Paediatric First Aid Requirements: What EYFS Actually Says

New versions of both EYFS frameworks came into force on 1 September 2026. Most of the guidance currently circulating was written for the 2024 or 2025 versions, so it is worth going back to what the frameworks actually say — clause by clause, with the wording quoted.

Last reviewed: 20 September 2026 against both EYFS statutory frameworks in force from 1 September 2026.

Which framework applies to you?

There are two, and they are not interchangeable. Both came into force on 1 September 2026 and both are mandatory, made under the Childcare Act 2006.

The core first aid wording is identical in both. Where they differ is registration and ratios, covered below.

The core requirement

Both frameworks say the same thing:

“At least one person who has a current paediatric first aid (PFA) certificate must be on the premises and available at all times when children are present and must accompany children on outings. The certificate must be for a full course consistent with the criteria set out in Annex A. PFA training must be renewed every three years and be relevant for people caring for young children and babies.”

Four separate obligations are packed into that paragraph, and settings tend to meet three of them:

• Current — not expired. A certificate that ran out last month is not cover.
• On the premises and available — not on a lunch break off-site, not the manager who is at head office on Tuesdays.
• At all times when children are present — including early drop-off and late pick-up, and including whoever is there at 7.30am.
• And on outings — which in practice means either the qualified person goes, or the outing does not.

Note the phrase “a full course”. That rules out an emergency PFA certificate as the qualification for the person holding the setting’s cover, which is the distinction most often missed.

Does an online paediatric first aid course count?

Not on its own. This is the most commercially significant sentence in the whole framework, and it sits in a footnote to Annex A:

“Face-to-face means trainers are physically present with their trainees. This excludes the use of online platforms.”

Annex A paragraph 5 requires the emergency PFA course to “be undertaken face-to-face and last for a minimum of 6 hours (excluding breaks)”. Paragraph 6 requires the full 12-hour course to cover the additional topics in addition to those areas, and states that the emergency elements “should be delivered face-to-face”.

So a fully online paediatric first aid certificate does not meet the criteria, however it is marketed. There is also a practical reason, in Annex A paragraph 4: adequate resuscitation and other equipment “including baby and junior models must be provided, so that all trainees are able to practice and demonstrate techniques”. You cannot demonstrate infant CPR competence through a screen.

Blended delivery is possible — the additional content of the full course can be covered flexibly — but the emergency core has to be taught in a room with a trainer and a manikin. If you have bought online certificates for your team, that is worth checking before your next inspection rather than during it.

Full PFA or emergency PFA?

Annex A defines both. The full course includes everything in the emergency course, plus a second layer.

Emergency PFA still has a place: it widens cover so more of the team can act, and it is the shorter route for staff who need a PFA qualification inside the three-month window. Note the wording difference, because it is the whole distinction — clause 3.39 says staff must obtain “a PFA qualification”, while clause 3.37 says the setting’s cover must be “a full course consistent with the criteria set out in Annex A”. Annex A defines both courses, so on a plain reading an emergency certificate satisfies the ratio rule but not the “at all times” cover. The framework does not spell that out in as many words, so if you want no argument with an inspector, put your ratio-critical staff through the full 12-hour course. We work the choice through in detail in full or emergency paediatric first aid.

The three-month rule and staff:child ratios

This is where PFA stops being a safety requirement and starts affecting whether you can legally run your rooms. Clause 3.39 of the group framework:

“All staff who obtained a level 2 and/or level 3 qualification since 30 June 2016 must obtain a PFA qualification within three months of starting work in order to be included in the required staff:child ratios at level 2 or level 3 in an early years setting.”

Alongside it:

• Staff who completed the experience-based route must obtain a PFA qualification before they can be counted in the ratios at level 3 — there is no three-month grace period for them.
• To continue being counted, “the certificate must be renewed every 3 years”. An expired certificate removes that person from your ratio calculation on the day it expires.
• There is a disability exception (footnote 33): where a staff member cannot gain a PFA certificate because of a disability, they can still be included in ratios if otherwise competent to carry out their childcare duties, and where possible should attend a course and obtain written evidence of attendance.

The practical consequence: PFA expiry dates belong on the same tracker as your ratio planning, not in a folder. A certificate quietly lapsing is a staffing problem as much as a compliance one.

Childminders and registration

Childminders have an extra requirement on top of the shared wording. Clause 3.42 of the childminders framework:

“Childminders are required to have a paediatric first aid (PFA) certificate to register and must continue to hold this at all times that they are registered.”

That obligation comes from the Childcare (Early Years Register) Regulations 2008. It means PFA is not something to arrange after registration — it is a precondition of it, and letting it lapse affects registration itself rather than just a policy file. Assistants are covered by the same “at least one person on the premises” rule, so a childminder working with an assistant still needs qualified cover present whenever children are there.

How many paediatric first aiders do I need?

There is no ratio of first aiders to children in the framework. The minimum is one current full-PFA holder present at all times children are present. Beyond that, both frameworks say the same thing:

“Providers should take into account the number of children, staff, and layout of premises to ensure that a paediatric first aider is able to respond to emergencies quickly.”

That is a response-time test, not a headcount. A single-room pre-school with 16 children can reasonably be covered by one qualified person. A nursery with a baby unit upstairs, a pre-school room downstairs and a garden cannot — not because a rule says so, but because “available at all times” and “respond quickly” cannot both be true if the only qualified person is two floors away.

Then apply the arithmetic that catches people out: one qualified person cannot cover a setting open 7.30am to 6pm, because they take leave, get ill and go home at 4pm. Most settings conclude they need enough certificates that two qualified staff are on site through the core day, and at least one during the early and late hours. The same absence-cover logic applies in any workplace — we set out the general version in our guide to the first aid needs assessment.

Certificates, renewal and refreshers

Book renewals before expiry, not after. An expired certificate removes both your statutory cover and, for affected staff, their place in the ratios. The general principle on expiry is the same one we cover for workplace certificates in how long does a first aid certificate last.

Choosing a provider

There is no DfE approval scheme and no Ofsted approval scheme for paediatric first aid courses. Any course described as “Ofsted approved” is using language that does not correspond to anything. What the framework says is that providers are “responsible for identifying and selecting a competent training provider”, and it suggests considering:

• a provider that is a member of a trade body with an approval and monitoring scheme;
• the Voluntary Aid Societies (St John Ambulance, British Red Cross, St Andrew’s First Aid);
• a provider accredited by an Ofqual awarding organisation to deliver nationally regulated first aid qualifications.

It also points directly at HSE’s GEIS3 guidance on choosing a first aid training provider — the same due-diligence checklist used for workplace first aid. Ask for trainer qualifications, the quality assurance arrangements, confirmation that the course meets Annex A in full, and confirmation of face-to-face delivery of the emergency elements. What “accredited” and “regulated” actually mean is worth understanding before you compare quotes: we explain it in what an accredited qualification actually means.

First aid box, records and telling Ofsted

The training requirement sits alongside three others that inspections look at, from clauses 3.78 and 3.79 of the group framework:

• “Providers must ensure a first aid box with appropriate items for use on children is always accessible.” Note for use on children — an adult workplace kit is not the same thing.
• “Providers must keep a written record of accidents or injuries and first aid treatment.”
• Parents or carers must be informed of any accident or injury, and of any first aid given, “on the same day as, or as soon as reasonably practicable after” it happens.
• Registered providers must notify Ofsted, or their childminder agency, of any serious accident, illness, injury or death of a child in their care, and of the action taken.
• Clause 3.40: providers “should display (or make available to parents and/or carers) staff PFA certificates or a list of staff who have a current PFA certificate.”

What changed on 1 September 2026

New versions of both frameworks came into force. The paediatric first aid architecture — one full-PFA holder present at all times, Annex A criteria, three-year renewal, the three-month ratio rule — is stable, which is genuinely reassuring: if you were compliant under the previous version you are very likely still compliant.

What matters is that a great deal of published guidance now describes a superseded framework. The best-optimised competitor page on this topic at the time of writing was published in August 2025 about the framework that took effect on 1 September 2025. If you are relying on a guide, check which version it was written against, and check the framework itself where a decision turns on it.

Common mistakes

What this guide does not cover

Schools in England may also hold spare adrenaline auto-injectors, which is a separate arrangement from first aid training — we cover it in spare adrenaline auto-injectors in schools.

It covers England. Scotland, Wales and Northern Ireland have their own early years frameworks and requirements. It is not first aid training and does not teach clinical technique — the Annex A lists above are a syllabus, not instructions. Schools’ wider first aid duties for older pupils sit under the workplace regulations, which we cover in workplace first aid requirements. Safeguarding, safer eating and the learning and development requirements are outside its scope.

Paediatric first aid courses

Our Paediatric First Aid course is a 12-hour course — the full PFA level the EYFS framework requires — delivered face-to-face with baby and junior manikins so that every learner practises and is assessed on infant and child technique. It runs as open course places for individuals and childminders, and as a group course at your setting for up to 12 people, which is usually the cheaper route once you need three or more staff trained. We have been training early years staff across Greater Manchester and the North West since 1996.

Deals

First Aid at Work Courses

Frequently asked questions

Does an online paediatric first aid course meet EYFS requirements?

No. Annex A requires the emergency paediatric first aid elements to be delivered face-to-face, and the framework defines that as trainers being “physically present with their trainees”, explicitly excluding the use of online platforms. Annex A also requires baby and junior manikins so learners can practise and demonstrate techniques. Blended delivery can cover the additional full-course content, but the emergency core must be taught in person.

How long is a paediatric first aid certificate valid?

Three years. Annex A states the certificate must be renewed every three years, and for staff counted in the ratios the framework says renewal every three years is what keeps them in the ratio calculation.

How many paediatric first aiders does a nursery need?

There is no ratio in the framework. The minimum is at least one person with a current full PFA certificate on the premises and available at all times children are present, and accompanying outings. Providers should then take account of the number of children, staff and layout so that a first aider can respond to emergencies quickly — and in practice allow for leave, sickness and opening hours.

Is emergency paediatric first aid (6 hours) enough?

Not for the setting’s required cover. Clauses 3.37 and 3.42 require the certificate to be for a full course consistent with Annex A, which is the 12-hour course. Emergency PFA is useful for widening cover across a team and can satisfy the ratio requirement for some staff, but it does not discharge the “at all times” duty on its own.

What is the three-month rule for paediatric first aid?

Staff who obtained a level 2 or level 3 qualification since 30 June 2016 must obtain a PFA qualification within three months of starting work to be included in the required staff:child ratios at level 2 or level 3. Staff who completed the experience-based route must obtain it before being counted at level 3 — there is no grace period for them.

Do childminders have to have paediatric first aid?

Yes, and before registering. The childminders framework says childminders are required to have a PFA certificate to register and must continue to hold it at all times they are registered, under the Childcare (Early Years Register) Regulations 2008. The “at least one person on the premises” rule applies as well.

Is annual refresher training for paediatric first aid compulsory?

No. Annex A paragraph 7 says providers “should consider whether paediatric first aiders need to undertake annual refresher training” during the three-year certification period. It is worth considering — practical skills decay — but its absence is not a compliance failure.

Are paediatric first aid courses Ofsted approved?

No. There is no Ofsted or DfE approval scheme for paediatric first aid training. The framework makes providers responsible for selecting a competent training provider, and suggests considering a trade body with an approval and monitoring scheme, the Voluntary Aid Societies, or a provider accredited by an Ofqual awarding organisation. It also points to HSE’s GEIS3 guidance.

Does a First Aid at Work certificate cover paediatric first aid?

No. The framework requires PFA training to “be relevant for people caring for young children and babies”, and Annex A sets out a syllabus built around babies and children with baby and junior manikins. A workplace FAW certificate does not meet the EYFS requirement.

What happens if our paediatric first aider's certificate expires?

You lose your statutory cover from that date, because the framework requires a *current* certificate on the premises at all times children are present. For staff counted in the staff:child ratios at level 2 or level 3, an expired certificate also removes them from the ratio calculation. Book renewals before the expiry date.

Sources

• Department for Education, EYFS statutory framework for group and school-based providers, in force 1 September 2026 — clauses 3.37, 3.38, 3.39, 3.78, 3.79 and Annex A
• Department for Education, EYFS statutory framework for childminders, in force 1 September 2026 — clauses 3.42 and 3.43 and Annex A
• Childcare (Early Years Register) Regulations 2008, cited in the childminders framework for the registration requirement
• HSE, Selecting a first-aid training provider, GEIS3 (rev2), referenced by the framework itself

For the workplace side of first aid law, see workplace first aid requirements. Questions about what your setting needs? Call 0845 838 4643 or use the enquiry form on this page — we will tell you straight if you already have what you need.