# Missouri child care, camp and ratio rules

Source: https://backpr.com/resources/states/missouri. Last updated: 2026-10-19.

Checked October 2026 against Missouri's official rules and federal sources. General information, not legal advice; confirm with the agency.

### Child care licensing
Anyone caring for more than six children, or more than three children under age 2, must be licensed by DESE unless exempt (RSMo 210.201, 210.211). License types are family child care homes (up to 10 children), group child care homes (up to 20) and child care centers.

After-school and recreation programs: Several programs are exempt under RSMo 210.211: school systems, summer or day camps run in good faith mainly for recreation, programs serving only children in grade 6 or above, neighborhood youth development programs, and child care under the exclusive control of a religious organization. Any program that receives state or federal child care funds (other than USDA food program funds) cannot claim an exemption, and unlicensed programs must tell parents in writing that they are not licensed.

Licensing agency: Missouri Department of Elementary and Secondary Education (DESE), Office of Childhood, Child Care Compliance and Regulation (https://dese.mo.gov/childhood/child-care-licensing)

### Staff-to-child ratios in licensed centers
| Ages | Children per staff member | Largest group |
| --- | --- | --- |
| 3 years | 1:10 | 20 |
| 4 years | 1:10 | 20 |
| 5 years | 1:16 | 32 |
| School-age (6 and up) | 1:16 | 32 |

Rule: 5 CSR 25-500.112. These figures apply to groups made up only of that age: 3- and 4-year-olds together are 1:10 (group of 20), and children 5 and older are 1:16 (group of 32). A mixed group of 2-year-olds and older children is 1:10 (group of 20) with no more than four 2-year-olds. Outdoors, ratios may be 1.5 times the indoor ratio when no children 2 or younger are present. School-age means age 5 or older and in kindergarten or above. Amended effective January 30, 2024.

Sources: DESE Child Care Licensing (https://dese.mo.gov/childhood/child-care-licensing); 5 CSR 25-500, Licensing Rules for Group Child Care Homes and Child Care Centers (Secretary of State) (https://www.sos.mo.gov/CMSImages/AdRules/csr/current/5csr/5c25-500.pdf); RSMo 210.211, license required and exemptions (https://revisor.mo.gov/main/OneSection.aspx?section=210.211); RSMo 210.201, definitions (https://revisor.mo.gov/main/OneSection.aspx?section=210.201)

### Summer camps
We found no Missouri state license for youth camps. Summer and day camps run in good faith mainly for recreation are exempt from child care licensing (RSMo 210.211.1(4)). A 'day camp' runs between 6 a.m. and 7 p.m. when local schools are not in session, and a 'summer camp' runs May to September (RSMo 210.201). Both serve children 5 and older in kindergarten or above and can't share space with care for younger children. A camp that receives state or federal child care funds can't use the exemption.

Sources: RSMo 210.211 (https://revisor.mo.gov/main/OneSection.aspx?section=210.211); RSMo 210.201 (day camp and summer camp definitions) (https://revisor.mo.gov/main/OneSection.aspx?section=210.201); Missouri House, HB 3142 (2026) status (https://house.mo.gov/Bill.aspx?bill=HB3142&year=2026&code=R)

### Background checks
Before working, child care staff must have a qualifying result on a check that includes an FBI fingerprint check, the national sex offender registry, and the criminal, sex offender and child abuse/neglect registries (including the Family Care Safety Registry) for Missouri and every state lived in during the past five years. New staff may start on a temporary eligibility notice if they are supervised at all times. Checks are repeated every five years (5 CSR 25-600.010 and .020; RSMo 210.1080). We found no separate state requirement for exempt camps.

Sources: 5 CSR 25-600, Background Screening (Secretary of State) (https://www.sos.mo.gov/CMSImages/AdRules/csr/current/5csr/5c25-600.pdf); DESE Background Check Process (https://dese.mo.gov/childhood/child-care/background-check-process)

### Giving medication
Providers don't have to give medication, but if they do they need the parent's dated written permission stating how long it may be given. Prescription medicine must be in its original container labeled with the child's name, instructions and physician's name, and over-the-counter medicine in its original container labeled by the parent. All medication is stored out of children's reach or locked. Each dose is recorded with the date, time, amount and name of the person giving it (5 CSR 25-500.192(3)).

Sources: 5 CSR 25-500.192 Health Care (https://www.sos.mo.gov/CMSImages/AdRules/csr/current/5csr/5c25-500.pdf)

### Reporting child abuse
RSMo 210.115 lists required reporters, including day care center workers and other child-care workers, teachers, principals and other school officials, health and mental health practitioners, social workers, ministers, law enforcement, and any 'other person with responsibility for the care of children'. They must report to the Children's Division immediately. Anyone else may report. Hotline: 1-800-392-3738 (https://dss.mo.gov/cd/can.htm).

Sources: RSMo 210.115 (https://revisor.mo.gov/main/OneSection.aspx?section=210.115); Missouri DSS Child Abuse & Neglect Hotline (https://dss.mo.gov/cd/can.htm); Child Welfare Information Gateway, Mandatory Reporting of Child Abuse and Neglect (current through May 2023) (https://www.childwelfare.gov/resources/mandatory-reporting-child-abuse-and-neglect/)