is a need.  Children across the state are not experiencing anaphylaxis at an unprecedented rate.
3. Severe risk to children, even death, if administered unnecessarily.
4. Young children cannot verbalize their needs and symptoms.  Medication needs to be administered by a medical professional for children not already diagnosed with a severe allergy requiring an EPI pen. 

Strongly Oppose the Fastrack of Stock Epi Pens

Strongly opposed.

I am strongly opposed. 

We do not want the liability.  The only way I agree to the regulation is if our policy can state "We do NOT provide stock epi pens."  

I am writing to express my concerns regarding the epi-pen requirement for child day centers, which would effectively require multiple epi-pens for even small centers in order for the pen to always be accessible for separate groups of children. While children with known allergies often have families whose health insurance would greatly reduce the cost of epi pens that are kept at child day centers, the same would not be true of the center purchasing the epi pens, which would need to be done continually, as this medication does expire. This direct cost is a burden for child day centers, as is the burden of training, inspection, and the cost of workers time. Required timelines for training and the availability of training has in other areas proven a high chance of misalignment, and this is almost certain to add to the high stress of onboarding staff in a timely manner, and will likely result in otherwise ready staff who would not be able to work and can disrupt continuity of care for families. Unfortunately, the child care system is already financially difficult for families, staff, and the centers themselves, and any added burden directed by law must be supported financially-- even laws designed to keep children safer and prepare for the worst "what if" situations. Otherwise, centers must either pass costs on to families or sustain cuts in other areas that can only decrease quality of care, which goes against the spirit in which this law was proposed.

More information needs to be gathered on this prior to implementing.  We have not received information on how weights are to be obtained for weight specific RX's, how these will be filled etc.  This is an item that is not possible to fast track with all of the additional implementation materials required!

Opposed:  I have major concerns regarding the implementation of a stock epi pen.  I think that these concerns require more time for consideration for the development of liabilities, policies and procedures.   

I am opposed to having a required stock epinephrine pen in our small preschool.

The financial burden on small schools is ridiculous.

If this change is made, there needs to be monetary support behind it. Our small preschool would not be able to implement it without appropriate funds.

I am strongly opposed to centers being required to stock and administer epi pens.  I am opposed to this for a multitude of reasons including the following:

1. I am strongly against the idea of putting the responsibility on my teachers to administer any medications to a child that is not prescribed to them.  Despite how well they are trained, my teachers are not medical professionals and I do not think that they should be responsible for administering stock medications to a child.  I think there are too many liabilities associated with this process and I think there are not enough established policies in regards to those liabilities.
2. I have concerns relating to what the process of maintaining an epi pen is; where does it need to be stored, how do we tell if the epi pen has gone bad, what happens when an epi pen does go bad and we can't get a new one quickly to replace the bad one, what are the liabilities if we administer an epi pen that has gone bad.
3. The cost of these epi pens is astronomical and to be required to carry these epi pens without any thought to current drug costs or future drug costs is devastating to small business owners.
4. Another concern is with the families of these children who attend my center.  Am I, as the center's owner, going to be required to get written permission from every family stating that they agree to have my teachers administer a stock epi pen?  In addition, what happens if they do not want my teachers to administer a stock epi pen - what would the liabilities be following that situation?

Because of these reasons, I feel like fast tracking these regulations would be a disservice to families and children who attend daycare centers as well as the owners, directors and teachers.  These regulations need and require more thought behind developing them and more thought and cooperation in regards to identifying the liabilities behind them.  In addition, given more time, creating a grant or finding funding to help pay for stock epi pens would be helpful.

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.

I am deeply concerned about this policy and the well-being of the children attending preschool/child care centers. This amendment would expect childcare staff to determine when and how much Epinephrine should be administered. Childcare centers are not medical professionals; administering Epinephrine incorrectly poses significant medical risks. More information needs to be gathered before implementing this policy.  

I am writing to share my concerns regarding the Stock Epinephrine proposed requirements for day cares and preschools in Virginia.  After much thought and research, I feel compelled to speak out.  As a director and a parent, I am uncomfortable taking on the responsibility of deciding a child is in need of medical attention.  I would not be happy with a non-medically trained person making that decision for my own child.  After having spoken to a friend who is a trained nurse, I further understand that I could do more harm than good by taking on a role that I am not truly trained to take on.  Furthermore, we are here to help our children to the best of our abilities and not to take on task that could harm not only the child, but their families and my own as well.  

I oppose the fast track of possession and administration of epinephrine in the childcare facilities in Virginia , whether it's a licensed daycare center or a licensed family daycare home.

Once again, the state keeps adding to the burden of childcare providers with new regulations without factoring in what these cost. While this seems like a logical plan to implement, requiring providers to cover the cost of multiple epi pens (dosages for each age group) which will have to be replaced at regular intervals AS WELL AS training for each staff member (which you will also wind up charging us to do) is not a good plan.  Everyone loves to complain about how expensive childcare is but that fail to look at the regulatory burdens placed on us by the state. Please reconsider this option unless you will also provide a pathway to less expensive provisions for providers.

I am submitting this comment to express my absolute and unwavering opposition to any proposal that requires child care providers to administer EpiPens or epinephrine auto-injectors to children for whom these medications are not prescribed.

This expectation is not only unreasonable—it is dangerous, irresponsible, and completely unacceptable.

As a licensed child care facility owner, I already carry enormous responsibility for the safety and well-being of the children in my program. But the state is now attempting to place medical responsibilities on providers who are not medical professionals, are not licensed to administer prescription medication, and who would be held personally and financially liable for any adverse outcome. This is an outrageous burden.

Let me be clear:

• I will not take on medical liability for a child who does not have a prescription and an established medical plan.

• I will not allow the state to impose medical expectations on child care professionals who are not trained or legally protected to act in that capacity.

• I will not absorb the financial cost, the risk, or the legal exposure associated with this requirement.

This proposal fundamentally oversteps the role of a child care provider. We are caregivers, educators, and mandated reporters. We are not doctors, nurses, or emergency medical personnel. The state cannot simply assign us these responsibilities without proper licensure, authority, or liability protections, and expect us to comply.

Requiring us to administer a high-risk emergency medication to a non-prescribed child is a breach of professional boundaries, a violation of common sense, and a direct threat to the sustainability of private child care programs. It places every provider in the state in an impossible position—and it endangers both children and staff.

I strongly urge the state to withdraw this proposal. If the goal is to protect children, then regulations must be developed that do not expose child care providers to catastrophic liability and do not force us into medical roles we are neither trained for nor obligated to perform.

This requirement is unacceptable on every level. I oppose it fully and without reservation.

Robin Boling

I do not feel this is a good idea. That means we as the provider would take responsibility of any outcome of the medication that we have on sight. 

I posted a comment earlier about the cost of procurement for the various levels of epinephrine for the ages of children we serve. I neglected to mention how much this would raise the already ridiculous cost of insurance if our staff is now to be considered medical professionals in the administration of medical care. We already pay massive amounts for insurance and this will just make it worse.

Please do not Fast track this. More time is needed and budgets do not include this extra expense. I do not support this.

I am writing in opposition to the proposed amendment to the Standard for Licensed Child Day Centers requiring centers to possess and administer stock epinephrine to children for whom these medications are not individually prescribed.  Requiring child care staff to administer a high-risk emergency medication to an non-prescribed child puts children and staff at a great risk.  

Child Day Centers are responsible for the safety and well-being of the children enrolled.  We are not doctors, nurses, or emergency medical personnel.  We are educators/caregivers providing a safe environment for everyone.  

At Monarch Montessori School, we do not administer medication. We have chosen to allow parents options, which include coming into the facility to administer their child's medication if needed. Otherwise, medications are to be given at home. We do not require MAT training for our staff. Should we be required to administer epi-pens at our facility, additional training would be needed and staff would need eat the cost. Our policy has been to call emergency personnel if a child is in crisis although staff are trained in pediatric first-aid/CPR. The liability of administering medication incorrectly is too great. We would prefer not to be held responsible for that part of a child's care. We are not trained medical personnel and should not be required to perform the duties of medical personnel as a part of the school's routine operations. 

At Monarch Montessori School, we do not administer medication per our school policies. We have chosen to allow parents options, which include coming into the facility to administer their child's medication if needed. Otherwise, medications are to be given at home. We do not require MAT training for our teachers. Should we be required to administer epinephrine at our facility, additional training would be needed and since we are a small school, teachers would bear the expense.

Although medications can provide life-saving assistance, it is vitally important that medically-trained personnel provide that assistance. We do not operate in a clinical setting. We would never expect educators to also perform the duties of a nurse or physician in any other context. Our policy, which has been effective thus far has been to call 911 if a child is experiencing a medical emergency. Teachers also have no legal duty to administer medication.  Teachers have a duty to:

1. Supervise students properly.

2. Respond to and prevent bullying and harassment.

3. Take steps to prevent physical injuries from faulty equipment or other hazards.

4. Intervene in situations where a student is at risk of harming themselves or others.

 The liability of administering medication incorrectly is too great. Our General Liability Insurance does not cover medication administration. Additionally, we maintaining epinephrine on campus is both cost-prohibitive and will require additional training for teachers and administration. Storage and tracking the shelf-life of medications simply isn't within the scope of our duties and should not be required as a part of routine operations. We strongly urge VDOE to reconsider this proposal.

There is a real concern for businesses operating Childcare Services regarding General Liability coverage for administering an EpiPen to a child that does not have a prescription and an action plan from a Physician.  If Childcare Providers cannot obtain General Liability coverage for administering an EpiPen under these new circumstances, THEY COULD NO LONGER OPERATE. Although we have at least 1 or more children at each of our sites that have a prescription for an EpiPen and we are trained to administer the EpiPen, in over 17 years of operation and 1000’s of children under our care, we have never had to administer an EpiPen. In most action plans, Benadryl is the first step for a reaction. The Cost for operating Childcare services is already high enough and this just another cost that will burden Childcare facilities and ultimately parents and Guardians. If the Department of Education feels this is so important, then they should pay for the cost of the EpiPen.