Screening Nannies: Health Checks & Drug Testing

Health screening and drug testing are components of the nanny vetting process that many families feel uncomfortable requesting but rarely regret once completed. Your nanny will be in close physical contact with your children daily. For families with infants, immunocompromised members, or children with allergies, health verification is not merely prudent; it is essential.

This guide covers the common health screening components, drug testing options, legal considerations, and practical logistics of implementing these checks as part of your hiring process. It complements the broader screening framework in our nanny hiring guide and our detailed background check guide.

TB (Tuberculosis) Testing

A tuberculosis test is the most commonly requested health screening for nanny candidates. TB is an airborne disease that poses particular risk to infants and young children whose immune systems are still developing.

Testing Options

• Tuberculin skin test (TST / PPD): The traditional two-step test. A small amount of tuberculin is injected under the skin, and the result is read 48 to 72 hours later. Cost: $15 to $35.
• Blood test (IGRA): Interferon-Gamma Release Assay. A single blood draw with results in 24 to 48 hours. More accurate for individuals who have received the BCG vaccine (common among candidates born outside the U.S.). Cost: $40 to $80.

When to Require It

TB testing is especially important for: families with children under 12 months, households with immunocompromised members, and candidates who have recently traveled to or from high-prevalence countries. Many nanny agencies include TB testing as a standard requirement regardless of circumstances.

Drug Screening

Drug testing provides a baseline verification that the person caring for your children is not under the influence of substances that impair judgment, reaction time, or decision-making.

Standard Drug Panels

Most families opt for the standard 10-panel, which covers the broadest range of commonly abused substances at a reasonable cost. Testing is performed at occupational health clinics, urgent care centers, or through mobile testing services that come to your location.

Marijuana Considerations

With recreational marijuana now legal in many states, families face a nuanced decision. Legal status does not change the safety implications: a nanny who uses marijuana recreationally on their own time is making a legal choice, but a nanny who is impaired while caring for children is a safety concern regardless of legality. Many families address this through clear policies in their nanny contract rather than relying solely on pre-employment testing.

Vaccination Requirements

Pediatricians increasingly recommend that all caregivers who have close contact with infants and young children be up to date on key vaccinations.

Commonly Requested Vaccinations

• Tdap (Tetanus, Diphtheria, Pertussis): Whooping cough is particularly dangerous for infants under 6 months. A Tdap booster is the single most important vaccination for a nanny caring for a newborn.
• Annual flu vaccine: Reduces the risk of transmitting influenza to young children.
• COVID-19 vaccination: Many families continue to request current COVID vaccination or boosters, especially for infant care.
• MMR (Measles, Mumps, Rubella): Particularly important if the candidate's vaccination history is uncertain.

You can request proof of vaccination as a condition of employment. If a candidate has a medical or religious exemption, discuss with your pediatrician whether alternative precautions are sufficient for your family's situation.

Physical Fitness Assessment

Nanny work is physically demanding. A typical day may involve lifting a 25-pound toddler dozens of times, walking several miles pushing a stroller, getting up and down from the floor repeatedly, and maintaining high energy for 8 to 10 hours. While a formal physical examination is not standard practice, some families, particularly those with multiple young children or children with physical disabilities, request a general health clearance from the candidate's physician confirming they are physically capable of performing childcare duties.

Legal Considerations

Applying Requirements Consistently

To avoid potential discrimination claims, apply health screening requirements consistently to all candidates for the same position. Document your requirements in writing as part of the job posting, and obtain written consent before any testing.

State-Specific Rules

Some states have specific regulations around drug testing in employment. While most of these laws are designed for larger employers, check your state's requirements to ensure compliance. For more on the legal landscape, see our guide to nanny screening laws.

Handling Results

Health screening results are confidential medical information. Store them securely, share them only on a need-to-know basis, and never disclose results to other candidates or third parties. If a screening result leads you to withdraw an offer, communicate the decision professionally without disclosing specific findings beyond what is legally required.

Practical Logistics

When to Screen

Schedule health screenings after the interview and reference checks but before extending a formal offer. This avoids the cost of screening candidates you would not hire anyway while ensuring you have results before the nanny begins working with your children.

Where to Get Screenings Done

• Occupational health clinics: Specialize in employment-related health screenings. Many offer package pricing for combined TB, drug, and physical exams.
• Urgent care centers: Most offer walk-in drug testing and TB tests at competitive prices.
• Mobile screening services: Some companies will send a technician to your home for specimen collection, which is more convenient for all parties.
• Candidate's primary care physician: For vaccination verification and general health clearance, the candidate's own doctor is often the most efficient option.