Directors of 86 day care centers in a large metropolitan area were surveyed to determine the availability and factors affecting the availability of day care services for preschool children with special health care needs. Fiftysix (65%) centers enrolled preschoolers with special health care needs. Less than 5% of preschoolers enrolled had special health care needs, and few had disabilities or conditions that required special interventions. Barriers to admission included restrictive admittance requirements; lack of staff; fear of not meeting the child's needs; and lack of trained personnel. Supports needed by the centers included more staff, greater staff training, and increased funding. Over half of the directors expected benefits from enrollment of these children. Few, however, knew the Americans with Disabilities Act's requirements of inclusion of children with special health care needs. Data from the survey support a need for increased collaboration between the state's Part C system, agencies regulating and supporting day care services, and health care providers. Involvement of pediatric health care professionals at all levels of the child care system could assist in promoting quality day care for all children with special care needs and in producing much needed linkages between day care services and the child's health care providers.