At the beginning of 1990, 80 000 day-care centers in the US were serving about 4 million preschool children.1 This represents threefold increase since 1976 to 1977 in the number of centers and a fourfold increase in enrollments. Approximately 118 000 regulated family day-care providers were serving about 700 000 children. There were between 550 000 and 1.1 million nonregulated family day-care homes that were serving an unknown number of children. The number of regulated family day-care homes and the number of children enrolled in those homes increased since the mid-1970s, though not as much as the number enrolled in centers. About 17% of the children enrolled in center-based programs and 5% of those enrolled in regulated family day-care homes came from families receiving public assistance. Low-income families are overrepresented in Head Start and other sponsored non-profit programs.The fact that increasing numbers of children are enrolled in early education and care programs presents an opportunity to serve the needs of disadvantaged children who may not necessarily receive nutritious meals, environmental stimulation, developmental screening, and adequate preventive health care at home. Programs such as Head Start, for example, are required to provide a comprehensive set of services in addition to a developmentally appropriate curriculum.In the first part of this paper we examine the general health and safety procedures followed by center staff and family day-care providers for sick children ill providers. The extent to which providers conform to health and safety provisions will be examined. For example, do providers maintain records, obtain medical releases, have the phone number of a physician, have an emergency medical plan, have a list of persons to whom the child may be released, and conduct fire drills?
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