Few settings offer greater opportunity for improving our nation’s health than the child care environment. The experiences of early childhood, good and bad, lay the foundation for a lifetime. Non-parental child care settings ‒ where many young children spend part of their childhood ‒ provide a unique forum for shaping those experiences. A strategic approach, based on a holistic healthy child model, can use law and policy to support children’s mental and emotional well-being, promote social development, mitigate Adverse Childhood Experiences, and address fundamental social determinants of health.

“Child care is one component of the larger ECE space that provides education, care, and developmental services to children, birth through age 13 with full-day and partial-day programs, before-and-after school care and summer care.1 The ECE system (figure below2) is composed of three sub-systems: 1) child care, a market-based system subsidized by federal block grants to states; 2) Early Head Start and Head Start programs (EHS/HS), federally funded and granted to individual programs within states; and 3) Pre-Kindergarten, a state-funded discretionary program serving 4- and/or 3-year-olds in public school settings. Child care is a broad term that includes private, for-profit and non-profit child care centers, summer camps, family and kinship care, family child care providers, nannies and in-home care. Child care is defined by each state, usually through laws and regulations implementing those laws.”3

Early Care in Education diagram


Child Care Aware, a program funded by the U.S. Department of Health and Human Services, includes definitions of child care settings on their website.4 Child Care Aware defines child care settings as follows:

  1. Child Care Centers – “Child care centers care for children in groups and are generally operated out of non-residential, commercial buildings. Centers are larger and enroll more children than a home-based provider. They are usually divided into groups or classrooms of similarly aged children."5
  2. Family, Friend and Neighbor Care – “Family, Friend, and Neighbor Care is provided in the child’s or caregiver’s home by a person who is a relative, friend or neighbor, or a babysitter or nanny. These programs are typically legally exempt from regulations and may not be required to meet health, safety and training standards unless they care for children who receive government child care subsidies."6
  3. Family Child Care Homes – Family Child Care Homes provide care “for small groups of children in a residential building.” The residential building may or may not be the same home that the provider lives in, depending on the regulations in each state. “This type of care is known by many different names, including Family Child Care Home, Licensed Child Care Home, Licensed Group Family Child Care Home, Legally or License-Exempt Home, Certified Child Care Home, Registered Child Care Home or Family, Friend and Neighbor (FFN) Care, depending on where you live and the regulations in your state. Family Child Care Homes may also be classified as a Large or Small Family Home, depending on the maximum number of children in care."7

Every state regulates the ECE setting in some manner through licensing.8 State licensing regulations differ between states, often depending on the type of facility and provider.9 This makes grouping child care providers into distinct groups that can be compared across jurisdictions very difficult. Despite this difficulty, many efforts group the settings into family child care and child care centers.


Protocol for the Healthy Eating, Active Play and Screen Time Best Practices Maps (found at: http://www.publichealthlawcenter.org/heal/ChildCareMaps.html):

Child care facilities were classified as a home or a center by reviewing the definitions in the child care licensing regulations. Facilities were designated as centers if they operated out of a site that was not a residence, and generally cared for more than 15 children. Facilities were labeled as homes if they operated out of a private residence, and cared for a smaller number of children; generally fewer than 15.

Four states had no definition available in the regulations documents, and eleven states had vague or unclear definitions, leading to ambiguity. Where ambiguity existed or a definition was not found, the investigators searched the state’s child care services website or called the local child care services office for a definition or additional clarity. Investigators reviewed and discussed each designation to ensure agreement among the team.


Groupings for Child Care Settings by state:




1 The age range may differ depending on state laws and the child’s ability.
2 Figure created by Krista Scott, Senior Director for Child Care Health Policy, Child Care Aware® of America, and Anna Ayers Looby, Policy Analyst, Public Health Law Center.
4Child Care Centers, Child Care Aware, http://childcareaware.org/families/types-of-child-care/child-care-centers (Aug. 15, 2017).
5Family, Friend, and Neighbor Care, Child Care Aware, http://childcareaware.org/families/types-of-child-care/family-friend-and-neighbor-care (last visited Aug. 15, 2017).
6Family Child Care Homes, Child Care Aware, http://childcareaware.org/families/types-of-child-care/family-child-care-homes (last visited Aug. 15, 2017).
7 Family Child Care Homes, Child Care Aware, http://childcareaware.org/families/types-of-child-care/family-child-care-homes (last visited Aug. 15, 2017).
8 Please note that in some states, local governments can also regulate the early care and education setting. For more information, please visit http://www.publichealthlawcenter.org/resources/healthy-child-care.
9 The Public Health Law Center has analyzed the ECE licensing laws and regulations in all 50 states. For more information, please visit http://www.publichealthlawcenter.org/resources/healthy-child-care.