A:<\/strong> Yes. Privately-run child care centers — like other public accommodations such as private schools, recreation centers, restaurants, hotels, movie theaters, and banks — must comply with title III of the ADA. Child care services provided by government agencies, such as Head Start, summer programs, and extended school day programs, must comply with title II of the ADA. Both titles apply to a child care center’s interactions with the children, parents, guardians, and potential customers that it serves.<\/p>\nA child care center’s employment practices are covered by other parts of the ADA and are not addressed here. For more information about the ADA and employment practices, please call the Equal Employment Opportunity Commission (see question 30).<\/p><\/blockquote>\n
2. Q: Which child care centers are covered by title III?<\/h4>\nA:<\/strong> Almost all child care providers, regardless of size or number of employees, must comply with title III of the ADA. Even small, home-based centers that may not have to follow some State laws are covered by title III.<\/p>\nThe exception is child care centers that are actually run by religious entities such as churches, mosques, or synagogues. Activities controlled by religious organizations are not covered by title III.<\/p>\n
Private child care centers that are operating on the premises of a religious organization, however, are generally not<\/strong> exempt from title III. Where such areas are leased by a child care program not controlled or operated by the religious organization, title III applies to the child care program but not the religious organization. For example, if a private child care program is operated out of a church, pays rent to the church, and has no other connection to the church, the program has to comply with title III but the church does not.<\/p><\/blockquote>\nGeneral Information<\/h3>\n3. Q: What are the basic requirements of title III?<\/h4>\nA:<\/strong> The ADA requires that child care providers not discriminate against persons with disabilities on the basis of disability, that is, that they provide children and parents with disabilities with an equal opportunity to participate in the child care center’s programs and services. Specifically:<\/p><\/blockquote>\n\n- Centers cannot exclude children with disabilities from their programs unless their presence would pose a direct threat<\/em> to the health or safety of others or require a fundamental alteration<\/em> of the program.<\/li>\n<\/ul>\n
\n- Centers have to make reasonable modifications<\/em> to their policies and practices to integrate children, parents, and guardians with disabilities into their programs unless doing so would constitute a fundamental alteration<\/em>.<\/li>\n<\/ul>\n
\n- Centers must provide appropriate auxiliary aids and services needed for effective communication<\/em> with children or adults with disabilities, when doing so would not constitute an undue burden<\/em>.<\/li>\n<\/ul>\n
\n- Centers must generally make their facilities accessible to persons with disabilities. Existing facilities are subject to the readily achievable<\/em> standard for barrier removal, while newly constructed facilities and any altered portions of existing facilities must be fully accessible<\/em>.<\/li>\n<\/ul>\n
4. Q: How do I decide whether a child with a disability belongs in my program?<\/h4>\nA:<\/strong> Child care centers cannot just assume that a child’s disabilities are too severe for the child to be integrated successfully into the center’s child care program. The center must make an individualized assessment<\/em> about whether it can meet the particular needs of the child without fundamentally altering its program. In making this assessment, the caregiver must not react to unfounded preconceptions or stereotypes about what children with disabilities can or cannot do, or how much assistance they may require. Instead, the caregiver should talk to the parents or guardians and any other professionals (such as educators or health care professionals) who work with the child in other contexts. Providers are often surprised at how simple it is to include children with disabilities in their mainstream programs.<\/p>\nChild care centers that are accepting new children are not required to accept children who would pose a direct threat<\/em> (see question 8) or whose presence or necessary care would fundamentally alter<\/em> the nature of the child care program.<\/p><\/blockquote>\n5. Q: My insurance company says it will raise our rates if we accept children with disabilities. Do I still have to admit them into my program?<\/h4>\nA:<\/strong> Yes. Higher insurance rates are not a valid reason for excluding children with disabilities from a child care program. The extra cost should be treated as overhead and divided equally among all paying customers.<\/p><\/blockquote>\n6. Q: Our center is full and we have a waiting list. Do we have to accept children with disabilities ahead of others?<\/h4>\nA:<\/strong> No. Title III does not require providers to take children with disabilities out of turn.<\/p><\/blockquote>\n7. Q: Our center specializes in “group child care.” Can we reject a child just because she needs individualized attention?<\/h4>\nA:<\/strong> No. Most children will need individualized attention occasionally. If a child who needs one-to-one attention due to a disability can be integrated without fundamentally altering a child care program, the child cannot be excluded solely because the child needs one-to-one care.<\/p>\nFor instance, if a child with Down Syndrome and significant mental retardation applies for admission and needs one-to-one care to benefit from a child care program, and a personal assistant will be provided at no cost to the child care center (usually by the parents or though a government program), the child cannot be excluded from the program solely because of the need for one-to-one care. Any modifications necessary to integrate such a child must be made if they are reasonable and would not fundamentally alter the program. This is not to suggest that all children with Down Syndrome need one-to-one care or must be accompanied by a personal assistant in order to be successfully integrated into a mainstream child care program. As in other cases, an individualized assessment<\/em> is required. But the ADA generally does not require centers to hire additional staff or provide constant one-to-one supervision of a particular child with a disability.<\/p><\/blockquote>\n8. Q: What about children whose presence is dangerous to others? Do we have to take them, too?<\/h4>\nA:<\/strong> No. Children who pose a direct threat<\/em> — a substantial risk of serious harm to the health and safety of others — do not have to be admitted into a program. The determination that a child poses a direct threat may not be based on generalizations or stereotypes about the effects of a particular disability; it must be based on an individualized assessment<\/em> that considers the particular activity and the actual abilities and disabilities of the individual.<\/p>\nIn order to find out whether a child has a medical condition that poses a significant health threat to others, child care providers may ask all applicants whether a child has any diseases that are communicable through the types of incidental contact expected to occur in child care settings. Providers may also inquire about specific conditions, such as active infectious tuberculosis, that in fact pose a direct threat.<\/p><\/blockquote>\n
9. Q: One of the children in my center hits and bites other children. His parents are now saying that I can’t expel him because his bad behavior is due to a disability. What can I do?<\/h4>\nA:<\/strong> The first thing the provider should do is try to work with the parents to see if there are reasonable ways of curbing the child’s bad behavior. He may need extra naps, “time out,” or changes in his diet or medication. If reasonable efforts have been made and the child continues to bite and hit children or staff, he may be expelled from the program even if he has a disability. The ADA does not require providers to take any action that would pose a direct threat<\/em> — a substantial risk of serious harm — to the health or safety of others. Centers should not make assumptions, however, about how a child with a disability is likely to behave based on their past experiences with other children with disabilities. Each situation must be considered individually.<\/p><\/blockquote>\n10. Q: One of the children in my center has parents who are deaf. I need to have a long discussion with them about their child’s behavior and development. Do I have to provide a sign language interpreter for the meeting?<\/h4>\nA:<\/strong> It depends. Child care centers must provide effective communication to the customers they serve, including parents and guardians with disabilities, unless doing so poses an undue burden. The person with a disability should be consulted about what types of auxiliary aids and services will be necessary in a particular context, given the complexity, duration, and nature of the communication, as well as the person’s communication skills and history. Different types of auxiliary aids and services<\/em> may be required for lengthy parent-teacher conferences than will normally be required for the types of incidental day-to-day communication that take place when children are dropped off or picked up from child care. As with other actions required by the ADA, providers cannot impose the cost of a qualified sign language interpreter or other auxiliary aid or service on the parent or guardian.<\/p>\nA particular auxiliary aid or service is not required by title III if it would pose an undue burden<\/em>, that is, a significant difficulty or expense, relative to the center or parent company’s resources.<\/p><\/blockquote>\n11. Q: We have a “no pets” policy. Do I have to allow a child with a disability to bring a service animal, such as a seeing eye dog?<\/h4>\nA:<\/strong> Yes. A service animal is not<\/strong> a pet. The ADA requires you to modify your “no pets” policy to allow the use of a service animal by a person with a disability. This does not mean that you must abandon your “no pets” policy altogether, but simply that you must make an exception to your general rule for service animals.<\/p><\/blockquote>\n12. Q: If an older child has delayed speech or developmental disabilities, can we place that child in the infant or toddler room?<\/h4>\nA:<\/strong> Generally, no. Under most circumstances, children with disabilities must be placed in their age-appropriate classroom, unless the parents or guardians agree otherwise.<\/p><\/blockquote>\n13. Q: Can I charge the parents for special services provided to a child with a disability, provided that the charges are reasonable?<\/h4>\nA:<\/strong> It depends. If the service is required by the ADA, you cannot impose a surcharge for it. It is only if you go beyond what is required by law that you can charge for those services. For instance, if a child requires complicated medical procedures that can only be done by licensed medical personnel, and the center does not normally have such personnel on staff, the center would not be required to provide the medical services under the ADA. If the center chooses to go beyond its legal obligation and provide the services, it may charge the parents or guardians accordingly. On the other hand, if a center is asked to do simple procedures that are required by the ADA — such as finger-prick blood glucose tests for children with diabetes (see question 20) — it cannot charge the parents extra for those services. To help offset the costs of actions or services that are required by the ADA, including but not limited to architectural barrier removal, providing sign language interpreters, or purchasing adaptive equipment, some tax credits and deductions may be available (see question 24).<\/p><\/blockquote>\nPersonal Services<\/h3>\n14. Q: Our center has a policy that we will not give medication to any child. Can I refuse to give medication to a child with a disability?<\/h4>\nA:<\/strong> No. In some circumstances, it may be necessary to give medication to a child with a disability in order to make a program accessible to that child. While some state laws may differ, generally speaking, as long as reasonable care is used in following the doctors’ and parents’ or guardians written instructions about administering medication, centers should not be held liable for any resulting problems. Providers, parents, and guardians are urged to consult professionals in their state whenever liability questions arise.<\/p><\/blockquote>\n15. Q: We diaper young children, but we have a policy that we will not accept children more than three years of age who need diapering. Can we reject children older than three who need diapering because of a disability?<\/h4>\nA:<\/strong> Generally, no. Centers that provide personal services such as diapering or toileting assistance for young children must reasonably modify their policies and provide diapering services for older children who need it due to a disability. Generally speaking, centers that diaper infants should diaper older children with disabilities when they would not have to leave other children unattended to do so.<\/p>\nCenters must also provide diapering services to young children with disabilities who may need it more often than others their age.<\/p>\n
Some children will need assistance in transferring to and from the toilet because of mobility or coordination problems. Centers should not consider this type of assistance to be a “personal service.”<\/p><\/blockquote>\n
16. Q: We do not normally diaper children of any age who are not toilet trained. Do we still have to help older children who need diapering or toileting assistance due to a disability?<\/h4>\nA:<\/strong> It depends. To determine when it is a reasonable modification to provide diapering for an older child who needs diapering because of a disability and a center does not normally provide diapering, the center should consider factors including, but not limited to, (1) whether other non-disabled children are young enough to need intermittent toileting assistance when, for instance, they have accidents; (2) whether providing toileting assistance or diapering on a regular basis would require a child care provider to leave other children unattended; and (3) whether the center would have to purchase diapering tables or other equipment.<\/p>\nIf the program never provides toileting assistance to any child, however, then such a personal service would not be required for a child with a disability. Please keep in mind that even in these circumstances, the child could not be excluded from the program because he or she was not toilet trained if the center can make other arrangements, such as having a parent or personal assistant come and do the diapering.<\/p><\/blockquote>\n
Issues Regarding Specific Disabilities<\/h3>\n17. Q: Can we exclude children with HIV or AIDS from our program to protect other children and employees?<\/h4>\nA:<\/strong> No. Centers cannot exclude a child solely because he has HIV or AIDS. According to the vast weight of scientific authority, HIV\/AIDS cannot be easily transmitted during the types of incidental contact that take place in child care centers. Children with HIV or AIDS generally can be safely integrated into all activities of a child care program. Universal precautions, such as wearing latex gloves, should be used whenever caregivers come into contact with children’s blood or bodily fluids, such as when they are cleansing and bandaging playground wounds. This applies to the care of all children, whether or not they are known to have disabilities.<\/p><\/blockquote>\n18. Q: Must we admit children with mental retardation and include them in all center activities?<\/h4>\nA:<\/strong> Centers cannot generally exclude a child just because he or she has mental retardation. The center must take reasonable steps to integrate that child into every activity provided to others. If other children are included in group sings or on playground expeditions, children with disabilities should be included as well. Segregating children with disabilities is not acceptable under the ADA.<\/p><\/blockquote>\n19. Q: What about children who have severe, sometimes life-threatening allergies to bee stings or certain foods? Do we have to take them?<\/h4>\nA:<\/strong> Generally, yes. Children cannot be excluded on the sole basis that they have been identified as having severe allergies to bee stings or certain foods. A center needs to be prepared to take appropriate steps in the event of an allergic reaction, such as administering a medicine called “epinephrine” that will be provided in advance by the child’s parents or guardians.<\/p>\nThe Department of Justice’s settlement agreement with La Petite Academy addresses this issue and others (see question 26).<\/p><\/blockquote>\n
20. Q: What about children with diabetes? Do we have to admit them to our program? If we do, do we have to test their blood sugar levels?<\/h4>\nA:<\/strong> Generally, yes. Children with diabetes can usually be integrated into a child care program without fundamentally altering it, so they should not be excluded from the program on the basis of their diabetes. Providers should obtain written authorization from the child’s parents or guardians and physician and follow their directions for simple diabetes-related care. In most instances, they will authorize the provider to monitor the child’s blood sugar — or “blood glucose” — levels before lunch and whenever the child appears to be having certain easy-to-recognize symptoms of a low blood sugar incident. While the process may seem uncomfortable or even frightening to those unfamiliar with it, monitoring a child’s blood sugar is easy to do with minimal training and takes only a minute or two. Once the caregiver has the blood sugar level, he or she must take whatever simple actions have been recommended by the child’s parents or guardians and doctor, such as giving the child some fruit juice if the child’s blood sugar level is low. The child’s parents or guardians are responsible for providing all appropriate testing equipment, training, and special food necessary for the child.<\/p>\nThe Department of Justice’s settlement agreements with KinderCare and La Petite Academy address this issue and others (see question 26).<\/p><\/blockquote>\n
21. Q: Do we have to help children take off and put on their leg braces and provide similar types of assistance to children with mobility impairments?<\/h4>\nA:<\/strong> Generally, yes. Some children with mobility impairments may need assistance in taking off and putting on leg or foot braces during the child care day. As long as doing so would not be so time consuming that other children would have to be left unattended, or so complicated that it can only done by licensed health care professionals, it would be a reasonable modification<\/em> to provide such assistance.<\/p>\nThe Department of Justice’s settlement agreement with the Sunshine Child Center of Gillett, Wisconsin, addresses this issue and others (see question 26).<\/p><\/blockquote>\n
Making the Child Care Facility Accessible<\/h3>\n22. Q: How do I make my child care center’s building, playground, and parking lot accessible to people with disabilities?<\/h4>\nA:<\/strong> Even if you do not have any disabled people in your program now, you have an ongoing obligation to remove barriers to access for people with disabilities. Existing privately-run child care centers must remove those architectural barriers that limit the participation of children with disabilities (or parents, guardians, or prospective customers with disabilities) if removing the barriers is readily achievable<\/em>, that is, if the barrier removal can be easily accomplished and can be carried out without much difficulty or expense. Installing offset hinges to widen a door opening, installing grab bars in toilet stalls, or rearranging tables, chairs, and other furniture are all examples of barrier removal that might be undertaken to allow a child in a wheelchair to participate in a child care program. Centers run by government agencies must insure that their programs are accessible unless making changes imposes an undue burden; these changes will sometimes include changes to the facilities.<\/p><\/blockquote>\n