In California, child care pediatric first aid and CPR requirements come down to one rule with a few moving parts: every licensed child care facility must have at least one person on-site with current pediatric first aid and pediatric CPR certification whenever children are present, including during off-site activities. The certification has to come from the American Red Cross, the American Heart Association, or another program approved by the California Emergency Medical Services Authority (EMSA). As of January 1, 2026, the course must also cover anaphylaxis prevention and the emergency use of epinephrine auto-injectors.1California Legislative Information. California Health and Safety Code HSC 1596.866
Who Has to Be Certified
The rule is written around a minimum, not a mandate for every employee.
At a child care center, at least one director or teacher must complete the full health and safety training, which includes pediatric first aid and CPR. Beyond that, the facility has to make sure at least one staff member with a current completion card is on-site at all times children are present, and that a certified person travels with children on field trips.2Legal Information Institute. California Code of Regulations Title 22 Section 101216 – Personnel Requirements The statute does not require every employee to be certified, but relying on a single person creates scheduling problems the moment they take a sick day.
In a family child care home, the licensee who provides care directly must hold the certification. If the licensee is ever absent during operating hours, at least one other staff member on-site must have a current pediatric first aid and CPR card. Additional staff beyond that minimum are not required to hold certification, though the state encourages it.3California Department of Social Services. Family Child Care Homes Manual
The 2026 Anaphylaxis and Epinephrine Addition
Beginning January 1, 2026, any pediatric first aid or CPR course used to meet the licensing requirement must include instruction on recognizing and treating anaphylaxis and on using epinephrine auto-injectors.1California Legislative Information. California Health and Safety Code HSC 1596.866
If your last certification was completed on or before December 31, 2025, and did not cover anaphylaxis, you do not need to recertify immediately. Your next renewal, however, must meet the new standard. Before enrolling in a renewal course in 2026 or later, confirm that the curriculum includes epinephrine auto-injector training.
Approved Training Programs and Course Formats
Only EMSA-recognized programs count. The statute specifically names the American Red Cross and the American Heart Association, and EMSA approves other vendors that meet its curriculum and instructor standards.1California Legislative Information. California Health and Safety Code HSC 1596.866 Approved courses cover infant and child CPR, AED use, conscious and unconscious choking, bleeding control, and common pediatric emergencies, plus anaphylaxis and epinephrine use from 2026 onward. Ask any vendor for proof of EMSA approval before paying.4California Emergency Medical Services Authority. EMSA Childcare Provider Training Requirements
Format rules matter too, and they trip people up. The pediatric first aid and CPR portion must be completed either entirely in-person or in a hybrid format that pairs a virtual lecture with in-person skills practice and testing. A fully online first aid or CPR course does not satisfy the requirement no matter who offers it. EMSA also prohibits replacing a live instructor with pre-recorded video for any course. Video can supplement live instruction; it cannot stand in for it. The preventive health and safety portion, by contrast, can be completed virtually, in-person, or hybrid.4California Emergency Medical Services Authority. EMSA Childcare Provider Training Requirements
How Often You Have to Renew
Pediatric first aid and CPR certification must be renewed every two years. Each renewal requires the same eight hours as initial certification: four hours of pediatric first aid and four hours of pediatric CPR. There is no abbreviated refresher option.4California Emergency Medical Services Authority. EMSA Childcare Provider Training Requirements
The certification has to stay current at all times. A single-day gap between the expiration date on your old card and the completion date on your new one puts the facility out of compliance if you are the only certified person on-site. Schedule renewal well before your card expires. If an instructor offers to run the course in fewer hours than required, that is not a compliant course; EMSA accepts reports at ChildCare@emsa.ca.gov.
What the 16-Hour Health and Safety Training Actually Covers
New licensees often hear about a “16-hour training” and assume it is all first aid and CPR. It isn’t. The 16 hours split into two separate blocks:
- Pediatric first aid and CPR, 8 hours total: four hours of pediatric first aid and four hours of pediatric CPR/AED training.4California Emergency Medical Services Authority. EMSA Childcare Provider Training Requirements
- Preventive health and safety practices, 8 hours total: infectious disease recognition and prevention, immunizations, childhood injury prevention, lead exposure prevention, and at least one hour of childhood nutrition.1California Legislative Information. California Health and Safety Code HSC 1596.866
Only the first block is what gets renewed every two years. The childhood nutrition hour applies to licenses issued after January 1, 2016.
Proof You Need to Keep On-Site
Licensed facilities must be able to produce proof of current certification when the Community Care Licensing Division asks for it. Acceptable proof is a current course completion card in pediatric first aid and CPR issued by the American Red Cross, the American Heart Association, or another EMSA-approved program.3California Department of Social Services. Family Child Care Homes Manual Keep copies at the facility where a licensing analyst can review them. Each card should show the provider’s name, completion date, and expiration date.
Community Care Licensing conducts both announced and unannounced visits.5California Department of Social Services. Community Care Licensing Division If an analyst asks for your card and you cannot produce it, the facility can be cited even if the provider has in fact been trained.
When Standard Training Isn’t Enough
The EMSA-approved curriculum covers general pediatric emergencies. It does not cover condition-specific protocols for children with complex health needs, such as administering insulin or glucagon for a child with diabetes. Under the Americans with Disabilities Act, child care providers must make reasonable modifications to their policies so children with disabilities can participate, which can include training staff on these interventions.6ADA.gov. Equal Access to Child Care If a child in your care needs specialized emergency support, coordinate with the child’s parents and physician on an individualized care plan. That supplemental training sits on top of your EMSA requirement, not in place of it.
What Happens If You Lapse
Letting first aid and CPR certification expire is treated as a licensing deficiency. The Community Care Licensing Division can issue citations with penalties for serious deficiencies left uncorrected, and continued non-compliance can escalate to conditions on the license or revocation. The cost of keeping certification current is minor next to a single enforcement action, and smaller still next to the liability exposure of having only uncertified staff on-site during a real pediatric emergency.