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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.

For more information on the way that states classified the child care settings for this project, please visit Child Care Setting Classification by State.

Child Care Regulations

To see the child care licensing regulations used for this research, see The Public Health Law Center’s state-specific child care regulations and resources and highlighting protocol. For more information, please visit the state-specific child care regulations and resources and highlighting protocol.

Study Limitations

This analysis focuses solely on the content of the standards. It does not address whether the standards are being implemented effectively, nor does it address how these standards do or do not take into account the perspectives, needs, and priorities of providers and children from socially disadvantaged and marginalized groups.

More research is needed that intentionally and authentically incorporates the experiences and needs of socially disadvantaged and marginalized communities (including child care providers, families, and the children they serve) in assessing the application of evidence-based best practices. Research must be done to support a better understanding of the role of racism (historic, current, structural, and institutional) and other systemic barriers to equitable outcomes for these groups.

How were best practices selected?

Researchers selected the nutrition, physical activity, and screen time practices for obesity prevention in child care settings that either had demonstrated evidence for effectiveness in the published literature or were determined to be key promising practices by a national group of expert stakeholders.

How were regulations coded for adherence to best practices?

Two reviewers independently scored/coded each state’s regulatory documents using a common research tool with standardized coding guidelines. Reviewer consensus determined the final score for each child care setting. For more information about this research, please see the research information page or contact Natasha Frost, Senior Staff Attorney at the Public Health Law Center, at