Who Needs It and Who Can Be Included in Staff-to-Child Ratios?
If you manage a nursery, preschool, school nursery or Reception provision, Paediatric First Aid is about much more than making sure one person in the building has a first aid certificate. It is knowing how many First Aiders does a nursery need.
One of the most important questions for early-years managers is:
Which members of staff need Paediatric First Aid training to be included in our staff-to-child ratios?
This is particularly important when employing newly qualified Level 2 or Level 3 practitioners, students and apprentices.
There is also considerable confusion around the difference between Full Paediatric First Aid (PFA) and Emergency Paediatric First Aid (EPFA).
In this article, we break down the requirements contained within the Early Years Foundation Stage (EYFS) statutory framework for group and school-based providers in England, including the framework applying from 1 September 2026.
First: Paediatric First Aid and Staff Ratios Are Two Separate Requirements
This is probably the most important point for nursery managers to understand.
The EYFS contains:
1. A requirement for the nursery or setting to have full Paediatric First Aid cover.
AND
2. Paediatric First Aid requirements affecting whether certain individual practitioners can be included within the required Level 2 and Level 3 staff-to-child ratios.
These rules work together.
Therefore, simply saying:
“We have one first aider in the nursery, so we’re covered.”
doesn’t tell the whole story.
You also need to look at the qualifications and PFA status of the individual practitioners you are counting within your qualified ratios.
The Full Paediatric First Aid Requirement
The EYFS requires at least one person who holds a current Paediatric First Aid (PFA) certificate to be on the premises and available at all times when children are present.
Importantly, this certificate must be for a full Paediatric First Aid course that meets the criteria set out in Annex A of the EYFS.
A person with the appropriate full PFA certificate must also accompany children on outings.
Paediatric First Aid training must be renewed every three years.
So, at an absolute minimum, whenever EYFS children are present, the setting must make sure someone with full PFA is available.
But this is only one part of the requirements.
Paediatric First Aid and Staff-to-Child Ratios
The second requirement is where nursery managers need to pay particular attention.
The EYFS states that staff who obtained a Level 2 and/or Level 3 qualification since 30 June 2016 must obtain a Paediatric First Aid qualification within three months of starting work if they are to be included in the required staff-to-child ratios at Level 2 or Level 3.
To continue being counted at that level, their PFA certificate must be renewed every three years.
This means a newly qualified Level 2 or Level 3 practitioner cannot simply be counted indefinitely within the qualified ratio without meeting the applicable PFA requirement.
Their early-years qualification is only one part of the picture.
Managers also need to check their Paediatric First Aid status.
Does It Have to Be Full Paediatric First Aid?
This is where an important distinction needs to be made.
For staff who obtained their Level 2 or Level 3 qualification on or after 30 June 2016, the individual PFA requirement for being counted at Level 2 or Level 3 can be met by holding either:
Full Paediatric First Aid
or
Emergency Paediatric First Aid.
However, the setting still needs to comply with the separate requirement to have at least one person with the full Paediatric First Aid qualification on the premises and available whenever children are present.
So, for example:
A nursery may have several Level 2 and Level 3 practitioners who hold Emergency Paediatric First Aid and are eligible to count within the relevant qualified ratios.
However, the nursery still needs someone with the full PFA qualification available on the premises.
This distinction is extremely important when planning staff training.
So Does Every Nursery Worker Need Paediatric First Aid?
Not necessarily.
The EYFS requirements are more specific than simply saying:
“Every single employee counted anywhere in the ratio must have PFA.”
For example, the Department for Education states that staff at other levels do not require PFA simply to be included within staff-to-child ratios.
However, where a practitioner is being counted within the required Level 2 or Level 3 qualified ratio and falls within the relevant qualification rules, PFA can be a requirement for that individual to count at that level.
There are also specific PFA requirements affecting students, long-term volunteers and apprentices.
Therefore, nursery managers should assess each employee according to:
- their role
- age
- qualification
- date their qualification was obtained
- level at which they are being counted
- PFA qualification
- whether they are an apprentice or student.
This is much safer than assuming that one rule applies to everyone.
What About Staff Who Qualified Before 30 June 2016?
The EYFS specifically applies the Level 2/Level 3 PFA ratio requirement to staff who obtained their relevant qualification since 30 June 2016.
Therefore, a long-standing practitioner who obtained their qualification before this date may be treated differently for the purposes of this particular PFA ratio requirement.
However, the setting’s overall PFA obligations still apply.
Providers should also consider whether relying on a small number of trained employees provides sufficient first-aid coverage in practice.
What About Apprentices?
This is a particularly important area for nursery managers.
Under the EYFS, providers must generally not include anyone aged under 17 within ratios.
There is an exception for apprentices.
Apprentices may be included in ratios from the age of 16.
However, an apprentice cannot automatically be included just because they have started an apprenticeship.
Specific conditions apply.
The EYFS allows apprentices aged 16 or over to potentially be counted in ratios at the level below the level they are studying.
But the provider must be satisfied that the apprentice is:
suitable, competent and responsible
AND
they must hold a:
valid and current Paediatric First Aid qualification.
This is an important requirement.
Does an Apprentice Need PFA to Be Counted in Ratio?
If the nursery is using the EYFS provision that allows an apprentice to count at the level below their level of study, yes – the apprentice must hold a valid and current Paediatric First Aid qualification.
The same provision applies to students and long-term volunteers aged 17 or over.
This means managers should not simply look at the apprenticeship programme and assume the learner can automatically be added to the qualified staffing ratio.
Check their PFA first.
At What Level Can an Apprentice Count?
The EYFS gives useful clarification on this.
A student or apprentice studying towards an approved Level 3 qualification, including relevant qualifications at Levels 4, 5 and 6, may potentially count within the Level 2 ratio.
A student or apprentice studying towards an approved Level 6 qualification leading to Early Years Teacher Status (EYTS) or Qualified Teacher Status (QTS) may potentially count within the Level 3 ratio.
The other requirements still apply.
They must be of the appropriate age, the provider must consider them suitable, competent and responsible, and they must hold valid and current PFA.
Can a 16-Year-Old Apprentice Be Included?
Yes, potentially.
Apprentices are an exception to the general minimum age rule and can potentially be included in ratios from 16 years old, subject to the other EYFS requirements.
However, there is another important rule.
Anyone under the age of 17 must not be allowed to care for children unsupervised at any time.
So there is an important distinction between:
being included within a ratio
and
being allowed to work alone with children.
A 16-year-old apprentice may potentially be counted within the appropriate ratio, but they cannot be left caring for the children unsupervised.
What About Students and Long-Term Volunteers?
Students and long-term volunteers aged 17 or over can also potentially be included within ratios at the level below their level of study.
Again, this is subject to conditions.
The provider must be satisfied that they are:
- suitable
- competent
- responsible
and they must hold a valid and current Paediatric First Aid qualification.
This means PFA training may be essential if your setting relies on students or apprentices as part of its staffing arrangements.
Paediatric First Aid While Children Are Eating
There is another important requirement that nursery and school managers should be aware of.
While children are eating, there should always be a member of staff in the room who holds a valid Paediatric First Aid certificate for a full course consistent with the criteria set out in Annex A of the EYFS.
This deserves particular attention in larger nurseries.
Imagine you have:
Baby Room – lunch at 11:30am
Toddler Room – lunch at 11:45am
Preschool Room – lunch at 12:00pm
If those eating periods overlap, managers need to make sure appropriate full-PFA-qualified staff are available in the rooms as required.
This is another reason why relying on one full Paediatric First Aider across a large setting can create practical problems.
Why Is First Aid During Mealtimes So Important?
One of the most immediate risks to young children during eating is choking.
A child who is coughing effectively may still be moving air.
A child with a completely obstructed airway may be unable to:
- breathe
- speak or cry
- cough effectively.
Their condition can deteriorate extremely quickly.
Staff caring for young children need the confidence to recognise choking and take appropriate action immediately.
The person sitting closest to the child when they start choking is the person who may need to act.
That’s one of the reasons why good PFA coverage across a nursery is so valuable.
School Nurseries Must Follow the EYFS Requirements Too
These requirements are not limited to private nurseries.
The EYFS framework for group and school-based providers covers early-years provision within schools as well as other group settings.
Schools with early-years children therefore need to consider the EYFS Paediatric First Aid requirements.
A school may already have employees trained in:
- First Aid at Work
- Emergency First Aid at Work
- Paediatric First Aid
- Emergency Paediatric First Aid.
However, managers need to check that the qualifications held actually meet the relevant EYFS requirements.
Having a workplace first aider somewhere else in the school does not remove the EYFS Paediatric First Aid requirements.
What About Reception Classes?
Reception is part of the Early Years Foundation Stage.
Therefore, schools need to consider the EYFS safeguarding and welfare requirements when caring for Reception-age children.
Schools shouldn’t assume that because children have entered primary school, the early-years requirements no longer matter.
The EYFS covers children from birth to five and includes Reception.
This is particularly important when planning:
- first-aid provision
- staff deployment
- eating arrangements
- trips and outings
- emergency procedures.
Private Nurseries Must Follow the Requirements Too
The same EYFS framework applies to relevant group-based early-years providers, including private, voluntary and independent provision.
Therefore, whether you run a private day nursery, preschool or school-based early-years provision, you need to understand both:
the overall full PFA requirement
and
the individual PFA requirements affecting qualified staff ratios.
Don’t Confuse “We Have a First Aider” With “Our Ratios Are Compliant”
This is probably one of the biggest takeaways from this article.
Imagine a nursery has six employees working that day.
The manager holds full PFA.
It might be tempting to say:
“We’re fine. We have a Paediatric First Aider.”
But the manager also needs to look at the practitioners being counted within the required qualified ratios.
If some of those employees require PFA in order to be counted at Level 2 or Level 3 and don’t hold it, simply having the manager’s PFA certificate doesn’t fix that problem.
There are two separate questions:
Question 1
Do we have appropriate full Paediatric First Aid cover for the setting?
Question 2
Are the individual members of staff we’re counting within our qualified ratios eligible to be counted?
Nursery managers need to be able to answer yes to both.
Example: Newly Qualified Level 3 Practitioner
Imagine Sophie has recently completed an approved Level 3 Early Years Educator qualification.
She starts work at a nursery.
The nursery wants to include Sophie within its required Level 3 ratio.
Because she obtained her qualification after 30 June 2016, she needs to obtain an appropriate PFA qualification within three months of starting work in order to be included in the required Level 3 ratio.
She can satisfy that individual PFA requirement with either:
Full PFA
or
Emergency PFA.
However, the nursery still needs to ensure someone holding full PFA is on the premises and available whenever children are present.
Example: 16-Year-Old Apprentice
Now imagine Ben is 16 and has started an approved Level 3 early-years apprenticeship.
The nursery wants to count him within the Level 2 ratio.
This may be possible.
However, the provider needs to be satisfied that Ben is suitable, competent and responsible.
He must also hold a valid and current PFA qualification.
And because Ben is under 17, he must not be left caring for children unsupervised.
So:
16 years old + apprentice + enrolled on Level 3
does not automatically equal:
“Can be counted at Level 2.”
The other conditions must also be satisfied.
Example: A Large Nursery
Imagine a nursery has 70 children across four rooms.
The nursery manager holds full PFA.
Several other practitioners have Emergency PFA.
Could that arrangement potentially satisfy the PFA requirements?
Possibly – because different requirements apply to the overall full PFA cover and to the individual PFA qualification needed by certain practitioners to count within qualified ratios.
But the nursery also needs to think practically.
What happens if the manager:
- is off sick?
- takes annual leave?
- leaves the building?
- accompanies an outing?
- finishes early?
- is dealing with another emergency?
What happens when children in several rooms eat simultaneously?
This is why a nursery should not plan its PFA provision around the bare minimum.
How Many Full Paediatric First Aiders Should a Nursery Have?
The EYFS doesn’t set a universal rule such as:
One full Paediatric First Aider for every 10 children.
At least one full-PFA-qualified person must be available on the premises whenever children are present.
But providers should consider:
- number of children
- number of staff
- layout of the premises
- opening hours
- shifts
- staff breaks
- annual leave
- sickness
- outings
- eating arrangements
- children’s individual needs.
The Department for Education encourages settings to have more than one PFA-trained member of staff present with young children.
For many nurseries, training several or even most practitioners can make managing these requirements considerably easier.
What Happens on Outings?
A person with the appropriate current PFA certificate must accompany children on outings.
This means managers need to consider both groups of children.
For example:
Twelve preschool children are going to the park.
One of your full PFA-qualified employees accompanies them.
But what happens to the children who remain at the nursery?
You still need to ensure that your provision at the nursery meets the EYFS requirements.
This is why trips should form part of your first-aid planning.
Don’t Forget Certificate Expiry Dates
Paediatric First Aid certificates need to be renewed every three years.
This is particularly important where someone’s PFA certificate affects whether they can be included within the required qualified staff-to-child ratio.
An expired certificate isn’t simply an administrative inconvenience.
It could affect your staffing arrangements.
Managers should therefore monitor PFA expiry dates carefully.
Ideally, don’t wait until the week before expiry.
Plan refresher training several months ahead.
Create a PFA and Qualifications Matrix
A simple spreadsheet can make managing this much easier.
For every practitioner, record:
Name
Age – particularly for apprentices
Role
Early-years qualification
Qualification level
Date qualification was achieved
Level at which they are counted
Full PFA / Emergency PFA
PFA training date
PFA expiry date
Apprentice/student status
Usual room
This allows managers to see quickly whether the people they are counting within their staffing arrangements meet the relevant requirements.
Full PFA or Emergency PFA – Which Should a Nursery Choose?
Although Emergency PFA can satisfy the individual PFA requirement for certain Level 2 and Level 3 practitioners, there can be considerable advantages to providing the full Paediatric First Aid course more widely.
It gives managers more flexibility.
For example, if several employees hold full PFA, it becomes easier to manage:
- sickness
- holidays
- shifts
- staff turnover
- mealtimes
- outings
- training days.
It also means more members of your team have completed the broader PFA syllabus.
So while the legal requirements should always be understood correctly, nurseries may choose to train beyond the minimum.
A Quick PFA Compliance Check for Nursery Managers
Ask yourself:
Do we have at least one person with full PFA available whenever children are present?
Do we have full PFA cover for outings?
Do we have appropriate full-PFA-qualified staff present while children are eating?
Which of our practitioners are being counted at Level 2?
Which are being counted at Level 3?
When did they obtain their qualifications?
Do those practitioners have the PFA qualification required for them to count?
Do we have apprentices included within our ratios?
If so, do they hold valid and current PFA?
Are we satisfied our apprentices are suitable, competent and responsible?
Are any apprentices under 17?
If so, are we ensuring they are never left caring for children unsupervised?
When do our PFA certificates expire?
What happens if our main full Paediatric First Aider is absent tomorrow?
If you’re unsure about any of those answers, it may be time to review your training matrix.
Paediatric First Aid Training for Nurseries, Preschools and Schools
Paediatric First Aid isn’t simply about obtaining a certificate.
The ultimate purpose is to make sure staff caring for babies and young children have the knowledge and practical skills to respond when something goes wrong.
At HMB Training Services, our Paediatric First Aid training helps early-years practitioners develop confidence in dealing with emergencies involving babies and children.
Training can include areas such as:
- CPR
- use of an AED
- choking
- unconsciousness
- anaphylaxis
- seizures
- bleeding
- burns
- head injuries
- fractures
- shock
- childhood illnesses and emergencies.
For nursery managers, training more of the team in full Paediatric First Aid can also make managing staffing, ratios, mealtimes, outings and unexpected absence much simpler.
So, Who Needs Paediatric First Aid in a Nursery?
The answer is more detailed than simply:
“One person in the nursery needs PFA.”
Yes, the EYFS requires at least one person with a current full Paediatric First Aid certificate to be on the premises and available whenever children are present.
But that’s only one part of the requirements.
Nursery managers also need to look at the individual employees being counted within their Level 2 and Level 3 qualified staff-to-child ratios.
Staff who obtained their Level 2 or Level 3 qualification since 30 June 2016 must obtain an appropriate PFA qualification within three months of starting work if they are to be counted at that qualified level.
Apprentices aged 16 or over, and students and long-term volunteers aged 17 or over, who are being counted under the EYFS provision allowing them to count at the level below their study must also hold a valid and current PFA qualification.
And anyone under 17 must never be left to care for children unsupervised.
So don’t simply ask:
“Have we got a Paediatric First Aider?”
Ask:
“Do the individual practitioners we’re relying on to meet our qualified ratios meet the PFA requirements that apply to them?”
That’s the question that can make the difference between simply having first-aid certificates on file and actually understanding your EYFS staffing requirements.
This article relates to early-years provision in England and is based on the Early Years Foundation Stage statutory framework for group and school-based providers applying from 1 September 2026. Providers should refer to the latest statutory framework and Department for Education guidance when determining the requirements applicable to their individual setting.
Making sure your team has the right Paediatric First Aid training isn’t just about meeting EYFS requirements – it’s about making sure staff feel confident and prepared if a baby or child becomes ill or injured.
At HMB Training Services, we provide practical, engaging Paediatric First Aid training for nurseries, preschools, school nurseries, Reception staff and other early-years professionals.
12-Hour Paediatric First Aid Course
Our 12-hour Paediatric First Aid course is designed to meet the Paediatric First Aid requirements of the EYFS.
The course can be completed through blended learning, combining online learning with practical, face-to-face training.
Learners develop the knowledge and practical skills needed to respond to a wide range of emergencies involving babies and children, including:
- CPR and resuscitation
- using an AED
- choking
- unconsciousness and the recovery position
- anaphylaxis and allergic reactions
- seizures and febrile convulsions
- catastrophic and serious bleeding
- head injuries
- burns and scalds
- fractures and soft-tissue injuries
- shock
- poisoning
- common childhood illnesses and emergencies.
Our training is practical and interactive, giving learners the opportunity to practise essential skills rather than simply listening to a presentation.
Emergency Paediatric First Aid
We also provide Emergency Paediatric First Aid training for organisations that need the shorter course for appropriate members of their team.
As explained throughout this article, Full Paediatric First Aid and Emergency Paediatric First Aid are not interchangeable in every situation. Nursery and school managers should consider which qualification each member of staff requires based on their role and how they are being counted within the EYFS staffing arrangements.
If you’re unsure which course your staff need, we’re happy to help you work through your requirements.
Need to Get Your Nursery Team PFA Trained?
Don’t wait until certificates are about to expire – or until staffing changes leave you struggling to maintain your Paediatric First Aid cover.
HMB Training Services can train your team at your workplace, making it easier to get multiple members of staff trained together and minimise disruption to your setting.
Whether you need to train newly qualified practitioners, apprentices, existing nursery staff or an entire early-years team, we can help you choose the appropriate course.
Ready to Book?
Get in touch with HMB Training Services to discuss your Paediatric First Aid training requirements, request a quote or arrange training for your team.
Not sure how many staff need training or whether they need Full Paediatric First Aid or Emergency Paediatric First Aid?
Contact us and we’ll help you identify the most appropriate training for your setting.
For more information, contact us on 01543 453338
Email – info@hmbtrainingservices.co.uk
