Guidelines for 0-3 Childcare During COVID-19: Balancing Physical Health and Safety with Social Emotional Development

Above, we share a picture that demonstrates how, even with the most extreme precautions, connection is still possible. Here, we are comforted by the reminder that situations will be different, but care is still present and possible. Childcare providers of young children will naturally have reactions to these differences, and space must be made to tend to those reactions. There is no one correct approach, but rather many ways of balancing physical health and safety needs with social-emotional development. Photo credit: Mary Dossman and Julie Doherty


Childcare providers are historically undervalued (Tobia, 2020) and are in one of the most underpaid jobs (McClean, 2020), yet are the foundation upon which much of working America is built. The current pandemic has highlighted the extent to which childcare workers are essential (Simonton, 2020) for the functioning of the U.S. economy, and in particular, for working mothers, who historically and currently have taken the brunt of the childcare responsibilities (Cohen & Hsu, 2020; Collins, Landivar, Ruppanner, & Scarborough, 2020; Rhubart, 2020) and associated mental health distress (Miller, 2020). Childcare centers have also struggled to balance financial concerns and best practice care (Covert, 2020). Now, as many employees have returned to work, it is important to consider how to support childcare providers doing this critical work. A key focus must be to provide high-quality care to young children while managing health and safety requirements and limitations of a pandemic. The focus of this article is on supporting the social-emotional health of our youngest children during a time that pushes many of us apart physically.

A note about the current context in the USA

After weeks or months at home and a potentially abrupt disruption for many children and families, returning to childcare may be challenging for young children, their parents/caregivers, and the childcare providers who will be ‘holding’ their distress during separations. Layered on top of the COVID-19 pandemic context and its related disruptions is the racism pandemic (APA, 2020 in Mills, 2020) that resulted in disproportionate impacts (Martin, 2020) on children and families of color. The murder of George Floyd in Minneapolis (and a long history in the U.S. of previous and subsequent deaths of Black individuals as well as Indigenous individuals and people of color) gave new light to the public health crisis of racism in America (Devakumar et al., 2020). The resulting civil unrest and racial trauma (Comas-Diaz, Hall, & Neville, 2019) that many people of color have and are experiencing creates further concern as families return to or continue to engage in childcare.

As with any stressful life event or adverse childhood experience, parents/caregivers and childcare providers are likely to see normative difficulty with separations, transitions, and rule-following. Children communicate through their behavior and emotions. This is especially true for the youngest children who do not yet have words to convey their emotional experience.  Childcare providers need to be attuned to the possibility of traumatic stress reactions developing in young children (Lingras, Griefer, Sheikh, & Fabre, 2019). Many social-emotional development strategies discussed below will help all children and may be particularly indicated for supporting children experiencing trauma. However, strategies specifically related to identifying and addressing trauma are beyond the scope of this paper. Therefore, we recommend that all childcare providers refamiliarize themselves with possible reactions of young children (Society for the Protection and Care of Children, 2020) and trauma guidelines and resources (e.g. National Child Traumatic Stress Network) in order to meet the needs young children in this moment.


We ask much of childcare providers of young children. They are charged with meeting both physical and mental health (social-emotional) needs during this global pandemic. As societal systems, including childcare, continue to oscillate between “dialing back” and re-opening in the coming months, childcare providers may continue to wrestle with balancing social-emotional needs and physical health and safety recommendations suggested by the Centers for Disease Control and Prevention (CDC, 2020) (i.e. wearing a mask when in public places, keeping a physical distance of 6 feet or more from non-household members, and limiting time in enclosed physical spaces/homes with individuals outside the household).

A note on masks, clear masks, and face shields

As noted above, the CDC recommends the use of masks when in the presence of others outside of one’s household. This inherently affects childcare settings, at minimum with respect to guidelines for the adult providers. In order to reduce the potential impact of a covered face, childcare providers may wish to explore using purchased or homemade clear masks that show more of the face (including the mouth and lips) while maintaining the needed properties of standard cloth masks. Some psychologists (McKoy, 2020) and mental health organizations (Florida Association for Infant Mental Health, 2020) have called for the use of these types of masks and face shields in childcare settings to minimize the impact on young children’s learning and development (Scott, 2020). These clear masks may be less obtrusive, but are, not surprisingly, more costly. Clear face shields or home-made clear masks may be a lower-cost alternative (see additional resources for the link).

It is important to note, however, that the above options are not the only way to resolve the mask/social-emotional communication dilemma. While hiding a person’s lips and parts of facial expression can present a communication barrier and impede social interactions (particularly for children who already struggled with reading facial expression, e.g. children on the Autism Spectrum), many cultures that use face coverings exist and at present no evidence exists to suggest that these children’s development is negatively impacted. For instance, although it can look different, the formation of attachment and relationship-building across cultures is well-established; attachment and positive relationships are common in cultures where face-coverings are work for religious or public health purposes, outside of COVID-19 recommendations (e.g. Mesman, Minter, Angnged, Cissé, Salali, & Migliano, 2018; Asanjarani, Abadi, Ghomi, Woundstra & Mesman, 2020; Deater-Deckard, Lansford, Malone, Alampay, Sorbing, et. al, 2011). Additionally, some evidence suggests no impact on facial expression processing with the addition of a mask (Roberson, Kikutani, Doge, Whitaker, & Majid, 2012).

However, wearing a mask is newer for many cultures and communities, and even in cultures where face coverings are practiced, children are still not accustomed to their primary caregivers and/or childcare providers wearing masks in their presence which may be associated with some distress. We also want to acknowledge the difference in childcare for infants and toddlers compared to preschoolers or elementary school children. Masks are not recommended for children under two. As such, infants and toddlers will likely experience their parents/caregivers and childcare providers differently than older children. Older children who are encouraged to wear masks will see adults modeling the same behavior. However, the youngest children have not yet developed the capacity to make meaning of mask-wearing. It is possible that they will instead rely on other cues from parents/caregivers and childcare providers to reassure and reinforce safety and comfort.

The Current Paper

This article is centered on suggestions for childcare providers in balancing the physical and mental healthcare needs of themselves and their young charges. We know circumstances and guidelines change rapidly and frequently. Routine communication about COVID-19 policies and procedures with parents/caregivers and other key stakeholders is essential.

Infant and young children’s needs while in childcare or early learning contexts generally reflect basic needs, emotional comfort, and social interaction and learning. We defer to the CDC recommendations for physical health and safety guidelines, which are generally consistent with traditional childcare practice, and will be familiar to childcare providers. While these guidelines provide specific childcare recommendations from a health and safety standpoint, they do not address the social-emotional needs that are so significant for young children. Thus, we provide suggestions for adapting practices to address emotional needs within the current health and safety framework.

In these suggestions, we are guided by the basics of child development and classroom management so that childcare providers have the necessary skills to incorporate these recommendations into their daily schedules. One relevant model is the Zero to Three that uses a Critical Competencies for Infant-Toddler EducatorsTM (Zero to Three, 2015; Dean, LeMoine, & Mayoral, 2016). This framework represents three areas of need: social-emotional development, cognitive development, and language and literacy development. We use a similar framework here, focusing on the first and third areas, to describe needs and supports in each domain in the context of global pandemic public health recommendations.

Supporting Safety and Basic Needs through Traditional Childcare Best Practices Relationships, Routines, Structure

The CDC’s detailed recommendations for childcare providers in caring for basic needs are consistent with existing health and safety regulations for childcare environments. For instance, child development literature has long established that childcare settings with consistent standards for group size, developmentally appropriate surroundings,  communication with primary caregivers, familial and culturally responsive supportive networks which encourage best outcomes for infants and toddlers (e.g. Lally, Torres, & Phelps, 2010; Zero to Three, 2015).

Health and safety standards are maintained through relationships and by comprehensive routines. In many senses, the best advice for enforcing new pandemic standards is to go “back to basics”. Setting and reinforcing rules helps increase feelings of safety by letting children know what to expect. Using child-directed activities engages children and helps ease transitions. Reinforcing and adhering to (and praising) longstanding standards and practices increases comfort for families and facilitates continued positive relationships between and among children and staff, even during times of stress. In addition:

  • Predictability is key. Even though the nuances of routines and transitions may change, much will stay the same.
    • Continue to maintain routines similar in timing, order, and activity as much as possible; schedules increase natural rhythms through predictability.
    • Keep infant/toddler environments in order and reinforce rules to increase feelings of safety by letting children know what to expect.
    • Use songs, chimes, or fun sounds to signal positive transitions. Consider using these signals more often than usual, including in infant rooms where verbal explanations may not be as meaningful as consistent sensory-based cues.
    • Address differences in practice/policy by naming them in developmentally appropriate terms. Adults may be required to use standards not recommended for children due to developmental stage, for example, mask-wearing for toddler childcare providers. Because mask-wearing for children under 2 is not recommended, it is important to name and explain these differences, so children understand what they are seeing.
  • Engagement enhances routines
    • Use increased verbal explanation during basic needs tasks. Support connection with infants and toddlers through verbal prompts and other non-verbal cues such as raised eyebrows, facial expressions, and hand gestures.
    • Build positive connections while wearing masks and/or gloves through exaggerated voice, eyes, touch, and hand movements after sanitizing.
    • Make handwashing and other new rules fun in order to smooth routines that are difficult or time-consuming. For instance, give a child a stamp on their hand that they need to wash off. Increase access to water play with soapy water that can double as extra hygiene maintenance. Sing songs that remind children to wash their hands longer (the ABCs adults are encouraged to sing are particularly relevant for young children!). Use ‘airplane arms’ or other child-appropriate images to remind children to give space and explain why adults are maintaining distance.
    • Communicate with parents/caregivers about changes in drop-off/pick-up routines. Encourage consistency of transition and basic needs strategies across home and school. Provide resources (Parlakian, 2020) to help parents and caregivers prepare their children. This will ease transitions between home and childcare as well as increase children’s sense of predictability across settings.
  • Prepare children for mask-wearing
    • Explain why people are wearing masks or other protective clothing in a positive and calm manner. Focus on the protective aspect and the use of masks as a kindness practice to reduce fear or othering. For instance, “we wear masks to protect from germs and help keep each other safe.”
    • Start with clothing such as bandanas or scarves (especially when asking children to wear masks) that will be more familiar to them.
    • Help children practice wearing a mask and increase exposure to caregiving adults wearing masks. For instance, childcare providers may encourage parents and caregivers to have a “mask day” at home where they and other close family members or friends show off masks so children can become accustomed to seeing familiar adults in masks.
    • Increase exposure to wearing a mask gradually for children (above 2) who are starting to wear masks. Hold the mask, put it near their faces, hold it over their mouths, and ultimately secure the mask around their ears to create distinct steps that children can practice. Consider ear extenders or headbands to reduce physical discomfort that might interfere with mask-wearing or elicit protests.

Supporting Social-Emotional Development Through Relationship-Building

COVID-19 public health guidelines have not only shaped how we keep ourselves and others healthy, it has also changed how we engage in relationship building. Many of our connections are now via virtual platforms and physically distanced interactions. However, this is often not the case for childcare providers and very-young children. Children of this age require close proximity for physical safety and support, emotional connection, and overall learning and development; relationships underlie all of these. Children’s early relationships with consistent, competent, and responsive caregivers (including primary caregivers at home and childcare providers) shape the way children see the world and help them learn how to interact within it.

One of the most essential functions of the relationships between caregivers and very-young children is the co-regulation of emotion. This applies to childcare providers’ interactions with children as well. Children can only learn how to manage their feelings and reactions in the context of these relationships with significant adults in their world.  This creates a paradox in the time of COVID-19; we are aware of the need to socially distance for safety but there are times when physical contact is necessary to calm a distressed young child.

While we strive for risk reduction, we must continue to be responsive to these most basic needs of young children.  When a child requires physical comforting (co-regulation of emotion), appropriate personal protective equipment (PPE) and protocols can balance the need to be responsive to the child with health and safety considerations (for example, hand-washing, changing a gown, etc.).  Co-regulation is a basic need in times of a child’s significant distress (e.g. at drop-off and separation from a parent). The following suggestions can help to mitigate risk while supporting this need.

Consider spending more time outside to help mitigate risk. Many approaches of early education including the Waldorf and Nature Preschool models encourage extensive outdoor time regardless of weather and serve as helpful guides (e.g. IASWECE Council, 2019; Amico, 2019; Larimore, 2016; Dennis, Wells, & Bishop, 2014). Consistent with child development literature, outside time is suggested to be beneficial to young children in many ways (Tillman, Tobin, Avison, & Gilliland, 2018):

  • Consider social distancing both inside and outside the classroom to mitigate risk. Encourage language like “we are giving space to help keep each other safe” to promote positive language rather than fear-based directions. Image-based behavioral reminders such as “airplane arms” can help even very young children concretize, visualize, and remember a more abstract rule.
  • Create visuals of peers, parents/caregivers, and childcare providers both with and without masks. This practice will provide reassurance about the caregiver’s identity and normalize the use of masks. These steps together can be used regularly and at times of heightened arousal to decrease a child’s stress.
    • Childcare providers can print a picture of their smiling face and name and wear it as a necklace/pin on a shirt (or even CDC recommended gowns).
    • Early childhood classrooms frequently display pictures of children’s family members; childcare providers can request both masked and unmasked pictures.
    • Early childhood classrooms frequently include pictures of children playing in various learning areas. Consider including pictures of children playing while masked. If these are not available from traditional learning stores, childcare providers can take photographs of children from their own settings for display.
  • Promote emotional comfort
    • Stuffed animals may be difficult to clean effectively to a degree needed during the COVID-19 pandemic. Consider dolls or other favorite toys that are plastic or rubber which can provide comfort but be more easily cleaned.
    • Cuddles and physical touch are often used to help infants and young children feel comfort when upset. Wearing gowns may help childcare providers feel protected and safer, which in turn will support the child; if the provider feel safer, the child will also likely feel safer.
    • Rely on auditory cues in addition to visual cues. Humming familiar songs/lullabies can signal comfort and predictability during different parts of a daily routine.
    • Understand and gauge the temperament of infants and toddlers. Young children will communicate their feelings about changes in the environment via potential “fussy” interactions. Childcare providers’ abilities to respond allows for the increased insight of the child’s needs, especially during times of significant changes such as COVID-19 practices.
  • As noted above, building relationships with parents/caregivers around new routines, expectations, and clear communications about policies and practices are central to smooth transitions with children. Providing recommended language and culturally-specific supports for families is even more important when discussing complex and stressful topics such as pandemic protocols.

Supporting Social-Emotional Development through Social Interactions and Intentional Teaching Practices

In the first years of life, children are developing the capacity for basic self-regulation skills by engaging with trusted adults to understand the world around them. Infants begin to learn about faces, preferring and responding to face-to-face interactions with caregivers. Throughout development, we see these skills advance, with increasing social smiling towards and eliciting responses from their primary caregivers and childcare providers.

Very-young children also use adult caregivers as a reference for how to interact with the world around them. This social referencing occurs in all contexts, including home and childcare, and involves looking towards adults for cues as to how to respond in a new environment or when a new person walks in the room. As social referencing becomes more advanced, young children move towards trusted adults and make contact with them to understand unfamiliar people or places. These trusted adults are used to make sense of the world and allow the young child freedom to explore.

Within the context of this rapid development, it is critical to consider the implications of implementing new health and safety practices, such as masks, in a childcare setting.

On the surface, it may seem that masks that hide faces and emotional expression inherently hinder social-emotional development. However, many strategies can mitigate this.

  • Physically distant, not socially distant:
    • Even very young children learn social-emotional skills best through interactions with peers and trusted adults. However, with an increase in distancing measures, childcare providers may be hesitant to be in close proximity with children and may need to keep children more physically distant from one another. To balance these competing needs, consider games and activities that do not require as much close proximity or touch.
    • Seat children in a circle so that infants and toddlers are able to face inward and see other children, even if they are not close enough to physically interact. This will increase interaction and attention to social cues, facial expressions, etc.
    • Play games across the circle that involve emotional expression and interactive activities (e.g., rolling a ball which can be disinfected back and forth).
  • Enhance social-emotional practices
    • Verbally express your own emotions throughout the day. Stating “you just put a really big smile on my face!” can help a child understand the emotion you are experiencing even if it is partially or fully covered by a mask.
    • Overemphasize gestures using your hands, eyes, and body movements.
    • Use emotional coaching/narration to provide young children with a better understanding of their own emotions. Narrate what you see them doing by making statements like “you are laughing and smiling, you must like it when we play peek-a-boo” is one example.
    • Increase the use of signs or gestures (Goldin-Meadow, 2009) for feelings words to “illustrate” the emotions of young children.
    • Enhance classroom practices related to routines, rules, and transition as described above in ‘Basic Needs’ to build social-emotional fortitude.
  • Emphasize social-emotional and play-based materials and activities
    • Add toys that have faces or emotion blocks that provide opportunities for childcare providers to comment on facial expressions and emotions (see additional resources for links). This can support young children’s awareness and attunement to the expressions of others and their own faces.
    • Engage in pretend play with children by allowing dolls or stuffed animals to wear masks or incorporating doctor toys into play areas and simulating a pretend doctor’s visit with new safety practices (Parlakian, 2020).
    • Add masks to typical social-emotional classroom materials and games, such as feelings charts, feelings bingo, or matching games (see additional resources for link to examples).
    • If you are wearing a mask, turn it into an activity and a way to get to know children. Activities that allow parents and caregivers to see “behind the mask” can serve to build relationships and/or social-emotional understanding. Consider adapting one like this activity geared towards older children (Stephens, 2020). These types of activities can be done in the childcare setting or as a “take-home” activity that parents complete to help childcare workers learn about their children.
    • Turn mask-wearing into a fun activity. Children can decorate their own cloth masks or masks for parents or siblings. Decorate pictures of masks or people wearing masks to normalize the presence of this new accessory.
    • Add more books about feelings and friendship within the setting. Even for infants, beginning to recognize different ‘feeling faces’ can help to build a strong social-emotional foundation.
    • Use social stories that help simplify changes in common childcare routines due to COVID-19 (Tuchel, 2020).

Supporting Language Development and Pre-Literacy

Children begin developing language skills beginning at birth through recognizing speech sounds of the language spoken by their primary caregivers. During the first year of life, infants begin communicating through babbling, gesturing towards the things they would like, and speaking their first words. Research has shown that, as these skills develop, infants attend to the mouths of their primary caregivers to learn speech sounds (Lewkowicz & Hansen-Tift, 2012; Tsang, Atagi, & Johnson, 2018). All these skills, in addition to parent-child interactions which support these behaviors early in life, are the foundation for children’s later literacy development (e.g. Dodici, Draper, & Peterson, 2003) and occur across environments.

Best practices for language development are again helpful in considering modifications during the pandemic. While many are concerned that young children’s language development may be impacted by the wearing of masks, as noted above, there is no evidence that children growing up in countries or cultures where masks or face coverings are worn more regularly have any more difficulty forming relationships or developing language skills (e.g. Roberson, et al., 2012). In fact, many strategies already in common use within childcare settings, such as developmentally appropriate sign language, pictures, and visual prompts, and narration/child-directed play inherently extend beyond facial expressions.

Infants and toddlers also spend time with parents and caregivers at home without masks, which will allow time to practice language development behaviors without face coverings. Therefore, childcare providers can support parents/caregivers by sharing standard strategies for practicing language development at home. As always, the use of books throughout the childcare space promotes language development. Include books that show people’s faces to talk about different types of emotions. Books (e.g. Alber, 2020a-c; Chevalier, 2020; Young, 2020), e-books (Ghosh Ippen & Brymer, 2020; Perenyi, 2020; Sedgwick Belgum, 2020) and classroom materials featuring children and adults wearing masks have been created (i.e., Tuchel, 2020; see additional resources for links). These are also important to include in the classroom and will normalize young children’s experiences.

Childcare Provider Well-Being

Much like the children, adults were shifted into a new mode of living. As this overnight change catches up with us, it is imperative to note that the same stressors described above have likely taken their toll on a child’s grown-ups. Returning to work ‘as usual’ will not feel ‘as usual.’ Many of the adaptations described above may feel counter to typical inclinations for interacting with young children. And yet the comfort and ability to have a voice, a belief of what is best for you as well as your setting and the children and families you serve is important. There may be varying perspectives, and changes may be worrisome to staff due to the impact on children, their own well-being, or both.

We know that when adults are stressed, their biological stress response is aroused (Deater-Deckard, 2004), which can impact the stress level of children in those adults’ care (Leerkes, 2016; Meaney et al., 1993). Conversely, when children are distressed and childcare providers cannot soothe them, this creates physiological distress for the adult too (Bornstein et al., 2017). Attempting to communicate with limited visible facial expressions may also feel culturally incongruous or physically exhausting. And the physiological sensation of wearing a mask for several hours a day may require adjustment. Therefore, it is essential that childcare providers have access to a space (and ideally a trained facilitator) to process emotions that arise during this time and to regularly care for their own well-being.

  • Take the time to teach your body to wear a mask (HealthcareCareWorkers Hosted, 2020), and consider tips for mask-wearing (Marksowitz, 2020) especially in warmer weather (Levine, 2020). Step away and take breaks to breathe deeply or get a sip of water if you need to re-regulate.
  • Make room for self-compassion (Neff, 2020). This starter kit can be a great place to begin (Butler, & McClain-Meeder, 2015).
  • Reflective supervision can be helpful for supporting childcare staff wellness needs.
  • Join a professional support network and advocate for self-care amongst staff (Goldberg, 2015).


As we look toward the future of childcare as well as an ever-evolving pandemic, we must acknowledge the beauty of each unique childcare setting and the variety of supports for children and their families. We acknowledge that each childcare setting will continue to make decisions based upon the needs of their children, families, staff, and communities using what they know about all areas of a child’s development. We hope this guidance provides alternative ways to support difficult decisions. We also acknowledge that the ways in which risks are weighed will vary by individual and context. There is no ‘one right way’ of navigating these complex and, at times, competing needs. These suggestions can guide conversation and expand practices that support social-emotional development, but they are not intended as definitive answers.


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Simonton, S. (2020, May 1). ‘Essential, not expendable’ – Childcare workers on the frontlines of COVID-19. Scalawag.

Society for the Protection and Care of Children. (2020). Reopening child care and early education programs during the COVID-19 pandemic. Society for the Protection and Care of Children.

Stephens, C. (2020, July 8). Behind my mask: A super kid self-portrait! Cassie Stephens Blog.

Tillman, S., Tobin, D., Avison, W., & Gilliland, J. (2018). Mental health benefits of interactions with nature in children and teenagers: a systematic review. Journal of Epidemiology and Community Health, 72(10), 958–966.

 Tobia, E. (2020, April 19). My business is ‘essential.’ It doesn’t feel that way. Barron’s.

Tsang, T., Atagi, N., & Johnson, S.P. (2018). Selective attention to the mouth is associated with expressive language skills in monolingual and bilingual infants. Journal of Experimental Child Psychology, 169, 93-109.

Tuchel, T. (2020, July 23). COVID-19 related stories for schools. Autism Little Learners.

Young, R. (2020). Riley’s Masked Adventure. Independently Published.

ZERO TO THREE. (2015). ZERO TO THREE’s cross-sector core competencies for the prenatal to age 5 field. Washington, DC: Zero to Three.

Additional Resources (not an endorsement of specific product/creator)

Sewing pattern for clear masks:

Toys with faces:

Classroom Materials/Lessons with Masks:

TED. (2014, June 3). Improving early child development with words. Retrieved from


Katherine A. Lingras, PhD, LP, University of Minnesota, Department of Psychiatry and Behavioral Sciences, MACMH-IEC Advisory Board*

Krista Mrozinski, MA, LMFT, Wake the World, MACMH-IEC Advisory Board*

Anna Clavin, MA, LMFT, IECMH-E (III), Ellison Center, MACMH-IEC Advisory Board*

Arielle Handevidt, MA, IMH-E®, Minnesota Association for Children’s Mental Health, MACMH-IEC Advisory Board*

Lauren Moberg, LMFT, IMH-E®, Minnesota Association for Children’s Mental Health, MACMH-IEC Advisory Board*

Cari Michaels, MPH, University of Minnesota Extension, Center for Family Development, MACMH-IEC Advisory Board*

Mary Mischke, MA. Ed, St. Paul Public Schools, MACMH-IEC Advisory Board*

Tracy Schreifels, MS, LMFT, IMH-E (IV), Ellison Center, MACMH-IEC Advisory Board*

Michele Fallon, LICSW, IMH-E(IV), Minnesota Association for Children’s Mental Health, MACMH-IEC Advisory Board*

*All authors are also Advisory Board members for the Minnesota Association for Children’s Mental Health – Infant and Early Childhood Division and this manuscript is submitted on behalf of the Board