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Adopted Rules: Closed to Comments

Adopted Rules Content: 

Statement of Basis and Purpose

Statutory Authority

The Board’s authority to codify these proposed amendments is found in Sections, 556, 558, and 1043 of the New York City Charter (the “Charter”). Sections 558(b) and (c) of the Charter empower the Board to amend the Health Code and to include all matters to which the Department’s authority extends. Section 556 of the Charter provides the Department with jurisdiction to protect and promote the health of all persons in the City of New York. Section 1043 grants the Department rule-making authority.


Article 47 of the Health Code governs center-based child care. The Board is amending the Article’s requirements by adding requirements pertaining to epinephrine auto-injectors, and training, and by clarifying requirements. The basis for the changes is set forth below.

Emergency Medical Care and Epinephrine Auto-Injectors

The Centers for Disease Control and Prevention estimates that four to six percent of children nationally have a food allergy; such food allergies include ones that are life-threatening. Rapid administration of an epinephrine auto-injector following a life-threatening allergen exposure is critical to preventing significant negative outcomes, including death. Having epinephrine auto-injectors on the premises at all times can save the lives of children with life-threatening food allergies who do not bring an epinephrine auto-injector with them to child care or shelter-base child supervision programs, and of children who have life-threatening food allergies identified for the first time while the child is in such programs.

In 2016, the New York State Public Health Law was amended[1] to allow certain entities, including child care providers, to obtain non-patient specific epinephrine auto-injectors and to administer them in an emergency. This new State law creates the opportunity for such programs to have this critical, lifesaving medication available. Accordingly, the amendments clarify requirements for emergency medical care and add a requirement that child care and child supervision programs maintain on site at least two unexpired epinephrine auto-injectors in each dosage appropriate for children who may be in the program, stored so they are easily accessible to staff and inaccessible to children. Programs will be required to have on site, whenever children are present, at least one staff person trained to recognize signs and symptoms of anaphylactic shock and to administer epinephrine as appropriate. The amendment also requires programs to monitor the auto-injectors’ expiration dates and call 911 after any administration, as required by the medication directions. Programs will be required to obtain parental consent at the time each child is enrolled in the program, and to train all staff in preventing and responding to emergencies related to food allergies.

The proposed language has been modified to require that epinephrine auto-injectors have retractable needles and to clarify storage requirements; and to allow all staff to administerasthma inhalers, nebulizers, and epinephrine auto-injectors to children whose parent or guardian has provided written consent, medical authorization, and training.


The amendments expand staff training requirements to promote high quality learning environments, enhance child health and safety, and align with the health and safety training requirements in the federal Child Care Development Block Grant (CCDBG) Act of 2014, which apply to any program enrolling a child whose enrollment is paid for by CCDBG subsidies.

First, the amendments provide that trainings currently required only for assistant teachers be mandated for all teaching staff. These core trainings address fundamental issues including preventing, recognizing signs of, and reporting injuries, infectious diseases, lead poisoning, and asthma; scheduling and conducting guided and structured physical activity; and promoting childhood growth and development.

The proposed language has been modified to include training regarding prevention of and response to emergencies related to food or allergic reaction, and prevention and control of infectious diseases (including immunization); and to require that at least five of the required 15 hours of training in certain topics take place each year.

Clarifying Requirements    

A number of the amendments clarify requirements and facilitate compliance with the Health Code. For example, some definitions have been added or clarified.

The Health Code previously required that documentation be provided under certain provisions. The amendments articulate more uniform requirements across additional provisions.  They also clarify, to the regulated community, that review of such documents will occur at least once a year.

            The amendments also articulate more precise requirements regarding program capacity, level of supervision, response to emergencies, response to medical emergencies, and the administration of some medications.  Various other technical edits have been made to the text for consistency. 

            In order to come into alignment with federal requirements and state policy regarding the vulnerabilities and special needs of children who are homeless or in foster care and thus require accommodations for compliance with certain rules, the proposed language has been modified to provide for a reasonable grace period for implementation of certain provisions pertaining to providing medical records.

 Tooth Brushing

The provisions regarding tooth brushing that were included in the original proposal are not included in these amendments. The Department has determined that further consideration is warranted.

[1] NYS Public Health §3000-C. Epinephrine Auto-injector devices. Effective March 28, 2017.

Effective Date: 
Thu, 07/12/2018