Yale University and Child Care Aware of America Collaborated and Found No Association Between Child Care and the Spread of COVID-19 to Providers

First Large-Scale Study Finds Child Care, Coupled with Infection Mitigation Efforts, is Not Associated With Spread of COVID-19


Foundation for Child Development Grants in Action

New Haven, CT (October 14, 2020) — Amidst ongoing debates over the safety of schools and child care, researchers at Yale University collaborated with Child Care Aware of America to conduct the first-ever large-scale assessment of the risk of working in child care during the COVID-19 pandemic. Their findings show child care programs that remained open throughout the pandemic did not contribute to the spread of the virus to providers, lending valuable insight to parents, policymakers, and providers alike.

The study, published today in Pediatrics, the peer-reviewed journal of the American Academy of Pediatrics, found that exposure to child care was not associated with an elevated risk of spreading COVID-19 from children to adults, provided the child care programs took multiple safety measures – including disinfecting, handwashing, symptom screening, social distancing, mask-wearing, and limiting group size – and were located in communities where the spread of COVID-19 was contained.

In the largest study performed during the pandemic to-date, a group of Yale University researchers surveyed 57,000 child care providers across all 50 states, Washington, DC, and Puerto Rico in May and June, 2020, comparing self-reported COVID-19 infections and hospitalizations among workers whose programs stayed open and those whose programs closed.

No differences in COVID-19 outcomes were observed between workers who continued to provide in-person care for young children and those who did not. These findings suggest that child care providers assume no heightened risk from their work – assuming that workplaces keep following core health and safety practices.

“Until now, decision makers had no way to assess whether opening child care centers would put staff at greater risk of contracting COVID-19,” said Walter Gilliam of the Yale University Child Study Center and the study’s lead author. “This study tells us that as long as there are strong on-site measures to prevent infection, providing care for young children doesn’t seem to add to the provider’s risk of getting sick.”

That doesn’t mean that child care workers avoided the novel coronavirus entirely. The study found that Black, Latino, and Native American child care providers were more likely to test positive for COVID-19 and be hospitalized for it. And, in counties with higher rates of coronavirus deaths – the study’s marker of community spread – child care workers were more likely to contract the virus.

“While plenty of U.S. child care workers contracted COVID-19 in May and June, it wasn’t driven by whether they were working with children or not,” explains Dr. Gilliam. The main factors in whether a child care worker got sick were the overall level of community transmission in the county where they lived, and race/ethnicity – with Black, Latino, and Native American people more likely to test positive or be hospitalized. These findings are in line with what other studies have found: both policy context and social context affect people’s risks and outcomes related to COVID-19.

Importantly, the research revealed that child care programs that stayed open were particularly conscientious in following recommended infection control measures. Over 90% of child care providers in open programs reported frequent handwashing and disinfection of surfaces. The survey also showed that child care sites had high rates of other infection control measures — like daily symptom checks, physical distancing, and “cohorting,” which means not mixing children or items between child groups. Researchers stress that infection control practices remain critical, especially in light of “vigilance fatigue,” a tendency to become less careful and consistent in efforts to protect against a threat as time goes on.

The study comes at a time when policymakers at all levels are weighing the costs and benefits of reopening businesses and community institutions – but sometimes without the benefit of data to guide their assessment of potential consequences.

“It’s understandable that families, employers, and early childhood development experts all want to see child care programs reopen. It’s hard for parents to work without childcare — and it’s hard for young children to thrive without opportunities to engage with attentive adults and other children,” says Dr. Lynette Fraga, the CEO of Child Care Aware of America, the country’s leading child care advocacy organization.

Given that 35% of jobs in child care were lost between February and April 2020, many child care professionals are eager to get back to work, too. Dr. Gilliam says: “Our study doesn’t fully answer the question of whether to reopen childcare or not — we don’t have data on children’s risk, and local levels of community spread matter a lot. But our study does offer solid evidence that, under certain conditions, it’s possible to open child care programs without putting staff in harm’s way.” Chief among these conditions: low rates of community spread — with local positive test rates under 5% — and high rates of protective practices at the child care setting, including physical distancing, frequent handwashing, and cohorting.

The study’s authors caution that their findings do not necessarily apply to teachers who work in schools or other settings with older children. “Adults who work with infants, toddlers, and preschoolers typically have a small group of children who stay together all day,” notes Gilliam. “Middle schools and high schools may have hundreds of people in a building — and typically, moving from class to class. Those factors alone make K-12 schools very different from child care programs.”

“Child care providers have done an excellent job mitigating the spread of this virus over the past six months,” said Dr. Fraga. “But they need our help to continue to do so — approximately 30-50% of child care providers may not reopen without $50 billion in federal assistance. And without child care, our economy cannot recover.”


The Yale Child Study Center at the Yale School of Medicine improves the mental health of children and families, advances understanding of their psychological and developmental needs, and treats and prevents childhood mental illness through the integration of research, clinical practice, and professional training. To learn more, visit medicine​.yale​.edu/​c​h​i​l​d​s​t​u​dy/.

Child Care Aware® of America is our nation’s leading voice for child care. CCAoA works with state and local Child Care Resource and Referral agencies (CCR&Rs) and other community partners to ensure that all families have access to quality, affordable child care. CCAoA leads projects that increase the quality and availability of child care, offers comprehensive training to child care professionals, undertakes research, and advocates for child care policies that improve the lives of children and families. To learn more, visit childcareaware​.org or COVID-19 Risk among Child Care Providers resource page. Follow CCAoA on Twitter @ChildCareAware and on Facebook at facebook​.com/​c​h​i​l​d​c​a​r​e​a​w​are.