24 Caring for Our Children: National Health and Safety Performance Standards References f. Methods of helping the child with special health care needs or behavior problems to participate in the facility’s 1. Fiene, R. 2002. 13 indicators of quality child care: Research update programs, including physical activity programs; Washington, DC: U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation. http://aspe. g. Role modeling, peer socialization, and interaction; hhs.gov/ basic-report/13-indicators-quality-child-care. h. Behavior modification techniques, positive behavioral 2. Moon R. Y., R. P. Oden. 2003. Back to sleep: Can we influence child care supports for children, promotion of self-esteem, and providers? Pediatrics 112:878-82. other techniques for managing behavior; i. Grouping of children by skill levels, taking into account 3. National Association for the Education of Young Children (NAEYC). the child’s age and developmental level; 2008. Leadership and management: A guide to the NAEYC early childhood j. Health services or medical intervention for children program standards and related accreditation criteria. Washington, DC: with special health care problems; NAEYC. k. Communication methods and needs of the child; l. Dietary specifications for children who need to avoid 4. Crowley, A. A. 1990. Health services in child day-care centers: A survey. specific foods or for children who have their diet J Pediatr Health Care 4:252-59. modified to maintain their health, including support for continuation of breastfeeding; 1.4.2.2 m. Medication administration (for emergencies or on an Orientation for Care of Children with ongoing basis); Special Health Care Needs n. Recognizing signs and symptoms of impending illness or change in health status; When a child care facility enrolls a child with special health o. Recognizing signs and symptoms of injury; care needs, the facility should ensure that all staff members p. Understanding temperament and how individual have been oriented in understanding that child’s special behavioral differences affect a child’s adaptive skills, health care needs and have the skills to work with that motivation, and energy; child in a group setting. q. Potential hazards of which staff should be aware; Caregivers/teachers in small family child care homes, who r. Collaborating with families and outside service pro- care for a child with special health care needs, should meet viders to create a health, developmental, and behavioral with the parents/guardians and meet or speak with the care plan for children with special needs; child’s primary care provider (if the parent/guardian has s. Awareness of when to ask for medical advice and provided prior, informed, written consent) or a child care recommendations for non-emergent issues that arise health con- sultant to ensure that the child’s special health in school (e.g., head lice, worms, diarrhea); care needs t. Knowledge of professionals with skills in various con- will be met in child care and to learn how these needs may ditions, e.g., total communication for children with deaf- affect his/her developmental progression or play with other ness, beginning orientation and mobility training for children. children with blindness (including arranging the physical In addition to Orientation Training, Standard 1.4.2.1, the environment effectively for such children), language orientation provided to staff in child care facilities should promotion for children with hearing- be based on the special health care needs of children who impairment and language delay/disorder, etc.; will be assigned to their care. All staff oriented for care u. How to work with parents/guardians and other pro- of children with special health needs should be knowledge- fessionals when assistive devices or medications are not able about the care plans created by the child’s primary consistently brought to the child care program or school; care provider in their medical home as well as any care v. How to safely transport a child with special health plans created by other health professionals and therapists care needs. involved in the child’s care. A template for a care plan for children with special health care needs can be found in RATIONALE Appendix O. Child care health consultants can be an A basic understanding of developmental disabilities and excellent resource for providing health and safety orienta- special care requirements of any child in care is a funda- tion or referrals to resources for such training. This training mental part of any orientation for new employees. Training may include, but is not limited to, the following topics: is an essential component to ensure that staff members a. Positioning for feeding and handling, and risks for develop and maintain the needed skills. A comprehensive curriculum is required to ensure quality services. However, injury for children with physical/mental disabilities; lack of specialized training for staff does not constitute b. Toileting techniques; grounds for exclusion of children with disabilities (1). c. Knowledge of special treatments or therapies (e.g., PT, Staff members need information about how to help children use and maintain adaptive equipment properly. Staff mem- OT, speech, nutrition/diet therapies, emotional support bers need to understand how and why various items are used and behavioral therapies, medication administration, and how to check for malfunctions. If a problem occurs with etc.) the child may need/receive in the child care setting; adaptive equipment, the staff must recognize the problem d. Proper use and care of the individual child’s adaptive equipment, including how to recognize defective equip- ment and to notify parents/guardians that repairs are needed; e. How different disabilities affect the child’s ability to participate in group activities;
25 Chapter 1: Staffing and inform the parent/guardian so that the parent/guardian b. Exclusion and readmission procedures and policies; can notify the health care or equipment provider of the c. Cleaning, sanitation, and disinfection procedures and problem and request that it be remedied. While the parent/ guardian is responsible for arranging for correction of policies; equipment problems, child care staff must be able to d. Procedures for administering medication to children observe and report the problem to the parent/guardian. Routine care of adaptive and treatment equipment, and for documenting medication administered to such as nebulizers, should be taught. children; e. Procedures for notifying parents/guardians of an COMMENTS infectious disease occurring in children or staff These training topics are generally applicable to all within the facility; personnel serving children with special health care f. Procedures and policies for notifying public health needs and apply to child care facilities. The curriculum officials about an outbreak of disease or the occurrence may vary depending on the type of facility, classifications of a reportable disease; of disabilities of the children in the facility, and ages of the g. Emergency procedures and policies related to children. The staff is assumed to have the training described unintentional injury, medical emergency, and in Orientation Training, Standard 1.4.2.1, including child natural disasters; growth and development. These additional topics will ex- h. Procedure for accessing the child care health consultant tend their basic knowledge and skills to help them work for assistance; more effectively with children who have special health care i. Injury prevention strategies and hazard identification needs and their families. The number of hours offered in procedures specific to the facility, equipment, etc.; any in-service training program should be determined by and the staff’s experience and professional background. Service j. Proper hand hygiene. plans in small family child care homes may require a modi- fied implementation plan. The parent/guardian is responsi- Before being assigned to tasks that involve identifying and ble for solving equipment problems. The parent/guardian responding to illness, staff members should receive orienta- can request that the child care facility remedy the problem tion training on these topics. Small family child care home directly if the caregiver/teacher has been trained on the caregivers/teachers should not commence operation before maintenance and repair of the equipment and if the receiving orientation on these topics in pre-service training. staff agrees to do it. RATIONALE TYPE OF FACILITY Children in child care are frequently ill (1). Staff members Center, Large Family Child Care Home responsible for child care must be able to recognize illness and injury, carry out the measures required to prevent the RELATED STANDARDS spread of communicable diseases, handle ill and injured 1.4.2.1 Initial Orientation of All Staff children appropriately, and appropriately administer 3.5.0.1 Care Plan for Children with Special Health required medications (2). Hand hygiene is one of the most important means of preventing spread of Care Needs infectious disease (3). 9.4.3.3 Training Record Appendix O: Care Plan for Children With Special Health TYPE OF FACILITY Needs Center, Large Family Child Care Home Reference RELATED STANDARDS 1.4.1.1 Pre-service Training 1. U.S. Department of Justice. 2011. Americans with Disabilities Act. 3.1.1.1 Conduct of Daily Health Check http://www.ada.gov. 3.1.1.2 Documentation of the Daily Health Check 9.4.3.3 Training Record 1.4.2.3 Orientation Topics References During the first three months of employment, the director 1. Aronson, S. S., T. R. Shope, eds. 2017. Managing infectious diseases in child of a center or the caregiver/teacher in a large family home care and schools: A quick reference guide. 4th ed. Elk Grove Village, IL: should document, for all full-time and part-time staff American Academy of Pediatrics. members, additional orientation in, and the employees’ satisfactory knowledge of, the following topics: 2. American Academy of Pediatrics, Council on School Health. 2009. Policy a. Recognition of symptoms of illness and correct statement: Guidance for the administration of medication in school. Pediatrics 124:1244-51. documentation procedures for recording symptoms of illness. This should include the ability to perform a 3. Centers for Disease Control and Prevention (CDC). 2016. Handwashing: daily health check of children to determine whether Clean hands save lives. http://www.cdc.gov/handwashing/. any children are ill or injured and, if so, whether a child who is ill should be excluded from the facility;
26 Caring for Our Children: National Health and Safety Performance Standards 1.4.3 COMMENTS FIRST AID AND CPR TRAINING The recommendations from the American Heart Asso- ciation (AHA) changed in 2010 from “A-B-C” (Airway, 1.4.3.1 Breathing, Chest compressions) to “C-A-B” (Chest com- First Aid and CPR Training for Staff pressions, Airway, Breathing) for adults and pediatric patients (children and infants, excluding newborns). Except The director of a center or a large family child care home for newborns, the ratio of chest compressions to ventilations and the caregiver/teacher in a small family child care home in the 2010 guidelines is 30:2. CPR skills are lost without should ensure all staff members involved in providing practice and ongoing education (3,5). direct care have documentation of satisfactory completion The most common renewal cycle required by organizations of training in pediatric first aid and pediatric CPR skills. that offer pediatric first aid and pediatric CPR training is to Pediatric CPR skills should be taught by demonstration, require successful completion of training every three years practice, and return demonstration to ensure the technique (4), though the AHA requires successful completion of can be per- formed in an emergency. These skills should be CPR class every two years. current according to the requirement specified for retrain- Inexpensive self-learning kits that require only thirty ing by the organization that provided the training. minutes to review the skills of pediatric CPR with a video At least one staff person who has successfully completed and an inflatable manikin are available from the AHA. training in pediatric first aid that includes CPR should be See “Infant CPR Anytime” and “Family and Friends in attendance at all times with a child whose special care CPR Anytime” at http://www.heart.org/HEARTORG/. plan indicates an increased risk of needing respiratory or Child care facilities should consider having an Automated cardiac resuscitation. External Defibrillators (AED) on the child care premises for Records of successful completion of training in pediatric potential use with adults. The use of AEDs with children first aid should be maintained in the personnel files of would be rare. the facility. RATIONALE TYPE OF FACILITY To ensure the health and safety of children in a child Center, Large Family Child Care Home care setting, someone who is qualified to respond to life- threatening emergencies must be in attendance at all times RELATED STANDARDS (1). A staff trained in pediatric first aid, including pediatric 1.4.3.2 Topics Covered in First Aid Training CPR, coupled with a facility that has been designed or 1.4.3.3 CPR Training for Swimming and Water Play modified to ensure the safety of children, can mitigate the 9.4.3.3 Training Record consequences of injury, and reduce the potential for death 10.6.1.1 Regulatory Agency Provision of Caregiver/Teacher from life-threatening conditions. Knowledge of pediatric first aid, including pediatric CPR which addresses manage- and Consumer Training and Support Services ment of a blocked airway and rescue breathing, and the 10.6.1.2 Provision of Training to Facilities by Health confidence to use these skills, are critically important to the outcome of an emergency situation. Agencies Small family child care home caregivers/teachers often work alone. They must have the necessary skills to manage References emergencies while caring for all the children in the group. Children with special health care needs who have compro- 1. Alkon, A., P. J. Kaiser, J. M. Tschann, W. T. Boyce, J. L. Genevro, M. Chesney. mised airways may need to be accompanied to child care 1994. Injuries in child-care centers: Rates, severity, and etiology. Pediatrics with nurses who are able to respond to airway problems (e.g., 94:1043-46. the child who has a tracheostomy and needs suctioning). First aid skills are the most likely tools caregivers/teachers 2. Stevens, P. B., K. A. Dunn. 1994. Use of cardiopulmonary resuscitation by will need. Minor injuries are common. For emergency situ- North Carolina day care providers. J School Health 64:381-83. ations that require attention from a health professional, first aid procedures can be used to control the situation until a 3. American Heart Association (AHA). 2010 AHA guidelines for cardiopul- health professional can provide definitive care. However, monary resuscitation and emergency cardiovascular care science. management of a blocked airway (choking) is a life-threat- Circulation 122: S640-56. ening emergency that cannot wait for emergency medical personnel to arrive on the scene (2). 4. Aronson, S. S., ed. 2007. Pediatric first aid for caregivers and teachers. Rev. Documentation of current certification of satisfactory com- 1st ed. Elk Grove Village, IL: American Academy of Pediatrics; Sudbury, pletion of pediatric first aid and demonstration of pediatric MA: Jones and Bartlett. CPR skills in the facility assists in implementing and in monitoring for proof of compliance. 5. American Heart Association (AHA). 2010. Hands-only CPR. http://handsonlycpr.org. 1.4.3.2 Topics Covered in First Aid Training First aid training should present an overview of Emergency Medical Services (EMS), accessing EMS, poison center services, accessing the poison center, safety at the scene, and isolation of body substances. First aid instruction should include, but not be limited to, recognition and first response of pediatric emergency management in a child care setting of the following situations:
27 Chapter 1: Staffing a. Management of a blocked airway and rescue breathing Small family child care home caregivers/teachers often for infants and children with return demonstration by work alone and are solely responsible for the health and the learner (pediatric CPR); safety of children in care. Such caregivers/teachers must have pediatric first aid competence. b. Abrasions and lacerations; c. Bleeding, including nosebleeds; COMMENTS d. Burns; Other children will have to be supervised while the injury e. Fainting; is managed. Parental notification and communication with f. Poisoning, including swallowed, skin or eye contact, emergency medical services must be carefully planned. First aid information can be obtained from the American and inhaled; Academy of Pediatrics (AAP) at http://www.aap.org and the g. Puncture wounds, including splinters; American Heart Association (AHA) at http://www.heart. h. Injuries, including insect, animal, and human bites; org/HEARTORG/. i. Poison control; j. Shock; TYPE OF FACILITY k. Seizure care; Center, Large Family Child Care Home l. Musculoskeletal injury (such as sprains, fractures); m. Dental and mouth injuries/trauma; RELATED STANDARDS n. Head injuries, including shaken baby syndrome/ 1.4.3.1 First Aid and CPR Training for Staff 3.6.1.3 Thermometers for Taking Human Temperatures abusive head trauma; 5.6.0.1 First Aid and Emergency Supplies o. Allergic reactions, including information about when 9.4.3.3 Training Record epinephrine might be required; Reference p. Asthmatic reactions, including information about 1. Aronson, S. S., ed. 2007. Pediatric first aid for caregivers and teachers. when rescue inhalers must be used; Rev. 1st ed. Elk Grove Village, IL: American Academy of Pediatrics; q. Eye injuries; Sudbury, MA: Jones and Bartlett. r. Loss of consciousness; s. Electric shock; 1.4.3.3 t. Drowning; CPR Training for Swimming and Water Play u. Heat-related injuries, including heat exhaustion/ Facilities that have a swimming pool should require at least heat stroke; one staff member with current documentation of successful v. Cold related injuries, including frostbite; completion of training in infant and child (pediatric) CPR w. Moving and positioning injured/ill persons; (Cardiopulmonary Resuscitation) be on duty at all times x. Illness-related emergencies (such as stiff neck, inexpli- during business hours. At least one of the caregivers/teachers, volunteers, or other cable confusion, sudden onset of blood-red or purple adults who is counted in the child:staff ratio for swimming rash, severe pain, temperature above 101°F [38.3°C] and water play should have documentation of successful orally, above 102°F [38.9°C] rectally, or 100°F [37.8°C] completion of training in basic water safety, proper use of or higher taken axillary [armpit] or measured by an swimming pool rescue equipment, and infant and child equivalent method, and looking/acting severely ill); CPR according to the criteria of the American Red Cross y. Standard Precautions; or the American Heart Association (AHA). z. Organizing and implementing a plan to meet an emer- For small family child care homes, the person trained gency for any child with a special health care need; in water safety and CPR should be the caregiver/teacher. aa. Addressing the needs of the other children in the group Written verification of successful completion of CPR and while managing emergencies in a child care setting; lifesaving training, water safety instructions, and emergency ab. Applying first aid to children with special health care procedures should be kept on file. needs. RATIONALE RATIONALE Drowning involves cessation of breathing and rarely First aid for children in the child care setting requires a requires cardiac resuscitation of victims. Nevertheless, more child-specific approach than standard adult-oriented because of the increased risk for cardiopulmonary arrest first aid offers. To ensure the health and safety of children related to wading and swimming, the facility should have in a child care setting, someone who is qualified to respond personnel trained to provide CPR and to deal promptly with to common injuries and life-threatening emergencies must a life-threatening drowning emergency. During drowning, be in attendance at all times. A staff trained in pediatric cold exposure provides the possibility of protection of the first aid, including pediatric CPR, coupled with a facility brain from irreversible damage associated with respiratory that has been designed or modified to ensure the safety of and cardiac arrest. Children drown in as little as two inches children, can reduce the potential for death and disability. of water. The difference between a life and death situation is Knowledge of pediatric first aid, including the ability to the submersion time. Thirty seconds can make a difference. demonstrate pediatric CPR skills, and the confidence to use these skills, are critically important to the outcome of an emergency situation (1).
28 Caring for Our Children: National Health and Safety Performance Standards The timely administration of resuscitation efforts by a and skills. Child health and employee health are integral to caregiver/teacher trained in water safety and CPR is critical. any education/training curriculum and program manage- Studies have shown that prompt rescue and the presence of ment plan. Planning and evaluation of training should be a trained resuscitator at the site can save about 30% of the based on performance of the staff member(s) involved. Too victims without significant neurological consequences (1). often, staff members make training choices based on what TYPE OF FACILITY they like to learn about (their “wants”) and not the areas Center, Large Family Child Care Home in which their performance should be improved (their RELATED STANDARDS “needs”). Participation in training does not ensure that the 1.1.1.5 Ratios and Supervision for Swimming, Wading, participant will master the information and skills offered in the training experience. Therefore, caregiver/teacher change and Water Play in behavior or the continuation of appropriate practice 2.2.0.4 Supervision Near Bodies of Water resulting from the training, not just participation in train- 2.2.0.5 Behavior Around a Pool ing, should be assessed by supervisors and directors (4). 6.3.1.7 Pool Safety Rules In addition to low child:staff ratio, group size, age mix of 6.4.1.1 Pool Toys children, and stability of caregiver/teacher, the training/ 9.4.3.3 Training Record education of caregivers/teachers is a specific indicator of Reference child care quality (2). Most skilled roles require training related to the functions and responsibilities the role requires. 1. Aronson, S. S., ed. 2007. Pediatric first aid for caregivers and teachers. Staff members who are better trained are better able to pre- Rev. 1st ed. Elk Grove Village, IL: American Academy of Pediatrics; vent, recognize, and correct health and safety problems. The Sudbury, MA: Jones and Bartlett. number of training hours recommended in this standard reflects the central focus of caregivers/teachers on child 1.4.4 development, health, and safety. CONTINUING EDUCATION/ Children may come to child care with identified special PROFESSIONAL DEVELOPMENT health care needs or special needs may be identified while attending child care, so staff should be trained in recog- 1.4.4.1 nizing health problems as well as in implementing care Continuing Education for Directors plans for previously identified needs. Medications are often and Caregivers/Teachers in Centers and required either on an emergent or scheduled basis for a Large Family Child Care Homes child to safely attend child care. Caregivers/teachers should be well trained on medication administration and appro- All directors and caregivers/teachers of centers and large priate policies should be in place. family child care homes should successfully complete at The National Association for the Education of Young least thirty clock-hours per year of continuing education/ Children (NAEYC), a leading organization in child care professional development in the first year of employment, and early childhood education, recommends annual sixteen clock-hours of which should be in child develop- training/professional development based on the needs ment pro- gramming and fourteen of which should be in of the program and the pre-service qualifications of child health, safety, and staff health. In the second and each staff (1). Training should address the following areas: of the following years of employment at a facility, all direc- a. Promoting child growth and development correlated tors and caregivers/teachers should successfully complete at least with developmentally appropriate activities; twenty-four clock-hours of continuing education based on b. Infant care; individual competency needs and any special needs of the c. Recognizing and managing minor illness and injury; children in their care, sixteen hours of which should be in d. Managing the care of children who require the special child development programming and eight hours of which should be in child health, safety, and staff health. procedures listed in Standard 3.5.0.2; Programs should conduct a needs assessment to identify e. Medication administration; areas of focus, trainer qualifications, adult learning strate- f. Business aspects of the small family child care home; gies, and create an annual professional development plan g. Planning developmentally appropriate activities in for staff based on the needs assessment. The effectiveness of training should be evident by the change in performance mixed age groupings; as measured by accreditation standards or other quality h. Nutrition for children in the context of preparing assurance systems. RATIONALE nutritious meals for the family; Because of the nature of their caregiving/teaching tasks, i. Age-appropriate size servings of food and child feeding caregivers/teachers must attain multifaceted knowledge practices; j. Acceptable methods of discipline/setting limits; k. Organizing the home for child care; l. Preventing unintentional injuries in the home (e.g., falls, poisoning, burns, drowning);
29 Chapter 1: Staffing m. Available community services; 5. Visiting Nurse Association (VNA); n. Detecting, preventing, and reporting child abuse 6. National Association of Pediatric Nurse Practitioners and neglect; (NAPNAP); o. Advocacy skills; 7. National Association for the Education of Young p. Pediatric first aid, including pediatric CPR; q. Methods of effective communication with children and Children (NAEYC); 8. National Association for Family Child Care (NAFCC); parents/guardians; 9. National Association of School Nurses (NASN); r. Socio-emotional and mental health (positive approaches 10. Emergency Medical Services for Children (EMSC) with consistent and nurturing relationships); National Resource Center; s. Evacuation and shelter-in-place drill procedures; 11. National Association for Sport and Physical t. Occupational health hazards; u. u. Infant safe sleep environments and practices; Education (NASPE); v. Standard Precautions; 12. American Dietetic Association (ADA); w. Shaken baby syndrome/abusive head trauma; 13. American Association of Poison Control Centers x. Dental issues; y. Age-appropriate nutrition and physical activity. (AAPCC). There are few illnesses for which children should be ex- For nutrition training, facilities should check that the cluded from child care. Decisions about management of nutritionist/registered dietician (RD), who provides advice, ill children are facilitated by skill in assessing the extent has experience with, and knowledge of, child development, to which the behavior suggesting illness requires special infant and early childhood nutrition, school-age child nutri- management (3). Continuing education on managing in- tion, prescribed nutrition therapies, food service and food fectious diseases helps prepare caregivers/teachers to make safety issues in the child care setting. Most state Maternal these decisions devoid of personal biases (5). Recommen- and Child Health (MCH) programs, Child and Adult Care dations regarding responses to illnesses may change Food Programs (CACFP), and Special Supplemental Nutri- (e.g., H1N1), so caregivers/teachers need to know where tion Programs for Women, Infants, and Children (WIC) they can find the most current information. All caregivers/ have a nutrition specialist on staff or access to a local con- teachers should be trained to prevent, assess, and treat sultant. If this nutrition specialist has knowledge and ex- injuries common in child care settings and to comfort perience in early childhood and child care, facilities might an injured child and children witnessing an injury. negotiate for this individual to serve or identify someone to serve as a consultant and trainer for the facility. COMMENTS Tools for assessment of training needs are part of the Many resources are available for nutritionists/RDs who accreditation self-study tools available from the NAEYC, provide training in food service and nutrition. Some the National Association for Family Child Care (NAFCC), resources to contact include: National Early Childhood Professional Accreditation (NECPA), Association for Christian Education Interna- a. Local, county, and state health departments to locate tional (ACEI), National AfterSchool Association (NAA), MCH, CACFP, or WIC programs; and the National Child Care Association (NCCA). Suc- cessful completion of training can be measured by a b. State university and college nutrition departments; performance test at the end of training and by ongoing c. Home economists at utility companies; evaluation of performance on the job. d. State affiliates of the American Dietetic Association; Resources for training on health and safety issues include: e. State and regional affiliates of the American Public a. State and local health departments (health education, Health Association; environmental health and sanitation, nutrition, public f. The American Association of Family and Consumer health nursing departments, fire and EMS, etc.); b. Networks of child care health consultants; Services; c. Graduates of the National Training Institute for Child g. National Resource Center for Health and Safety in Care Health Consultants (NTI); d. Child care resource and referral agencies; Child Care and Early Education; e. University Centers for Excellence on Disabilities; h. Nutritionist/RD at a hospital; f. Local children’s hospitals; i. High school home economics teachers; g. State and local chapters of: j. The Dairy Council; 1. American Academy of Pediatrics (AAP), including k. The local American Heart Association affiliate; l. The local Cancer Society; AAP Chapter Child Care Contacts; m. The Society for Nutrition Education; 2. American Academy of Family Physicians (AAFP); n. The local Cooperative Extension office; 3. American Nurses’ Association (ANA); o. Local community colleges and trade schools. 4. American Public Health Association (APHA); Nutrition education resources may be obtained from the Food and Nutrition Information Center at http://fnic.nal. usda.gov. The staff’s continuing education in nutrition may be supplemented by periodic newsletters and/or literature (frequently bilingual) or audiovisual materials prepared or recommended by the Nutrition Specialist.
30 Caring for Our Children: National Health and Safety Performance Standards Caregivers/teachers should have a basic knowledge of spe- References cial health care needs, supplemented by specialized train- ing for children with special health care needs. The type 1. National Association for the Education of Young Children (NAEYC). of special health care needs of the children in care should 2009. Standards for Early Childhood professional preparation programs. influence the selection of the training topics. The number Washington, DC: NAEYC. http://www.naeyc .org/files/naeyc/file/ of hours offered in any in-service training program should positions/ProfPrepStandards09.pdf. be determined by the experience and professional back- ground of the staff, which is best achieved through a 2. Whitebook, M., C. Howes, D. Phillips. 1998. Worthy work, unlivable regular staff conference mechanism. wages: The National child care staffing study, 1988-1997. Washington, DC: Center for the Child Care Workforce. Financial support and accessibility to training programs requires attention to facilitate compliance with this standard. 3. Crowley, A. A. 1990. Health services in child care day care centers: A Many states are using federal funds from the Child Care and survey. J Pediatr Health Care 4:252-59. Development Block Grant to improve access, quality, and affordability of training for early care and education pro- 4. Fiene, R. 2002. 13 indicators of quality child care: Research update. fessionals. College courses, either online or face to face, Washington, DC: U.S. Department of Health and Human Services, Office and training workshops can be used to meet the training of the Assistant Secretary for Planning and Evaluation. http://aspe.hhs.gov/ hours requirement. These training opportunities can also basic-report/13-indicators-quality-child-care. be conducted on site at the child care facility. Completion of training should be documented by a college transcript or 5. Aronson, S. S., T. R. Shope, eds. 2009. Managing infectious diseases in a training certificate that includes title/content of training, child care and schools: A quick reference guide. 2nd ed. Elk Grove Village, IL: contact hours, name and credentials of trainer or course American Academy of Pediatrics. instructor and date of training. Whenever possible the sub- mission of documentation that shows how the learner imple- 1.4.4.2 mented the concepts taught in the training in the child care Continuing Education for Small Family program should be documented. Although on-site training Child Care Home Caregivers/Teachers can be costly, it may be a more effective approach than participation in training at a remote location. Small family child care home caregivers/teachers should have at least thirty clock-hours per year (2) of continuing education Projects and Outreach: Early Childhood Research and in areas determined by self-assessment and, where possible, Evaluation Projects, Midwest Child Care Research Con- by a performance review of a skilled sortium at http://ccfl.unl.edu/projects_outreach/projects/ mentor or peer reviewer. current/ecp/mwcrc.php, identifies the number of hours for RATIONALE education of staff and fourteen indicators of quality from In addition to low child:staff ratio, group size, age mix of chil- a study conducted in four Midwestern states. dren, and continuity of caregiver/teacher, the training/educa- tion of caregivers/teachers is a specific indicator of child care TYPE OF FACILITY quality (1). Most skilled roles require training related to the Center, Large Family Child Care Home functions and responsibilities the role requires. Caregivers/ teachers who engage in on-going training are more likely to RELATED STANDARDS decrease morbidity and mor- tality in their setting (3) and are better able to prevent, recognize, and correct health and safety 1.8.2.2 Annual Staff Competency Evaluation problems. Children may come to child care with identified special 3.5.0.2 Caring for Children Who Require Medical health care needs or may develop them while attending Procedures child care, so staff must be trained in recognizing health problems as well as in implementing care plans for 3.6.3.1 Medication Administration previously identified needs. Because of the nature of their caregiving/teaching tasks, 9.4.3.3 Training Record caregivers/teachers must attain multifaceted knowledge and skills. Child health and employee health are integral to 10.3.3.4 Licensing Agency Provision of Child Abuse any education/training curriculum and program manage- Prevention Materials ment plan. Planning and evaluation of training should be based on performance of the caregiver/teacher. Provision of 10.3.4.6 Compensation for Participation in workshops and courses on all facets of a small family child Multidisciplinary Assessments for Children care business may be difficult to access and may lead to with Special Health Care or Education Needs caregivers/teachers enrolling in training opportunities in curriculum related areas only. Too often, caregivers/teachers 10.6.1.1 Regulatory Agency Provision of Caregiver/ make training choices based on what they like to learn about Teacher and Consumer Training and (their “wants”) and not the areas in which their performance Support Services should be improved (their “needs”). Small family child care home caregivers/teachers often work 10.6.1.2 Provision of Training to Facilities by Health alone and are solely responsible for the health and safety of Agencies small numbers of children in care. Peer review is part of the process for accreditation of family child care and can be Appendix C: Nutrition Specialist, Registered Dietitian, valuable in assisting the caregiver/teacher in the identification Licensed Nutritionist, Consultant, and Food of areas of need for training. Self-evaluation may not identify Service Staff Qualifications
31 Chapter 1: Staffing training needs or focus on areas in which the caregiver/ work and promotes networking and support. Satellite train- teacher is particularly interested and may be skilled ing via down links at local extension service sites, high already. schools, and community colleges scheduled at convenient evening or weekend times is another way to mix quality COMMENTS training with local availability and some networking. The content of continuing education for small family child RELATED STANDARDS care home caregivers/teachers should include the follow- 1.4.4.1 Continuing Education for Directors and Caregivers/ ing topics: a. Promoting child growth and development correlated Teachers in Centers and Large Family Child Care Homes with developmentally appropriate activities; 1.7.0.4 Occupational Hazards b. Infant care; 3.5.0.2 Caring for Children Who Require Medical c. Recognizing and managing minor illness and injury; Procedures d. Managing the care of children who require the special 9.2.4.3 Disaster Planning, Training, and Communication 9.2.4.4 Written Plan for Seasonal and Pandemic Influenza procedures listed in Standard 3.5.0.2; 9.2.4.5 Emergency and Evacuation Drills/Exercises Policy e. Medication administration; 9.4.3.3 Training Record f. Business aspects of the small family child care home; References g. Planning developmentally appropriate activities in 1. Whitebook, M., C. Howes, D. Phillips. 1998. Worthy work, unlivable mixed age groupings; wages: The national child care staffing study, 1988-1997. Washington, DC: h. Nutrition for children in the context of preparing Center for the Child Care Workforce. nutritious meals for the family; 2. The National Association of Family Child Care (NAFCC). 2005. Quality i. Age-appropriate size servings of food and child standards for NAFCC accreditation. 4th ed. Salt Lake City, UT: NAFCC. http://www.nafcc.org/documents/QualStd.pdf. feeding practices; j. Acceptable methods of discipline/setting limits; 3. Fiene, R. 2002. 13 indicators of quality child care: Research update. k. Organizing the home for child care; Washington, DC: U.S. Department of Health and Human Services, l. Preventing unintentional injuries in the home Office of the Assistant Secretary for Planning and Evaluation. http://aspe.hhs.gov/basic-report/13-indicators-qualitychild-care. (falls, poisoning, burns, drowning); m. Available community services; 1.4.5 n. Detecting, preventing, and reporting child abuse and SPECIALIZED TRAINING/EDUCATION neglect; 1.4.5.1 o. Advocacy skills; Training of Staff Who Handle Food p. Pediatric first aid, including pediatric CPR; q. Methods of effective communication with children All staff members with food handling responsibilities should obtain training in food service and safety. The director of a and parents/guardians; center or a large family child care home or the designated r. Socio-emotional and mental health (positive supervisor for food service should be a certified food protec- tion manager or equivalent as demonstrated by completing approaches with consistent and nurturing an accredited food protection manager course. Small family relationships); child care personnel should secure training in food service s. Evacuation and shelter-in-place drill procedures; and safety appropriate for their setting. t. Occupational health hazards; RATIONALE u. Infant-safe sleep environments and practices; Outbreaks of foodborne illness have occurred in many v. Standard Precautions; settings, including child care facilities. Some of these out- w. Shaken baby syndrome/abusive head trauma; breaks have led to fatalities and severe disabilities. Young x. Dental issues; children are particularly susceptible to foodborne illness, due y. Age-appropriate nutrition and physical activity. to their body size and immature immune systems. Because Small family child care home caregivers/teachers should large centers serve more meals daily than many restaurants maintain current contact lists of community pediatric do, the supervisors of food handlers in these settings should primary care providers, specialists for health issues of have successfully completed food service certification, and individual children in their care and child care health the food handlers in these settings should have successfully consultants who could provide training when needed. completed courses on appropriate food handling (1). In-home training alternatives to group training for small COMMENTS family child care home caregivers/teachers are available, Sponsors of the Child and Adult Care Food Program such as distance courses on the Internet, listening to audio- (CACFP) provide this training for some small family child tapes or viewing media (e.g., DVDs) with self-checklists. care home caregivers/teachers. For training in food handling, These training alternatives provide more flexibility for caregivers/teachers who are remote from central training locations or have difficulty arranging coverage for their child care duties to attend training. Nevertheless, gather- ing family child care home caregivers/teachers for training when possible provides a break from the isolation of their
32 Caring for Our Children: National Health and Safety Performance Standards caregivers/teachers should contact the state or local health Child abuse and neglect materials should be designed for department, or the delegate agencies that handle nutrition nonmedical audiences. and environmental health inspection programs for the child care facility. Training for food workers is mandatory RATIONALE in some jurisdictions. Other sources for food safety infor- Education is important in identifying manifestations of child mation are the Food and Drug Administration (FDA) maltreatment that can increase the likelihood of appropriate Food Code, family child care associations, child care reports to child protection and law enforcement agencies (5). resource and referral agencies, licensing agencies, and state departments of education. COMMENTS TYPE OF FACILITY Child abuse and neglect resources are available from the Center, Large Family Child Care Home American Academy of Pediatrics at https://www.aap.org/ RELATED STANDARD en-us/advocacy-and-policy/aap-health-initiatives/resilience/ 9.4.3.3 Training Record Pages/Child-Abuse-and-Neglect.aspx, the Child Welfare Reference Information Gateway at www.childwelfare.gov, Prevent Child Abuse America at www.preventchildabuse.org, 1. U.S. Department of Health and Human Services, Public Health Service, and The Early Childhood Learning & Knowledge Food and Drug Administration (FDA). 2009. Food code 2009. College Park, Center at https://eclkc.ohs.acf.hhs.gov/browse/ MD: FDA. http://www.fda.gov/Food/FoodSafety RetailFoodProtection/ keyword/child-abuse. FoodCode/FoodCode2009/default.htm. TYPE OF FACILITY 1.4.5.2 Center, Large Family Child Care Home Child Abuse and Neglect Education RELATED STANDARDS Caregivers/teachers are mandatory reporters of child abuse 2.2.0.9 Prohibited Caregiver/Teacher Behaviors and neglect. Caregivers/teachers should attend child abuse 2.4.2.1 Health and Safety Education Topics for Staff and neglect prevention education programs to educate 3.4.4.1 Recognizing and Reporting Suspected Child themselves and establish child abuse and neglect preven- tion and recognition guidelines for the children, caregivers/ Abuse, Neglect, and Exploitation teachers, and parents/guardians. The prevention education 3.4.4.2 Immunity for Reporters of Child Abuse program should address physical, sexual, and psychological or emotional abuse and neglect. The dangers of shaking and Neglect infants and toddlers and repeated exposure to domestic 3.4.4.3 Preventing and Identifying Shaken Baby violence should be included in the education and prevention materials. Caregivers/teachers should also receive education Syndrome/Abusive Head Trauma on promoting protective factors to prevent child maltreat- 3.4.4.4 Care for Children Who Have Been Abused/ ment. (Child maltreatment includes all types of abuse and neglect of a child under the age of 18 by a parent, caregiver, Neglected or another person in a custodial role (e.g., clergy, coach, 3.4.4.5 Facility Layout to Reduce Risk of Child Abuse teacher, etc.) (1). Caregivers/teachers should be able to identify signs of stress in families and assist families by and Neglect providing support and access/referral to resources when 9.2.1.1 Content of Policies needed. Children with disabilities are at a higher risk of 9.4.3.3 Training Record being abused than healthy children. Special training in child abuse and neglect of children with disabilities References should be provided (2). Risk factors for victimization include a child’s age and 1. Centers for Disease Control and Prevention. Child abuse and neglect special needs that may require increased attention from prevention. https://www.cdc.gov/violenceprevention/childmaltreatment/ the caregiver. Risk factors for perpetration include young index.html. Updated April 17, 2017. Accessed March 8, 2018 parental age, single parenthood, many dependent children, low parental income or parental unemployment, substance 2. Centers for Disease Control and Prevention. Violence prevention. Child abuse, and family history of child abuse/neglect, violence, abuse and neglect: risk and protective factors. https://www.cdc.gov/ and/or mental illness (2,3). Caregivers/teachers should violenceprevention/childmaltreatment/riskprotectivefactors.html. be aware of these factors so they can support parenting Updated April 18, 2017. Accessed January 11, 2018 practices when appropriate. Caregivers/teachers should be trained in compliance with their state’s child abuse and 3. Fortson BL, Klevens J, Merrick MT, Gilbert LK, Alexander SP. Preventing neglect reporting laws. Child abuse reporting requirements Child Abuse and Neglect: A Technical Package for Policy, Norm, and are available from the child care regulation department in Programmatic Activities. Atlanta, GA: National Center for Injury each state (4). Prevention and Control, Centers for Disease Control and Prevention; 2016. https://www.cdc.gov/violenceprevention/pdf/CAN-Prevention- Technical-Package.pdf. Accessed January 11, 2018 4. US Department of Health and Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau. Child Maltreatment 2014. http://www.acf.hhs.gov/sites/ default/files/cb/cm2014.pdf. Published 2016. Accessed January 11, 2018 5. Admon Livny K, Katz C. Schools, families, and the prevention of child maltreatment: lessons that can be learned from a literature review. Trauma Violence Abuse. 2016;pii:1524838016650186 NOTES Content in the STANDARD was modified on 5/22/2018
33 Chapter 1: Staffing 1.4.5.3 RATIONALE Training on Occupational Risk Related Young children’s identities cannot be separated from family, to Handling Body Fluids culture, and their home language. Children need both to see successful role models from their own ethnic and cultural All caregivers/teachers who are at risk of occupational groups and to develop the ability to relate to people who are exposure to blood or other blood-containing body fluids different from themselves (1). should be offered hepatitis B immunizations and should TYPE OF FACILITY receive annual training in Standard Precautions and Center exposure control planning. Training should be consistent RELATED STANDARD with applicable standards of the Occupational Safety and 9.4.3.3 Training Record Health Administration (OSHA) Standard 29 CFR 1910.1030, References “Occupational Exposure to Bloodborne Pathogens” and local occupational health requirements and should include, 1. Chang, H. 2006. Developing a skilled, ethnically and linguistically diverse but not be limited to: early childhood workforce. Adapted from Getting ready for quality: The a. Modes of transmission of bloodborne pathogens; critical importance of developing and supporting a skilled, ethnically and b. Standard Precautions; linguistically diverse early childhood workforce. http://www.buildinitiative. c. Hepatitis B vaccine use according to OSHA org/files/DiverseWorkforce.pdf. requirements; 2. National Association for the Education of Young Children (NAEYC). 2009. d. Program policies and procedures regarding exposure Quality benchmark for cultural competence project. Washington, DC: NAEYC. http://www.naeyc.org/files/naeyc/file/policy/state/QBCC_Tool.pdf. to blood/body fluid; e. Reporting procedures under the exposure control plan 1.4.6 EDUCATIONAL LEAVE/COMPENSATION to ensure that all first-aid incidents involving exposure are reported to the employer before the end of the work 1.4.6.1 shift during which the incident occurs (1). Training Time and Professional Development Leave RATIONALE Providing first aid in situations where blood is present is A center, large family child care home or a support agency an intrinsic part of a caregiver’s/teacher’s job. Split lips, for a network of small family child care homes should make scraped knees, and other minor injuries associated with provisions for paid training time for staff to participate in bleeding are common in child care. required professional development (that includes training Caregivers/teachers who are designated as responsible for as well as education) during work hours, or reimburse staff rendering first aid or medical assistance as part of their job for time spent attending professional development outside duties are covered by the scope of this standard. of regular work hours. Any hours worked in excess of forty hours in a week must be paid according to state and federal COMMENTS wage and hour regulations. OSHA has model exposure control plan materials for use RATIONALE by child care facilities. Using the model exposure control Most caregivers/teachers work long hours and most are plan materials, caregivers/teachers can prepare a plan to poorly paid (1). Using personal time for education required comply with the OSHA requirements. The model plan as a condition of employment is an unfair expectation until materials are available from regional offices of OSHA. compensation for work done in child care is much more equitable. Many child care workers also employed in another TYPE OF FACILITY vocation work at other jobs to make a living wage and would Center, Large Family Child Care Home miss income from their other jobs or risk losing that employ- ment. Additionally, the caregiver/teacher may incur stress in RELATED STANDARDS their family life when required to take time outside of child 9.4.3.3 Training Record care hours to participate in work-related training. Appendix L: Cleaning Up Body Fluids COMMENTS Professional development in child care often takes place when Reference the participant is not released from other work-related duties, such as caring for children or answering phones. Providing 1. U.S. Department of Labor, Occupational Safety and HealthAdministra- substitutes and released time during work hours for such tion. 2008. Toxic and hazardous substances: Bloodborne pathogens. training is likely to enhance the effectiveness of training; http://www.osha.gov/pls/oshaweb/owadisp.show _document?p_ and improve employee satisfaction/retention. table=STANDARDS&p_id=10051. Large family child care homes employ staff in the same way as centers, except for size and location in a residence. 1.4.5.4 For small family child care home caregivers/teachers, Education of Center Staff Centers should educate staff to support the cultural, lan- guage, and ethnic backgrounds of children enrolled in the program. In addition, all staff members should participate in diversity training that will ensure respectful service deliv- ery to all families and a staff that works well together (2).
34 Caring for Our Children: National Health and Safety Performance Standards released time and compensation while engaged in training to provide medical care for children with special health can be arranged only if the small family child care home care needs is particularly challenging. A substitute nurse caregiver/teacher is part of a support network that makes should be experienced in delivering the expected medical such arrange-ments. This standard does not apply to small services. Decisions should be made on whether a parent/ family child care home caregivers/teachers independent guardian will be allowed to provide needed on-site medical of networks. services. Substitutes should be aware of the care plans The Fair Labor Standard Act mandates payment of time (including emergency procedures) for children with and a half for all hours worked in excess of forty hours special health care needs. in a week. TYPE OF FACILITY RATIONALE Center, Large Family Child Care Home The risk to children from care by unqualified caregivers/ Reference teachers is the same whether the caregiver/teacher is a paid substitute or a volunteer (1). 1. Center for the Child Care Workforce, American Federation of Teachers (AFT). 2009. Wage data: Early childhood workforce hourly wage data. 2009 COMMENTS ed. Washington, DC: AFT. http://www.ccw.org/storage/ccworkforce/ Substitutes are difficult to find, especially at the last minute. documents/04-30-09 wwd fact sheet.pdf. Planning for a competent substitute pool is essential for child care operation. Requiring substitutes for small family 1.4.6.2 child care homes to obtain first aid and CPR certification Payment for Continuing Education forces small family child care home caregivers/teachers to close when they cannot be covered by a competent substi- Directors of centers and large family child care homes tute. Since closing a child care home has a negative impact should arrange for continuing education that is paid for on the families and children they serve, systems should be by the government, by charitable organizations, or by the developed to provide qualified alternative homes or substi- facility, rather than by the employee. Small family child tutes for family child care home caregivers/teachers. care home caregivers/teachers should avail themselves of training opportunities offered in their communities or The lack of back-up for family child care home caregivers/ online and claim their educational expenses as a business teachers is an inherent liability in this type of care. Parents/ expense on tax forms. guardians who use family child care must be sure they have RATIONALE suitable alternative care, such as family or friends, for situa- Caregivers/teachers often make low wages and may not be tions in which the child’s usual caregiver/teacher cannot able to pay for mandated training. A majority of child care provide the service. workers earnings are at or near minimum wage (1). TYPE OF FACILITY Substitutes should have orientation and training on basic Center, Large Family Child Care Home health and safety topics. Substitutes should not have an Reference infectious disease when providing care. 1. Center for the Child Care Workforce, American Federation of Teachers. TYPE OF FACILITY 2009. Wage data: Early childhood workforce hourly wage data. 2009 ed. Center, Large Family Child Care Home Washington, DC: AFT. http://www.ccw.org/storage/ccworkforce/ documents/04-30-09 wwd fact sheet.pdf. RELATED STANDARDS 1.1.1.1 Ratios for Small Family Child Care Homes 1.5 1.1.1.2 Ratios for Large Family Child Care Homes and SUBSTITUTES Centers 1.5.0.1 1.1.1.3 Ratios for Facilities Serving Children with Special Employment of Substitutes Health Care Needs and Disabilities Substitutes should be employed to ensure that child:staff 1.1.1.4 Ratios and Supervision During Transportation ratios and requirements for direct supervision are main- 1.1.1.5 Ratios and Supervision for Swimming, Wading, and tained at all times. Substitutes and volunteers should be at least eighteen years of age and must meet the require- Water Play ments specified throughout Standards 1.3.2.1 to 1.3.2.6. 1.3.2.1 Differentiated Roles Those without licenses/certificates should work under 1.3.2.2 Qualifications of Lead Teachers and Teachers direct supervision and should not be alone with a group 1.3.2.3 Qualifications for Assistant Teachers, Teacher of children. A substitute should complete the same background screen- Aides, and Volunteers ing processes as the caregiver/teacher. Obtaining substitutes 1.3.2.4 Additional Qualifications for Caregivers/Teachers Serving Children Three to Thirty-Five Months of Age 1.3.2.5 Additional Qualifications for Caregivers/Teachers Serving Children Three to Five Years of Age 1.3.2.6 Additional Qualifications for Caregivers/Teachers Serving School-Age Children
35 Chapter 1: Staffing 1.3.3.1 General Qualifications of Family Child Care 2. Diapering technique, if care is provided to children Caregivers/Teachers to Operate a Family Child in diapers, including appropriate diaper disposal and Care Home diaper changing techniques and use and wearing of gloves 1.3.3.2 Support Networks for Family Child Care 1.5.0.2 Orientation of Substitutes 3. Preventing shaken baby syndrome/abusive head 1.7.0.1 Pre-Employment and Ongoing Adult Health trauma Appraisals, Including Immunization 4. Strategies for coping with crying, fussing, or distraught infants and children Reference 5. Early brain development and its vulnerabilities 1. National Association for Family Child Care (NAFCC). NAFCC official 6. Other injury prevention and safety, including the Website. http://nafcc.net. role of a mandatory child abuse reporter to report 1.5.0.2 any suspected abuse/neglect Orientation of Substitutes 7. Correct food preparation and storage techniques, if employee prepares food The director of any center or large family child care home 8. Proper handling and storage of human (breast) milk, and the small family child care home caregiver/teacher when applicable, and formula preparation, if formula should provide orientation training to newly hired substi- is handled tutes, including a review of all the program’s policies and 9. Bottle preparation, including guidelines for human procedures (see sample that follows). This training should milk and formula, if care is provided to infants or include the opportunity for an evaluation and a repeat children with bottles demonstration of the training lesson. Orientation should 10. Proper use of gloves in compliance with be documented in all child care settings. Substitutes Occupational Safety and Health Administration should have background screenings. blood-borne pathogen regulations All substitutes should be oriented to, and demonstrate k. Emergency plans and practices competence in, the tasks for which they will be responsible. On the first day a substitute caregiver/teacher should be On employment, substitutes should be able to carry out the oriented on the following topics: duties assigned to them. a. Safe infant sleep practices RATIONALE 1. The practice of putting infants down to sleep posi- Because facilities and the children enrolled in them vary, tioned on their backs and on a firm surface, along orientation programs for new substitutes can be most pro- with all safe infant sleep practices, to reduce the risk ductive. Because of frequent staff turnover, comprehensive of sudden infant death syndrome (SIDS), as well as orientation programs are critical to protecting the health general nap time routines and healthy sleep hygiene and safety of children and new staff (1,2). Most SIDS deaths for all ages. in child care occur on the first day of care or within the first week due to unaccustomed prone (on stomach) sleeping. b. Any emergency medical procedure or medication needs Unaccustomed prone sleeping increases the risk of SIDS of the children 18 times (3). c. Access to the list of authorized individuals for releasing TYPE OF FACILITY children Center, Large Family Child Care Home, Small Family Child Care Home d. Any special dietary needs of the children During the first week of employment, all substitute RELATED STANDARDS caregivers/teachers should be oriented to, and should 1.2.0.2 Background Screening demonstrate competence in, at least the following items: 2.2.0.6 Discipline Measures e. The names of the children for whom the caregiver/ 2.2.0.7 Handling Physical Aggression, Biting, and Hitting 2.2.0.8 Preventing Expulsions, Suspensions, and Other teacher will be responsible and their specific develop- mental and special health care needs Limitations in Services f. The planned program of activities at the facility 2.2.0.9 Prohibited Caregiver/Teacher Behaviors g. Routines and transitions 3.1.4.4 Scheduled Rest Periods and Sleep Arrangements h. Acceptable methods of discipline 3.2.1.1 Type of Diapers Worn i. Meal patterns and safe food-handling policies of the 3.2.2.1 Situations that Require Hand Hygiene facility (Special attention should be given to life- 3.2.2.2 Handwashing Procedure threatening food allergies.) 3.2.2.3 Assisting Children with Hand Hygiene j. Emergency health and safety procedures 3.2.2.4 Training and Monitoring for Hand Hygiene k. General health policies and procedures as appropriate 3.2.2.5 Hand Sanitizers for the ages of the children cared for, including, but not 3.2.3.4 Prevention of Exposure to Blood and Body Fluids limited to 1. Hand hygiene techniques, including indications for hand hygiene
36 Caring for Our Children: National Health and Safety Performance Standards 3.4.3.1 Emergency Procedures CCHCs have knowledge of resources and regulations 3.4.3.2 Use of Fire Extinguishers and are comfortable linking health resources with child 3.4.3.3 Response to Fire and Burns care facilities. 5.4.1.1 General Requirements for Toilet and The child care health consultant should be knowledgeable in the following areas: Handwashing Areas a. Consultation skills both as a child care health consul- 5.4.1.2 Location of Toilets and Privacy Issues 5.4.1.3 Ability to Open Toilet Room Doors tant as well as a member of an interdisciplinary team 5.4.1.4 Preventing Entry to Toilet Rooms by Infants and of consultants; b. National health and safety standards for out-of-home Toddlers child care; 5.4.1.5 Chemical Toilets c. Indicators of quality early care and education; 5.4.1.6 Ratios of Toilets, Urinals, and Hand Sinks to d. Day-to-day operations of child care facilities; e. State child care licensing and public health requirements; Children f. State health laws, Federal and State education laws (e.g., 5.4.1.7 Toilet Learning/Training Equipment ADA, IDEA), and state professional practice acts for 5.4.1.8 Cleaning and Disinfecting Toileting Equipment licensed professionals (e.g., State Nurse Practice Acts); 5.4.1.9 Waste Receptacles in the Child Care Facility g. Infancy and early childhood development, social and emotional health, and developmentally appropriate and in Child Care Facility Toilet Room(s) practice; 5.4.5.1 Sleeping Equipment and Supplies h. Recognition and reporting requirements for infectious 5.4.5.2 Cribs diseases; 5.4.5.3 Stackable Cribs i. American Academy of Pediatrics (AAP) and Early and 5.4.5.4 Futons Periodic Screening, Diagnosis, and Treatment (EPSDT) 5.4.5.5 Bunk Beds screening recommendations and immunizations 9.2.2.3 Exchange of Information at Transitions schedules for children; 9.2.3.11 Food and Nutrition Service Policies and Plans j. Importance of medical home and local and state 9.2.3.12 Infant Feeding Policy resources to facilitate access to a medical home as 9.2.4.1 Written Plan and Training for Handling Urgent well as child health insurance programs including Medicaid and State Children’s Health Insurance Medical Care or Threatening Incidents Program (SCHIP); 9.2.4.2 Review of Written Plan for Urgent Care k. Injury prevention for children; 9.4.1.18 Records of Nutrition Service l. Oral health for children; Appendix D: Gloving m. Nutrition and age-appropriate physical activity recommendations for children including feeding of References infants and children, the importance of breastfeeding and the prevention of obesity; 1. Landry SH, Zucker TA, Taylor HB, et al. Enhancing early child care quality n. Inclusion of children with special health care needs, and learning for toddlers at risk: the responsive early childhood program. and developmental disabilities in child care; Dev Psychol. 2014;50(2):526–541 o. Safe medication administration practices; p. Health education of children; 2. Ellenbogen S, Klein B, Wekerle C. Early childhood education as a resilience q. Recognition and reporting requirements for child abuse intervention for maltreated children. Early Child Dev Care. 2014;184:1364– and neglect/child maltreatment; 1377 r. Safe sleep practices and policies (including reducing the risk of SIDS); 3. Ball HL, Volpe LE. Sudden infant death syndrome (SIDS) risk reduction s. Development and implementation of health and safety and infant sleep location—moving the discussion forward. Soc Sci Med. policies and practices including poison awareness and 2013;79:84–91 poison prevention; t. Staff health, including adult health screening, occupa- NOTES tional health risks, and immunizations; Content in the STANDARD was modified on 5/22/2018 u. Disaster planning resources and collaborations within child care community; 1.6 v. Community health and mental health resources for CONSULTANTS child, parent/guardian and staff health; w. Importance of serving as a healthy role model for 1.6.0.1 children and staff. Child Care Health Consultants A facility should identify and engage/partner with a child care health consultant (CCHC) who is a licensed health professional with education and experience in child and community health and child care and preferably specialized training in child care health consultation.
37 Chapter 1: Staffing The child care health consultant should be able to perform t. Working with other consultants such as nutritionists/ or arrange for performance of the following activities: RDs, kinesiologists (physical activity specialists), oral a. Assessing caregivers’/teachers’ knowledge of health, health consultants, social service workers, early child- hood mental health consultants, and education development, and safety and offering training as consultants. indicated; b. Assessing parents’/guardians’ health, development, and The role of the CCHC is to promote the health and develop- safety knowledge, and offering training as indicated; ment of children, families, and staff and to ensure a healthy c. Assessing children’s knowledge about health and safety and safe child care environment (11). and offering training as indicated; The CCHC is not acting as a primary care provider at d. Conducting a comprehensive indoor and outdoor health the facility but offers critical services to the program and and safety assessment and on-going observations of the families by sharing health and developmental expertise, child care facility; assessments of child, staff, and family health needs and e. Consulting collaboratively on-site and/or by telephone community resources. The CCHC assists families in care or electronic media; coordination with the medical home and other health and f. Providing community resources and referral for health, developmental specialists. In addition, the CCHC should mental health and social needs, including accessing collaborate with an interdisciplinary team of early child- medical homes, children’s health insurance programs hood consultants, such as, early childhood education, (e.g., CHIP), and services for special health care needs; mental health, and nutrition consultants. g. Developing or updating policies and procedures for In order to provide effective consultation and support child care facilities (see comment section below); to programs, the CCHC should avoid conflict of interest h. Reviewing health records of children; related to other roles such as serving as a caregiver/teacher i. Reviewing health records of caregivers/teachers; or regulator or a parent/guardian at the site to which child j. Assisting caregivers/teachers and parents/guardians care health consultation is being provided. in the management of children with behavioral, social The CCHC should have regular contact with the facility’s and emotional problems and those with special health administrative authority, the staff, and the parents/guard- care needs; ians in the facility. The administrative authority should k. Consulting a child’s primary care provider about the review, and collaborate with the CCHC in implementing child’s individualized health care plan and coordinating recommended changes in policies and practices. In the case services in collaboration with parents/guardians, the pri- of consulting about children with special health care needs, mary care provider, and other health care professionals the CCHC should have contact with the child’s medical (the CCHC shows commitment to communicating with home with permission from the child’s parent/guardian. and helping coordinate the child’s care with the child’s Programs with a significant number of non-English- medical home, and may assist with the coordination of speaking families should seek a CCHC who is culturally skilled nursing care services at the child care facility); sensitive and knowledgeable about community health l. Consulting with a child’s primary care provider about resources for the parents’/guardians’ native culture medications as needed, in collaboration with parents/ and languages. guardians; m. Teaching staff safe medication administration practices; RATIONALE n. Monitoring safe medication administration practices; CCHCs provide consultation, training, information and o. Observing children’s behavior, development and health referral, and technical assistance to caregivers/teachers (10). status and making recommendations if needed to staff Growing evidence suggests that CCHCs support healthy and parents/guardians for further assessment by a and safe early care and education settings and protect and child’s primary care provider; promote the healthy growth and development of children p. Interpreting standards, regulations and accreditation and their families (1-10). Setting health and safety policies requirements related to health and safety, as well as in cooperation with the staff, parents/guardians, health providing technical advice, separate and apart from professionals, and public health authorities will help ensure an enforcement role of a regulation inspector or deter- successful implementation of a quality program (3). The mining the status of the facility for recognition; specific health and safety consultation needs for an individ- q. Understanding and observing confidentiality ual facility depend on the characteristics of that facility requirements; (1-2). All facilities should have an overall child care r. Assisting in the development of disaster/emergency health consultation plan (1,2,10). medical plans (especially for those children with special The special circumstances of group care may not be part health care needs) in collaboration with community of the health care professional’s usual education. Therefore, resources; caregivers/teachers should seek child care health consul- s. Developing an obesity prevention program in consulta- tants who have the necessary specialized training or experi- tion with a nutritionist/registered dietitian (RD) and ence (10). Such training is available from instructors who physical education specialist;
38 Caring for Our Children: National Health and Safety Performance Standards are graduates of the National Training Institute for Child organizations, other non-profit organizations, and/or Care Health Consultants (NTI) and in some states from universities. Some professional organizations include child state-level mentoring of seasoned child care health con- care health consultants in their special interest groups, sultants known to chapter child care contacts networked such as the AAP’s Section on Early Education and Child through the Healthy Child Care America (HCCA) Care and the National Association of Pediatric Nurse initiatives of the AAP. Practitioners (NAPNAP). Some professionals may not have the full range of knowl- CCHCs who are not employees of health, education, family edge and expertise to serve as a child care health consultant service or child care agencies may be self-employed. Com- but can provide valuable, specialized expertise. For exam- pensating them for their services via fee-for-service, an ple, a sanitarian may provide consultation on hygiene and hourly rate, or a retainer fosters access and accountability. infectious disease control and a Certified Playground Safety Listed below is a sample of the policies and procedures child Inspector would be able to provide consultation about gross care health consultants should review and approve: motor play hazards. a. Admission and readmission after illness, including COMMENTS inclusion/exclusion criteria; The U.S. Department of Health and Human Services b. Health evaluation and observation procedures on Maternal and Child Health Bureau (MCHB) has supported the development of state systems of child care health con- intake, including physical assessment of the child and sultants through HCCA and State Early Childhood Com- other criteria used to determine the appropriateness prehensive Systems grants. Child care health consultants of a child’s attendance; provide services to centers as well as family child care homes c. Plans for care and management of children with through on-site visits as well as phone or email consultation. communicable diseases; Approximately twenty states are funding child care health d. Plans for prevention, surveillance and management consultant initiatives through a variety of funding sources, of illnesses, injuries, and behavioral and emotional including Child Care Development Block Grants, TANF, problems that arise in the care of children; and Title V. In some states a wide variety of health consul- e. Plans for caregiver/teacher training and for communica- tants, e.g., nutrition, kinesiology (physical activity), mental tion with parents/guardians and primary care providers; health, oral health, environmental health, may be available f. Policies regarding nutrition, nutrition education, to programs and those consultants may operate through a age-appropriate infant and child feeding, oral health, team approach. Connecticut is an example of one state that and physical activity requirements; has developed interdisciplinary training for early care and g. Plans for the inclusion of children with special health or education consultants (health, education, mental health, mental health care needs as well as oversight of their social service, nutrition, and special education) in order to care and needs; develop a multidisciplinary approach to consultation (8). h. Emergency/disaster plans; Some states offer CCHC training with continuing educa- i. Safety assessment of facility playground and indoor play tion units, college credit, and/or a certificate of completion. equipment; Credentialing is an umbrella term referring to the various j. Policies regarding staff health and safety; means employed to designate that individuals or organiza- k. Policy for safe sleep practices and reducing the risk tions have met or exceeded established standards. These of SIDS; may include accreditation of programs or organizations l. Policies for preventing shaken baby syndrome/abusive and certification, registration, or licensure of individuals. head trauma; Accreditation refers to a legitimate state or national organi- m. Policies for administration of medication; zation verifying that an educational program or organiza- n. Policies for safely transporting children; tion meets standards. Certification is the process by which o. Policies on environmental health – handwashing, a non-governmental agency or association grants recognition sanitizing, pest management, lead, etc. to an individual who has met predetermined qualifications specified by the agency or association. Certification is TYPE OF FACILITY applied for by individuals on a voluntary basis and repre- Center, Large Family Child Care Home sents a professional status when achieved. Typical qualifica- tions include 1) graduation from an accredited or approved RELATED STANDARDS program and 2) acceptable performance on a qualifying 1.6.0.3 Early Childhood Mental Health Consultants examination. While there is no national accreditation of 1.6.0.4 Early Childhood Education Consultants CCHC training programs or individual CCHCs at this time, this is a future goal. References CCHC services may be provided through the public health system, resource and referral agency, private source, 1. Alkon, A., J. Bernzweig, K. To, J. K. Mackie, M. Wolff, J. Elman. 2008. local community action program, health professional Child care health consultation programs in California: Models, services, and facilitators. Public Health Nurs 25:126-39. 2. Alkon, A., J. Farrer, J. Bernzweig. 2004. Roles and responsibilities of child care health consultants: Focus group findings. Pediatric Nurs 30:315-21. 3. Crowley, A. A. 2000. Child care health consultation: The Connecticut experience. Maternal Child Health J 4:67-75.
39 Chapter 1: Staffing 4. Gupta, R. S., S. Shuman, E. M. Taveras, M. Kulldorff, J. A. Finkelstein. consultant improves health policies and health and safety 2005. Opportunities for health promotion education in child care. practices and improves children’s immunization status, Pediatrics 116:499-505. access to a medical home, enrollment in health insurance, timely screenings, and potentially reduces the prevalence 5. Farrer, J., A. Alkon, K. To. 2007. Child care health consultation pro- of obesity with a targeted intervention (5-11). Furthermore, grams: Barriers and opportunities. Maternal Child Health J 11:111-18. in one state, child care center medication administration regulatory compliance was associated with weekly visits by 6. Heath, J. M., et al. 2005. Creating a statewide system of multi-disciplinary a trained nurse child care health consultant who delivered consultation system for early care and education in Connecticut. a standardized best practice curriculum (12). Farmington, CT: Child Health and Development Institute of Connecticut. http://nitcci.nccic.acf.hhs.gov/resources/10262005_93815_901828.pdf. COMMENTS State child care regulations display a wide range of fre- 7. Crowley, A. A., J. M Kulikowich. 2009. Impact of training on child care quency and recommendations in states that require CCHC health consultant knowledge and practice. Pediatric Nurs 35:93-100. visits (5,6,13), from as frequently as once a week for pro- grams serving children under three years of age to twice 8. Crowley, A. A., R. M. Sabatelli. 2008. Collaborative child care health a year for programs serving children three to five years consultation: A conceptual model. J for Specialists in Pediatric Nurs of age (2,5,6,13). 13:74-88. TYPE OF FACILITY 9. Dellert, J. C., D. Gasalberti, K. Sternas, P. Lucarelli, J. Hall. 2006. Center, Large Family Child Care Home Outcomes of child care health consultation services for child care providers in New Jersey: A pilot study. Pediatric Nurs 32:530-37. RELATED STANDARDS 1.1.1.3 Ratios for Facilities Serving Children with 10. 1Alkon, A., J. Bernzweig, K. To, M. Wolff, J. F. Mackie. 2009. Child care health consultation improves health and safety policies and practices. Special Health Care Needs and Disabilities Academic Pediatrics 9:366-70. 1.6.0.1 Child Care Health Consultants 1.6.0.5 Specialized Consultation for Facilities Serving 11. 1Crowley, A. A. 2001. Child care health consultation: An ecological model. J Society Pediat Nurs 6:170-81. Children with Disabilities 3.6.2.7 Child Care Health Consultants for Facilities That 1.6.0.2 Frequency of Child Care Health Care for Children Who Are Ill Consultation Visits 4.4.0.1 Food Service Staff by Type of Facility and Food The child care health consultant (CCHC) should visit each Service facility as needed to review and give advice on the facility’s 4.6.0.2 Nutritional Quality of Food Brought From Home health component and review the overall health status of 9.4.1.17 Documentation of Child Care Health the children and staff (1-4). Early childhood programs that serve any child younger than three years of age should be Consultation/Training Visits visited at least once monthly by a health professional with 10.3.4.3 Support for Consultants to Provide Technical general knowledge and skills in child health and safety and health consultation. Child care programs that serve Assistance to Facilities children three to five years of age should be visited at least 10.3.4.4 Development of List of Providers of Services to quarterly and programs serving school-age children should be visited at least twice annually. In all cases, the frequency Facilities of visits should meet the needs of the composite group of children and be based on the needs of the program for References training, support, and monitoring of child health and safety needs, including (but not limited to) infectious 1. Alkon, A., J. Bernzweig, K. To, J. K. Mackie, M. Wolff, J. Elman. 2008. disease, injury prevention, safe sleep, nutrition, oral health, Child care health consultation programs in California: Models, services, physical activity and outdoor learning, emergency prepara- and facilitators. Public Health Nurs 25:126-39. tion, medication administration, and the care of children with special health care needs. Written documentation of 2. Crowley, A. A. 2000. Child care health consultation: The Connecticut CCHC visits should be maintained at the facility. experience. Maternal Child Health J 4:67-75. RATIONALE Almost everything that goes on in a facility and almost 3. Dellert, J. C., D. Gasalberti, K. Sternas, P. Lucarelli, J. Hall. 2006. everything about the facility itself affects the health of the Outcomes of child care health consultation services for child care children, families, and staff. (1-4). Because infants are devel- providers in New Jersey: A pilot study. Pediatric Nursing 32:530-37. oping rapidly, environmental situations can quickly create harm. Their rapid changes in behavior make regular and 4. Gupta, R. S., S. Shuman, E. M. Taveras, M. Kulldorff, J. A. Finkelstein. frequent visits by the CCHC extremely important (2-4). 2005. Opportunities for health promotion education in child care. More frequent visits should be arranged for those facilities Pediatrics 116:499-505. that care for children with special health care needs and those programs that experience health and safety problems 5. Healthy Child Care Consultant Network Support Center, CHT Resource and high turnover rate to ensure that staff have adequate Group. 2006. The influence of child care health consultants in promoting training and ongoing support (2). In one study, 84% of child children’s health and well-being: A report on selected resources. http:// care directors who were required to have weekly health hcccnsc.jsi.com/resources/publications/CC_lit_review_Screen_All.pdf. consultation visits considered the visits critical for chil- dren’s health and program health and safety (2). Growing 6. Alkon, A., J. Bernzweig, K. To, M. Wolff, J. F. Mackie. 2009. Child care evidence suggests that frequent visits by a trained health health consultation improves health and safety policies and practices. Academic Pediatrics 9:366-70. 7. Crowley, A. A. & Kulikowich, J. Impact of training on child care health consultant knowledge and practice. Pediatric Nursing. 2009, 35 (2): 93-100. 8. Nurse Consultant Intervention Improves Nutrition and Physical Activity Knowledge, Policy, and Practice and Reduces Obesity in Child Care. A. Crowley, A. Alkon, B Neelon, S. Hill, P. Yi, E. Savage, V. Ngyuen, J. Kotch. Head Start Research Conference, Washington, DC. June 20, 2012.
40 Caring for Our Children: National Health and Safety Performance Standards 9. Benjamin, S. E., A. Ammerman, J. Sommers, J. Dodds, B. Neelon, D. S. f. Helping address mental health needs and reduce job Ward. 2007. Nutrition and physical activity self-assessment for child care stress within the staff; (NAP SACC): Results from a pilot intervention. Journal of Nutrition Education and Behavior 39(3):142-9. g. Improving management of children with challenging behaviors; 10. Bryant, D. “Quality Interventions for Early Care and Education.” Early Developments, Spring 2013, http://fpg.unc.edu/sites/default/files/ h. Preventing the development of problem behaviors; resources/early-developments/FPG_EarlyDevelopments_v14n1.pdf. i. Providing a classroom climate that promotes positive 11. Isbell P, Kotch JB, Savage E, Gunn E, Lu LS, Weber DJ. Improvement of social-emotional development; child care programs’ policies, practices, and children’s access to health j. Recognizing and appropriately responding to the care linked to child care health consultation. NHSA Dialog: A Research to Practice Journal 2013;16 (2):34-52 (ISSN:1930-1395). needs of children with internalizing behaviors, such as persistent sadness, anxiety, and social withdrawal; 12. Crowley, A. A. & Rosenthal, M. S. IMPACT: Ensuring the health and k. Actively teaching developmentally appropriate social safety of Connecticut’s early care and education programs. 2009. skills, conflict resolution, and emotional regulation; Farmington, CT: The Child Health and Development Institute of l. Addressing the mental health needs and daily stresses Connecticut. of those who care for young children, such as families and caregivers/teachers; 13. National Resource Center for Health and Safety in Child Care and Early m. Helping the staff to address and handle unforeseen crises Education. 2010. Child care health consultant requirements and profiles or bereavements that may threaten the mental health of by state. http://nrckids.org/default/assets/File/CCHC%20by%20state%20 staff or children and families, such as the death of a NOV%202012_FINAL.pdf. caregiver/teacher or the serious illness of a child. NOTES Content in the STANDARD was modified on 8/22/2013. RATIONALE As increasing numbers of children are spending longer hours 1.6.0.3 in child care settings, there is an increasing need to build the Early Childhood Mental Health Consultants capacity of caregivers/teachers to attend to the social-emo- tional and behavioral well-being of children as well as their A facility should engage a qualified early childhood mental health and learning needs. Early childhood mental health health consultant who will assist the program with a range underlies much of what constitutes school readiness, includ- of early childhood social-emotional and behavioral issues ing emotional and behavioral regulation, social skills (i.e., and who will visit the program at minimum quarterly and taking turns, postponing gratification), the ability to more often as needed. inhibit aggressive or anti-social impulses, and the skills to The knowledge base of an early childhood mental health verbally express emotions, such as frustration, anger, anxiety, consultant should include: and sadness. Supporting children’s health, mental health a. Training, expertise and/or professional credentials in and learning requires a comprehensive approach. Child care programs need to have health, education, and mental mental health (e.g., psychiatry, psychology, clinical health consultants who can help them implement universal, social work, nursing, developmental-behavioral selected and targeted strategies to improve school readiness medicine, etc.); in young children in their care (1-5). Mental health consul- b. Early childhood development (typical and atypical) of tants in collaboration with education and child care health infants, toddlers, and preschool age children; consultants can reduce the risk for children being expelled, c. Early care and education settings and practices; can reduce levels of problem behaviors, increase social skills d. Consultation skills and approaches to working as a team and build staff efficacy and capacity (1-11). with early childhood consultants from other disciplines, especially health and education consultants, to effec- COMMENTS tively support directors and caregivers/teachers. Access to an early childhood mental health consultant The role of the early childhood mental health consultant should be in the context of an ongoing relationship, with should be focused on building staff capacity and be both at least quarterly regular visits to the classroom to consult. proactive in decreasing the incidence of challenging class- However, even an on-call-only relationship is better than room behaviors and reactive in formulating appropriate no relationship at all. Regardless of the frequency of con- responses to challenging classroom behaviors and should tact, this relationship should be established before a crisis include: arises, so that the consultant can establish a useful proactive a. Developing and implementing classroom curricula working relationship with the staff and be quickly mobilized regarding conflict resolution, emotional regulation, when needs arise. This consultant should be viewed as an and social skills development; important part of the program’s support staff and should b. Developing and implementing appropriate screening collaborate with all regular classroom staff, administration, and referral mechanisms for behavioral and mental and other consultants such as child care health consultants health needs; and education consultants, and support staff. In most cases, c. Forming relationships with mental health providers there is no single place in which to look for early childhood and special education systems in the community; d. Providing mental health services, resources and/or referral systems for families and staff; e. Helping staff facilitate and maintain mentally healthy environments within the classroom and overall system;
41 Chapter 1: Staffing mental health consultants. Qualified potential consultants written plan for this consultation which must be signed may be identified by contacting mental health and behav- annually by the consultant. This plan should outline the ioral providers (e.g., child clinical and school psychologists, responsibilities of the consultant and the services the licensed clinical social workers, child psychiatrists, develop- consultant will provide to the program. mental pediatricians, etc.), as well as training programs at The knowledge base of an early childhood education local colleges and universities where these professionals are consultant should include: being trained. Colleges and universities may be a good place a. Working knowledge of theories of child development to find well-supervised consultants-in-training at a poten- tially reasonable cost, although consultant turnover may and learning for children from birth through eight be higher. years across domains, including socio-emotional development and family development; TYPE OF FACILITY b. Principles of health and wellness across the domains, Center, Large Family Child Care Home including social and emotional wellness and approaches in the promotion of healthy development and resilience; RELATED STANDARDS c. Current practices and materials available related to 1.6.0.1 Child Care Health Consultants screening, assessment, curriculum, and measurement 1.6.0.4 Early Childhood Education Consultants of child outcomes across the domains, including prac- tices that aid in early identification and individualizing References for a wide range of needs; d. Resources that aid programs to support inclusion of 1. Brennan, E. M., J. Bradley, M. D. Allen, D. F. Perry. 2008. The evidence children with diverse health and learning needs and base for mental health consultation in early childhood settings: A research families representing linguistic, cultural, and economic syn- thesis addressing staff and program outcomes. Early Ed Devel diversity of communities; 19:982-1022. e. Methods of coaching, mentoring, and consulting that meet the unique learning styles of adults; 2. National Scientific Council on the Developing Child. 2008. Mental health f. Familiarity with local, state, and national regulations, problems in early childhood can impair learning and behavior for life. standards, and best practices related to early education Working Paper no. 6. http://developingchild.harvard.edu/library/ and care; reports_and_working_papers/working_papers/wp6/. g. Community resources and services to identify and serve families and children at risk, including those 3. Perry, D. F., M. D. Allen, E. M. Brennan, J. R. Bradley. 2010. The evidence related to child abuse and neglect and parent education; base for mental health consultation in early childhood settings: A research h. Consultation skills as well as approaches to working synthesis addressing children’s behavioral outcomes. Early Ed Devel as a team with early childhood consultants from other 21:795-824. disciplines, especially child care health consultants, to effectively support program directors and their staff. 4. Perry, D. F., R. Kaufmann, J. Knitzer. 2007. Early childhood social and The role of the early childhood education consultant emotional health: Building bridges between services and systems. should include: Baltimore, MD: Paul Brookes Publishing. a. Review of the curriculum and written policies, plans and procedures of the program; 5. Perry, D. F., M. C. Dunne, L. McFadden, D. Campbell. 2008. Reducing b. Observations of the program and meetings with the the risk for preschool expulsion: Mental health consultation for young director, caregivers/teachers, and parents/guardians; children with challenging behaviors. J Child Fam Studies 17:44-54. c. Review of the professional needs of staff and program and provision of recommendations of current resources; 6. Committee on Integrating the Science of Early Childhood Development, d. Reviewing and assisting directors in implementing and Board on Children, Youth, and Families. 2000. From neurons to neighbor- monitoring evidence based approaches to classroom hoods. Ed. J. P. Shonkoff, D. A. Phillips. Washington, DC: National management; Academy Press. e. Maintaining confidences and following all Family Educational Rights and Privacy Act (FERPA) 7. Gilliam, W. S. 2005. Prekindergarteners left behind: Expulsion rates in state regulations regarding disclosures; prekindergarten programs. Foundation for Child Development (FCD). Policy f. Keeping records of all meetings, consultations, recom- Brief Series no. 3. New York: FCD. http://www.challengingbehavior.org/ mendations and action plans and offering/providing explore/policy_docs/prek _expulsion.pdf. summary reports to all parties involved; g. Seeking and supporting a multidisciplinary approach 8. Gilliam, W. S., G. Shahar. 2006. Preschool and child care expulsion and to services for the program, children and families; suspension: Rates and predictors in one state. Infants Young Children h. Following the National Association for the Education 19:228-45. of Young Children (NAEYC) Code of Ethics; i. Availability by telecommunication to advise regarding 9. Gilliam, W. S. 2007. Early Childhood Consultation Partnership: Results of a practices and problems; random-controlled evaluation. New Haven, CT: Yale Universty. http://www. chdi.org/admin/uploads/5468903394946c41768730.pdf. 10. American Academy of Pediatrics, Committee on School Health. 2003. Policy statement: Out-of-school suspension and expulsion. Pediatrics 112:1206-9. 11. Duran, F., K. Hepburn, M. Irvine, R. Kaufmann, B. Anthony, N. Horen, D. Perry. 2009. What works?: A study of effective early childhood mental health consultation programs. Washington, DC: Georgetown University Center for Child and Human Development. http://gucchdtacenter.georgetown.edu/ publications/ECMHCStudy _Report.pdf. 1.6.0.4 Early Childhood Education Consultants A facility should engage an early childhood education consul- tant who will visit the program at minimum semi-annually and more often as needed. The consultant must have a mini- mum of a Baccalaureate degree and preferably a Master’s degree from an accredited institution in early childhood education, administration and supervision, and a minimum of three years in teaching and administration of an early care/education program. The facility should develop a
42 Caring for Our Children: National Health and Safety Performance Standards j. Availability for on-site visit to consult to the program; b. A physician with pediatric experience, especially those k. Familiarity with tools to evaluate program quality, such with developmental-behavioral training; as the Early Childhood Environment Rating Scale– c. A registered dietitian; Revised (ECERS–R), Infant/Toddler Environment d. A psychologist; Rating Scale–Revised (ITERS–R), Family Child Care e. A psychiatrist; Environment Rating Scale–Revised (FCCERS–R), f. A physical therapist; School-Age Care Environment Rating Scale (SACERS), g. An adaptive equipment technician; Classroom Assessment Scoring System (CLASS), as well h. An occupational therapist; as tools used to support various curricular approaches. i. A speech pathologist; j. An audiologist for hearing screenings conducted RATIONALE The early childhood education consultant provides an objec- on-site at child care; tive assessment of a program and essential knowledge about k. A vision screener; implementation of child development principles through l. A respiratory therapist; curriculum which supports the social and emotional health m. A social worker; and learning of infants, toddlers and preschool age children n. A parent/guardian of a child with special health care (1-5). Furthermore, utilization of an early childhood edu- cation consultant can reduce the need for mental health needs; consultation when challenging behaviors are the result of o. Part C representative/service coordinator; developmentally inappropriate curriculum (6,7). Together p. A mental health consultant; with the child care health consultant, the early childhood q. Special learning consultant/teacher (e.g., teacher education consultant offers core knowledge for addressing children’s healthy development. specializing in work with visually impaired child or sign language interpreters); TYPE OF FACILITY r. A teacher with special education expertise; Center, Large Family Child Care Home s. The caregiver/teacher; t. Individuals identified by the parent/guardian; RELATED STANDARDS u. Certified child passenger safety technician with training 1.6.0.1 Child Care Health Consultants in safe transportation of children with special needs. 1.6.0.3 Early Childhood Mental Health Consultants RATIONALE The range of professionals needed may vary with the References facility, but the listed professionals should be available as consultants when needed. These professionals need not 1. Dunn, L., K. Susan. 1997. What have we learned about developmentally be on staff at the facility, but may simply be available when appropriate practice? Young Children 52:4-13. needed through a variety of arrangements, including con- tracts, agreements, and affiliations. The parent’s participa- 2. Wesley, P. W., V. Buysse. 2006. Ethics and evidence in consultation. Topics tion and written consent in the native language of the Early Childhood Special Ed 26:131-41. parent, including Braille/sign language, is required to include outside consultants (1). 3. Wesley, P. W., S. A. Palsha. 1998. Improving quality in early childhood TYPE OF FACILITY environments through on-site consultation. Topics Early Childhood Center, Large Family Child Care Home Special Ed 18:243-53. Reference 4. Wesley, P. W., V. Buysee. 2005. Consultation in early childhood settings. 1. Cohen, A. J. 2002. Liability exposure and child care health consultation. Baltimore, MD: Brookes Publishing. http://www.ucsfchildcarehealth.org/pdfs/forms/CCHCLiability.pdf. 5. Bredekamp, S., C. Copple, eds. 2000. Developmentally appropriate practice 1.7 in early childhood programs serving children from birth through age 8. STAFF HEALTH Rev ed. National Association for the Education of Young Children (NAEYC). Publication no. 234. Washington, DC: NAEYC. http://www. 1.7.0.1 naeyc.org/files/naeyc/file/positions/position statement Web.pdf. Pre-Employment and Ongoing Adult Health Appraisals, Including Immunization 6. The Connecticut Early Education Consultation Network. CEECN: Guidance, leadership, support. http://ctconsultationnetwork.org. All paid and volunteer staff members should have a health appraisal before their first involvement in child care work. 7. Connecticut Department of Public Health. Child day care licensing The appraisal should identify any accommodations required program. http://www.ct.gov/dph/cwp/view.asp?a=3141&Q=387158&dphNav_ of the facility for the staff person to function in his or her GID=1823/. assigned position. 1.6.0.5 Specialized Consultation for Facilities Serving Children with Disabilities When children at the facility include those with special health care needs, developmental delay or disabilities, and mental health or behavior problems, the staff or docu- mented consultants should involve any of the following consultants in the child’s care, with prior informed, written parental consent and as appropriate to each child’s needs: a. A registered nurse, nurse practitioner with pediatric experience, or child care health consultant;
43 Chapter 1: Staffing Health appraisals for paid and volunteer staff members to adjust the activities of that person. For example, child should include: care facilities typically require the following activities a. Physical exam; of caregivers: b. Dental exam; c. Vision and hearing screening; a. Moving quickly to supervise and assist young children; d. The results and appropriate follow up of a tuberculosis b. Lifting children, equipment, and supplies; c. Sitting on the floor and on child-sized furniture; (TB) screening, using the Tuberculin Skin Test (TST) d. Washing hands frequently; or IGRA (interferon gamma release assay), once upon e. Responding quickly in case of an emergency; entering into the child care field with subsequent TB f. Eating the same food as is served to the children screening as determined by history of high risk for TB thereafter; (unless the staff member has dietary restrictions); e. A review and certification of up-to-date immune status g. Hearing and seeing at a distance required for per the current Recommended Adult Immunization Schedule found in Appendix H, including annual playground supervision or driving; influenza vaccination and up to date Tdap; h. Being absent from work for illness no more often than f. A review of occupational health concerns based on the performance of the essential functions of the job. the typical adult, to provide continuity of caregiving All adults who reside in a family child care home who are relationships for children in child care. considered to be at high risk for TB, should have completed TB screening (1) as specified in Standard 7.3.10.1. Adults Healthy Young Children: A Manual for Programs, from the who are considered at high risk for TB include those who National Association for the Education of Young Children are foreign-born, have a history of homelessness, are HIV- (NAEYC), provides a model form for an assessment by a infected, have contact with a prison population, or have health professional. See also Model Child Care Health contact with someone who has active TB. Policies, from NAEYC and from the American Academy Testing for TB of staff members with previously negative of Pediatrics (AAP). skin tests should not be repeated on a regular basis unless required by the local or state health department. A record Concern about the cost of health exams (particularly when of test results and appropriate follow-up evaluation should many caregivers/teachers do not receive health benefits and be on file in the facility. earn minimum wage) is a barrier to meeting this standard. When staff members need hepatitis B immunization to meet RATIONALE Occupational Safety and Health Administration (OSHA) Caregivers/teachers need to be physically and emotionally requirements (4), the cost of this immunization may or may healthy to perform the tasks of providing care to children. not be covered under a managed care contract. If not, the Performing their work while ill can spread infectious cost of health supervision (such as immunizations, dental disease and illness to other staff and the children in their and health exams) must be covered as part of the employee’s care (2). Under the Americans with Disabilities Act (ADA), preparation for work in the child care setting by the prospec- employers are expected to make reasonable accommoda- tive employee or the employer. Child care workers are among tions for persons with disabilities. Under ADA, accommo- those for whom annual influenza vaccination is strongly dations are based on an individual case by case situation. recommended. Undue hardship is defined also on a case by case basis. Accommodation requires knowledge of conditions that Facilities should consult with ADA experts through the U.S. must be accommodated to ensure competent function Department of Education funded Disability and Business of staff and the well-being of children in care (3). Technical Assistance Centers (DBTAC) throughout the coun- Since detection of tuberculosis using screening of healthy try. These centers can be reached by calling 1-800-949-4232 individuals has a low yield compared with screening of con- (callers are routed to the appropriate region) or by accessing tacts of known cases of tuberculosis, public health authori- regional center’s contacts directly at http://adata.org/Static/ ties have determined that routine repeated screening of Home.aspx. healthy individuals with previously negative skin tests is not a reasonable use of resources. Since local circumstances and TYPE OF FACILITY risks of exposure may vary, this recommendation should be Center, Large Family Child Care Home subject to modification by local or state health authorities. RELATED STANDARDS COMMENTS 1.7.0.3 Health Limitations of Staff Child care facilities should provide the job description or list of activities that the staff person is expected to perform. 1.7.0.4 Occupational Hazards Unless the job description defines the duties of the role specifically, under federal law the facility may be required 7.2.0.1 Immunization Documentation 7.2.0.2 Unimmunized Children 7.2.0.3 Immunization of Caregivers/Teachers 7.3.10.1 Measures for Detection, Control, and Reporting of Tuberculosis 7.3.10.2 Attendance of Children with Latent Tubercu- losis Infection or Active Tuberculosis Disease Appendix E: Child Care Staff Health Assessment
44 Caring for Our Children: National Health and Safety Performance Standards References b. After serious or prolonged illness; c. When their condition or health could affect promotion 1. Baldwin, D., S. Gaines, J. L. Wold, A. Williams. 2007. The health of female child care providers: Implications for quality of care. J Comm Health Nurs or reassignment to another role; 24:1-7. d. Before return from a job-related injury; e. If there are workers’ compensation issues or if the 2. Keyes, C. R. 2008. Adults with disabilities in early childhood settings. Child Care Info Exchange 179:82-85. facility is at risk of liability related to the employee’s or volunteer’s health problem. 3. Occupational Safety and Health Administration. 2008. Bloodborne If a staff member is found to be unable to perform the acti- pathogens. Title 29, pt. 1910.1030. http://www.osha.gov/pls/oshaweb/owadisp. vities required for the job because of health limitations, the show_document?p_table=standards&p _id=10051. staff person’s duties should be limited or modified until the health condition resolves or employment is terminated 4. Centers for Disease Control and Prevention. 2015. Recommended adult because the facility can prove that it would be an undue hard- immunization schedule – United States, 2015. http://www.cdc.gov/ ship to accommodate the staff member with the disability. vaccines/schedules/easy-to-read/adult.html. RATIONALE 1.7.0.2 Under the Americans with Disabilities Act (ADA), employ- Daily Staff Health Check ers are expected to make reasonable accommodations for persons with disabilities. Under ADA, accommodations are On a daily basis, the administrator of the facility or caregiver/ based on an individual case by case situation (1). Undue teacher should observe staff members, substitutes, and hardship is defined also on a case by case basis (1). volunteers for obvious signs of ill health. When ill, staff members, substitutes and volunteers may be directed to go COMMENTS home. Staff members, substitutes, and volunteers should be Facilities should consult with ADA experts through the U.S. responsible for reporting immediately to their supervisor Department of Education funded Disability and Business any injuries or illnesses they experience at the facility or Technical Assistance Centers throughout the country. elsewhere, especially those that might affect their health or These centers can be reached by calling 1-800-949-4232 the health and safety of the children. It is the responsibility and callers are routed to the appropriate region or access- of the administration, not the staff member who is ill or ing contacts directly at http://adata.org/Static/Home.aspx. injured, to arrange for a substitute caregiver/teacher. RATIONALE TYPE OF FACILITY Sometimes adults report to work when feeling ill or become Center, Large Family Child Care Home ill during the day but believe it is their responsibility to stay. The administrator’s or caregiver’s/teacher’s observation of RELATED STANDARDS illness followed by sending the staff member home may pre- 7.6.1.4 Informing Public Health Authorities of Hepatitis B vent the spread of illness. Arranging for a substitute caregiver/ teacher ensures that the children receive competent care (1,2). Virus (HBV) Cases COMMENTS 7.6.3.4 Ability of Caregivers/Teachers with HIV Infection Administrators and caregivers/teachers need guidelines to ensure proper application of this standard. For a demon- to Care for Children stration of how to implement this standard, see the video series, Caring for Our Children, available from National Reference Association for the Education of Young Children (NAEYC) and the American Academy of Pediatrics (AAP) (1). 1. ADA National Network. The Americans with Disabilities Act (ADA) from a TYPE OF FACILITY civil rights perspective. http://adaanniversary.org/2010/ap03_ada_ Center, Large Family Child Care Home civilrights/03_ada_civilrights_09_natl.pdf. References 1.7.0.4 1. Baldwin D., S. Gaines, J. L. Wold, A. Williams. 2007. The health of female Occupational Hazards child care providers: Implications for quality of care. J Comm Health Nurs 24:1-7. Written personnel policies of centers and large family child care homes should address the major occupational health 2. Murph, J. R., S. D. Palmer, D. Glassy, eds. 2005. Health in child care: A hazards for workers in child care settings. Special health manual for health professionals. 4th ed. Elk Grove Village, IL: American concerns of pregnant caregivers/teachers should be carefully Academy of Pediatrics. evaluated, and up-to-date information regarding occupa- tional hazards for pregnant caregivers/teachers should 1.7.0.3 be made available to them and other workers. The occupa- Health Limitations of Staff tional hazards including those regarding pregnant workers listed in Appendix B: Major Occupational Health Hazards, Staff and volunteers must have a primary care provider’s should be referenced and used in evaluations by caregivers/ release to return to work in the following situations: teachers and supervisors. a. When they have experienced conditions that may affect their ability to do their job or require an accommodation to prevent illness or injury in child care work related to their conditions (such as pregnancy, specific injuries, or infectious diseases);
45 Chapter 1: Staffing RATIONALE l. Stated provisions for back-up staff, for example, to allow Early care and education employees need to learn about caregivers/teachers to take necessary time off when ill and practice ways to minimize risk of illness and injury without compromising the function of the center or and promote wellness for themselves (1). As a workforce incurring personal negative consequences from the composed primarily of women of childbearing age, preg- employer (this back-up should also include a stated nancy is common among caregivers/teachers in child care plan to be implemented in the event a staff member settings. All female staff members of childbearing age needs to have a short, but relatively immediate break should be encouraged to discuss the potential exposure away from the children); to risks that could cause harm to their unborn child with their primary health care provider (1). m. Adult size furniture in the classroom for the staff; TYPE OF FACILITY n. Access to experts in child development and behavior to Center, Large Family Child Care Home RELATED STANDARD help problem solve child specific issues. 1.7.0.1 Pre-Employment and Ongoing Adult Health RATIONALE Appraisals, Including Immunization One of the best indicators of quality child care is consistent References staff with low turnover rates (5,6). According to the Bureau of Labor Statistics’ Website, “in 2007, hourly earnings of 1. Aronson, S. S., T. R. Shope, eds. 2017. Managing infectious diseases in nonsupervisory workers in the child day care services child care and schools: A quick reference guide, pp. 43-48. 4th Edition. industry averaged $10.53” (1). About 42% of all child care Elk Grove Village, IL: American Academy of Pediatrics. workers have a high school degree or less, reflecting the minimal training requirements for most jobs. Many child 1.7.0.5 care workers leave the industry due to stressful working Stress conditions and dissatisfaction with benefits and pay (1). Stress reduction measures (particularly adequate wages and Caregivers/teachers should be able to: reasonable health care benefits) contribute to decreased staff a. Identify risks associated with stress; turnover and thereby promote quality care (2). The health, b. Identify stressors specific to child caregiving; welfare, and safety of adult workers in child care determine c. Identify specific ways to manage stress in the child care their ability to provide care for the children. Serious physical abuse sometimes occurs when the caregiver/ environment. teacher is under high stress. Too much stress can not only The following measures to lessen stress for the staff should affect the caregiver’s/teacher’s health, but also the quality of be implemented to the maximum extent possible: the care that the adult is able to give. A caregiver/teacher a. Wages and benefits (including health care insurance) who is feeling too much stress may not be able to offer the praise, nurturing, and direction that children need for good that fairly compensate the skills, knowledge, and perfor- development (3). Regular breaks with substitutes when the mance required of caregivers/teachers, at the levels of caregiver/teacher cannot continue to provide safe care can wages and benefits paid for other jobs that require help ensure quality child care. comparable skills, knowledge, and performance; Sound-absorbing materials in the work area, break times, b. Job security; and a separate lounge allow for respite from noise and from c. Training to improve skills and hazard recognition; non-auditory stress. Unwanted sound, or noise, can be d. Stress management and reduction training; damaging to hearing as well as to psychosocial well-being. e. Written plan/policy in place for the situation in which a The stress effects of noise will aggravate other stress factors caregiver/teacher recognizes that s/he or a colleague is present in the facility. Lack of adequate sound reduction stressed and needs help immediately (the plan should measures in the facility can force the caregiver/teacher to allow for caregivers/teachers who feel they may lose speak at levels above those normally used for conversation, control to have a short, but relatively immediate break and thus may increase the risk of throat irritation. When away from the children at times of high stress); caregivers/teachers raise their voices to be heard, the f. Regular work breaks and paid time-off; children tend to raise theirs, escalating the problem. g. Appropriate child:staff ratios; h. Liability insurance for caregivers/teachers; COMMENTS i. Staff lounge separate from child care area with adult Documentation of implementation of stress reduction mea- size furniture; sures should be on file in the facility. Rest breaks of twenty j. The use of sound-absorbing materials in the workspace; minutes or less are customary in industry and are customar- k. Regular performance reviews which, in addition to ily paid for as working time. Meal periods (typically thirty addressing any areas requiring improvement, provide minutes or more) generally need not be compensated as constructive feedback, individualized encouragement work time as long as the employee is completely relieved and appreciation for aspects of the job well performed; from duty for the entire meal period (4). For resources on respite or crisis care, contact the ARCH National Respite Network at http://archrespite.org.
46 Caring for Our Children: National Health and Safety Performance Standards Caregivers/teachers who use tobacco can experience RATIONALE stress related to nicotine withdrawals. For help dealing with The quality and continuity of the child care workforce is the stress from tobacco addiction, see the Tobacco Research main determining factor of the quality of care. Nurturing the and Intervention Program’s Forever Free booklet on smok- nurturers is essential to prevent burnout and promote reten- ing, stress, and mood at http://www.smokefree.gov/pubs/ tion. Fair labor practices should apply to child care as well as FFree6.pdf . Or, for help quitting smoking, visit the other work settings. Child care workers should be considered Smoke Free Website at http://www.smokefree.gov. as worthy of benefits as workers in other careers. TYPE OF FACILITY Medical coverage should include the cost of the health Center, Large Family Child Care Home appraisals and immunizations required of child care work- RELATED STANDARDS ers, and care for the increased incidence of communicable 1.1.1.1 Ratios for Small Family Child Care Homes disease and stress-related conditions in this work setting. 1.1.1.2 Ratios for Large Family Child Care Homes and The potential for acquiring injuries and infections when caring for young children is a health and safety hazard for Centers child care workers. Information abounds about the risk of 1.1.1.3 Ratios for Facilities Serving Children with Special infectious disease for children in child care settings. Chil- dren are reservoirs for many infectious agents. Staff mem- Health Care Needs and Disabilities bers come into close and frequent contact with children and 1.1.1.4 Ratios and Supervision During Transportation their excretions and secretions and are vulnerable to these 1.1.1.5 Ratios and Supervision for Swimming, Wading, illnesses. In addition, many child care workers are women who are planning a pregnancy or who are pregnant, and and Water Play they may be vulnerable to potentially serious effects of infection on the outcome of pregnancy (2). References Sick leave is important to minimize the spread of communi- cable diseases and maintain the health of staff members. 1. U.S. Department of Labor, Bureau of Labor Statistics. 2010. Career guide to Sick leave promotes recovery from illness and thereby industries: Child day care services, 2010-11 Edition. http://www.bls.gov/oco/ decreases the further spread or recurrence of illness. cg/cgs032.htm. Workplace benefits contribute to higher morale and less staff turnover, and thus promote quality child care. Lack 2. U.S. Department of Labor, Bureau of Labor Statistics. 2010. Occupational of benefits is a major reason reported for high turnover of employment statistics: occupational employment and wages, May 2009. child care staff (1). http://www.bls.gov/oes/current/oes399011.htm. COMMENTS 3. Healthy Childcare Consultants (HCCI). Stress management for child Staff benefits may be appropriately addressed in center caregivers. Pelham, AL: HCCI. personnel policies and in state and federal labor standards. Not all the material that has to be addressed in these poli- 4. U.S. Department of Labor, Wage and Hour Division. 2009. Fact sheet #46: cies is appropriate for state child care licensing require- Daycare centers and preschools under the Fair Labor Standards Act (FLSA). ments. Having facilities acknowledge which benefits they Rev. ed. http://www.dol.gov/whd/regs/compliance/whdfs46.pdf. do provide will help enhance the general awareness of staff benefits among child care workers and other concerned 5. Fiene, R. 2002. 13 indicators of quality child care: Research update. parties. Currently, this standard is difficult for many facilities Washington, DC: U.S. Department of Health and Human Services, Office of to achieve, but new federal programs and shared access to the Assistant Secretary for Planning and Evaluation. http://aspe.hhs.gov/ small business benefit packages will help. Many options are basic-report/13-indicators-qualitychild-care. available for providing leave benefits and education reim- bursements, ranging from partial to full employer contribu- 6. National Institute of Child Health and Human Development (NICHD). tion, based on time employed with the facility. Caregivers/ 2006. The NICHD study of early child care and youth development: teachers should be encouraged to have health insurance. Findings for children up to age 4 1/2 years. Rockville, MD: NICHD. Health benefits can include full coverage, partial coverage (at least 75% employer paid), or merely access to group rates. 1.8 Some local or state child care associations offer reduced HUMAN RESOURCE MANAGEMENT group rates for health insurance for child care facilities and individual caregivers/teachers. 1.8.1 BENEFITS TYPE OF FACILITY Center, Large Family Child Care Home 1.8.1.1 Basic Benefits The following basic benefits should be offered to staff: a. Affordable health insurance; b. Paid time-off (vacation, sick time, personal leave, holidays, family, parental and medical leave, etc.); c. Social Security or other retirement plan; d. Workers’ compensation; e. Educational benefits. Centers and large family child care homes should have written policies that detail these benefits of employees at the facility.
47 Chapter 1: Staffing RELATED STANDARDS requirements, or by accrediting bodies (1). In some states, a 1.4.6.1 Training Time and Professional Development central Child Development Personnel Registry may track and certify the qualifications of staff. Leave 1.4.6.2 Payment for Continuing Education TYPE OF FACILITY 9.3.0.1 Written Human Resource Management Policies for Center, Large Family Child Care Home Centers and Large Family Child Care Homes RELATED STANDARDS References 1.4.4.1 Continuing Education for Directors and 1. Whitebook, M., C. Howes, D. Phillips. 1998. Worthy work, unlivable wages: Caregivers/Teachers in Centers and Large The national child care staffing study, 1988-1997. Washington, DC: Center for Family Child Care Homes the Child Care Workforce. 1.4.4.2 Continuing Education for Small Family Child Care Home Caregivers/Teachers 2. National Association for the Education of Young Children (NAEYC). 2008. 1.4.5.1 Training of Staff Who Handle Food Leadership and management: A guide to the NAEYC early childhood pro- 1.4.5.2 Child Abuse and Neglect Education gram standards and related accreditation criteria. Washington, DC: NAEYC. 1.4.5.3 Training on Occupational Risk Related to Handling Body Fluids 1.8.2 1.4.5.4 Education of Center Staff EVALUATION 1.4.6.1 Training Time and Professional Development Leave 1.4.6.2 Payment for Continuing Education 1.8.2.1 1.8.2.2 Annual Staff Competency Evaluation Staff Familiarity with Facility Policies, Plans and Procedures References All caregivers/teachers should be familiar with the provisions 1. National Association for the Education of Young Children (NAEYC). 2008. of the facility’s policies, plans, and procedures, as described Leadership and management: A guide to the NAEYC early childhood in Chapter 9: Administration. The compliance with these program standards and related accreditation criteria. Washington, DC: policies, plans, and procedures should be used in staff per- NAEYC. formance evaluations and documented in the personnel file. RATIONALE 2. Owens, C. 1997. Rights in the workplace: A guide for child care teachers. Written policies, plans and procedures provide a means of Washington, DC: Worker Option Resource Center. staff orientation and evaluation essential to the operation of any organization (1). 1.8.2.3 TYPE OF FACILITY Staff Improvement Plan Center, Large Family Child Care Home Reference When a staff member of a center or a large family child care home does not meet the minimum competency level, that 1. Boone, L. E., D. L. Kurtz. 2010. Contemporary business. Hoboken, NJ: employee should work with the employer to develop a plan John Wiley and Sons. to assist the person in achieving the necessary skills. The plan should include a timeline for completion and conse- 1.8.2.2 quences if it is not achieved. Annual Staff Competency Evaluation RATIONALE For each employee, there should be a written annual Children must be protected from incompetent caregiving. self- evaluation, a performance review from the personnel A system for evaluation and a plan to promote continued supervisor, and a continuing education/professional devel- development are essential to assist staff to meet performance opment plan based on the needs assessment, described in requirements (1). Standard 1.4.4.1 through Standard 1.4.5.4. RATIONALE COMMENTS A system for evaluation of employees is a basic component of Whether the caregiver/teacher meets the minimum com- any personnel policy (1). Staff members who are well trained petency level is related to the director’s assessment of the are better able to prevent, recognize, and correct health and caregiver’s/teacher’s performance. safety problems (2). COMMENTS TYPE OF FACILITY Formal evaluation is not a substitute for continuing feedback Center, Large Family Child Care Home on day-to-day performance. Performance appraisals should include a customer satisfaction component and/or a peer RELATED STANDARDS review component. Compliance with this standard may be 1.4.1.1 Pre-service Training determined by licensing requirements set by the state and 1.4.2.1 Initial Orientation of All Staff local regulatory processes, and by state and local funding 1.4.2.2 Orientation for Care of Children with Special Health Care Needs 1.4.2.3 Orientation Topics 1.4.3.1 First Aid and CPR Training for Staff
48 Caring for Our Children: National Health and Safety Performance Standards 1.4.4.1 Continuing Education for Directors and If the staff follows the National Association for the Educa- Caregivers/Teachers in Centers and Large tion of Young Children (NAEYC) Code of Ethical Conduct, Family Child Care Homes peers are expected to observe, support and guide peers. In addition within the role of the child care health consultant 1.4.4.2 Continuing Education for Small Family Child and the education consultant are guidelines for observation Care Home Caregivers/Teachers of staff within the classroom. It should be within the role of the director and assistant director guidelines for direct 1.4.5.1 Training of Staff Who Handle Food observation of staff for health, safety, developmentally 1.4.5.2 Child Abuse and Neglect Education appropriate practice, and curriculum. For more information 1.4.5.3 Training on Occupational Risk Related to on the NAEYC Code of Ethical Conduct, go to http://www. naeyc.org/files/naeyc/file/positions/PSETH05.pdf. Handling Body Fluids TYPE OF FACILITY 1.4.5.4 Education of Center Staff Center, Large Family Child Care Home 1.4.6.1 Training Time and Professional Development Reference Leave 1. Nolan, Jr., J. F., L. A. Hoover. 2010. Teacher supervision and evaluation. 1.4.6.2 Payment for Continuing Education Hoboken, NJ: John Wiley and Sons. 9.4.3.1 Maintenance and Content of Staff and Volunteer 1.8.2.5 Records Handling Complaints About Caregivers/Teachers Reference When complaints are made to licensing or referral agencies 1. University of California Berkeley Human Resources. Guide to managing about caregivers/teachers, the caregivers/teachers should human resources. Chapter 7: Performance management. http://hrweb. receive formal notice of the complaint and the resulting berkeley.edu/guides/managing-hr/managing -successfully/performance- action, if any. Caregivers/teachers should maintain records management/introduction/. of such complaints, post substantiated complaints with cor- rection action, make them available to parents/guardians on 1.8.2.4 request, and post a notice of how to contact the state agency Observation of Staff responsible for maintaining complaint records. RATIONALE Observation of staff by a designee of the program director Parents/guardians seeking child care should know if pre- should include an assessment of each member’s adherence vious complaints have been made, particularly if the com- to the policies and procedures of the facility with respect to plaint is substantiated. This information should be easily sanitation, hygiene, and management of infectious diseases. accessible to the parents/guardians. Parents/guardians can Routine, direct observation of employees is the best way then evaluate whether or not the complaint is valid, and to evaluate hygiene and safety practices. The observation whether the complaint has been adequately addressed should be followed by positive and constructive feedback to and necessary changes have been made. staff. Staff will be informed in their job description and/or COMMENTS employee handbook that observations will be made. This policy requires program development by licensing agencies. RATIONALE TYPE OF FACILITY Ongoing observation is an effective tool to evaluate consis- Center, Large Family Child Care Home tency of staff adherence to program policies and procedures (1). It also serves to identify areas for additional orientation and training. COMMENTS Videotaping of these assessments may be a useful way to provide feedback to staff around their adherence to policies and procedures regarding hygiene and safety practices. If videotaping includes interactions with children, parent/ guardian permission must be obtained before taping occurs. Desirable interactions can be encouraged and discussing methods of improvement can be facilitated through video- taping. Videotaped interactions can also prove useful to caregivers/teachers when informing, illustrating and dis- cussing an issue with the parents/guardians. It gives the parents/guardians a chance to interpret the observations and begin a healthy, respectful dialogue with caregivers/ teachers in developing a consistent approach to supporting their child’s healthy development. Sharing videotaping must have participant approval to avoid privacy issues.
2 CHAPTER Program Activities for Healthy Development
51 Chapter 2: Program Activities for Healthy Development 2.1 promotion and disease prevention topics (e.g., handwash- PROGRAM OF ing, oral health, nutrition, physical activity, healthy sleep DEVELOPMENTAL ACTIVITIES habits) (1-3). Health and safety behaviors should be modeled by staff 2.1.1 to foster healthy habits for children during their time in GENERAL PROGRAM ACTIVITIES child care. Staff should ensure that children and parents/guardians 2.1.1.1 understand the need for a safe indoor and outdoor learn- Written Daily Activity Program and ing/play environment and feel comfortable when playing Statement of Principles indoors and outdoors. Continuity and consistency by a caring staff are vital so that Facilities should have a written comprehensive and coor- children and parents/guardians know what to expect. dinated planned program of daily activities appropriate for groups of children at each stage of early childhood. This RATIONALE plan should be based on a statement of principles for the Children attending early care and education programs facility and each child’s individual development.The objec- with well-developed curricula are more likely to achieve tive of the program of daily activities should be to foster appropriate levels of development (4). incremental developmental progress in a healthy and safe Early childhood specialists agree on the environment, and the program should be flexible to capture a. Inseparability and interdependence of cognitive, physi- the interests and individual abilities of the children. Infants and toddlers learn through healthy and ongoing cal, emotional, communication, and social development. relationships with primary caregivers/teachers, and a Social-emotional capacities do not develop or function relationship-based plan should be shared with parents/ separately. guardians that includes opportunities for parents/ b. Influence of the child’s health and safety on cognitive, guardians to be an integral partner and member of physical, emotional, communication, and social this relationship system. development. Centers and all family child care homes should develop c. Central importance of continuity and consistent rela- a written statement of principles that set out the basic tionships with affectionate care that is the formation of elements from which the daily indoor/outdoor program strong, nurturing relationships between caregivers/ is to be built. teachers and children. These principles should address the following elements: d. Relevance of the development phase or stage of the a. Overall child health and safety child. b. Physical development, which facilitates small and large e. Importance of action (including play) as a mode of learning and to express self (5). motor skills Those who provide early care and education must be able c. Family partnership, which acknowledges the essential to articulate the components of the curriculum they are implementing and the related values/principles on which role of the family, and reflects their culture and the curriculum is based. In centers and large family child language care homes, because more than 2 caregivers/teachers are d. Social development, which leads to cooperative play involved in operating the facility, a written statement of with other children and the ability to make relationships principles helps achieve consensus about the basic elements with other children, including those of diverse back- from which all staff will plan the daily program (4). grounds and ability levels and adults A written description of the planned program of daily e. Emotional development, which facilitates self-awareness activities allows staff and parents/guardians to have a and self-confidence common understanding and gives them the ability to f. Cognitive development, which includes an understand- compare the program’s actual performance to the stated ing of the world and environment in which children live intent. Early care and education is a “delivery of service” and leads to understanding science, math, and literacy involving a contractual relationship between the caregiver/ concepts, as well as increasing the use and understand- teacher and the consumer. A written plan helps to define ing of language to express feelings and ideas the service and contributes to specific and responsible oper- All the principles should be developed with play being the ations that are conducive to sound child development and foundation of the planned curriculum. Material such as safety practices and to positive consumer relations (4). blocks, clay, paints, books, puzzles, and/or other manipula- Professional development is often required to enable staff tives should be available indoors and outdoors to children to develop proficiency in the development and implemen- to further the planned curriculum. tation of a curriculum that they use to carry out daily The program plan should provide for the incorporation of activities appropriately (1). specific health education topics on a daily basis throughout the year. Topics of health education should include health
52 Caring for Our Children: National Health and Safety Performance Standards Planning ensures that some thought goes into indoor and 2.4.1.2 Staff Modeling of Healthy and Safe Behavior and outdoor programming for children. The plan is a tool for Health and Safety Education Activities monitoring and accountability. Also, a written plan is a tool for staff and parent/guardian orientation. 2.4.1.3 Gender and Body Awareness 2.4.2.1 Health and Safety Education Topics for Staff COMMENTS 2.4.3.1 Opportunities for Communication and Modeling The National Association for the Education of Young Chil- dren (NAEYC) accreditation criteria and procedures, the of Health and Safety Education for Parents/ National Association for Family Child Care accreditation Guardians standards, and the National Child Care Association stan- 2.4.3.2 Parent/Guardian Education Plan dards can serve as resources for planning program activities. References Parents/guardians and staff can experience mutual learn- ing in an open, supportive early care and education setting. 1. Rosenthal MS, Crowley AA, Curry L. Family child care providers’ self- Suggestions for topics and methods of presentation are perceived role in obesity prevention: working with children, parents, and widely available. For example, the publication catalogs external influences. J Nutr Educ Behav. 2013;45(6):595–601 of the NAEYC and the American Academy of Pediatrics contain many materials for child, parent/guardian, and 2. Bonuck KA, Schwartz B, Schechter C. Sleep health literacy in Head Start staff education on child development and physical and families and staff: exploratory study of knowledge, motivation, and mental health development, covering topics such as the competencies to promote healthy sleep. Sleep Health. 2016;2(1):19–24 importance of attachment and temperament. A certified health education specialist, a child care health consultant, 3. Policy on oral health in child care centers. Pediatr Dent. 2016;38(6):34–36 or an early childhood mental health consultant can also 4. Modigliani K. Quality Standards for NAFCC Accreditation. 4th ed. The be a source of assistance. National Foundation for Family Child Care Foundation, Family Child TYPE OF FACILITY Care Project - Wheelock College. Salt Lake City, UT: The National Center, Large Family Child Care Home, Small Family Association for Family Child Care Foundation; 2013 Child Care Home 5. Pinkham AM, Kaefer T, Neuman SB, eds. Knowledge Development in Early Childhood: Sources of Learning and Classroom Implications. RELATED STANDARDS New York, NY: The Guilford Press; 2012 2.1.1.2 Health, Nutrition, Physical Activity, and Safety NOTES Awareness Content in the STANDARD was modified on 5/30/2018 2.1.1.3 Coordinated Child Care Health Program Model 2.1.1.8 Diversity in Enrollment and Curriculum 2.1.1.2 2.1.2.1 Personal Caregiver/Teacher Relationships for Health, Nutrition, Physical Activity, and Safety Awareness Infants and Toddlers 2.1.2.2 Interactions with Infants and Toddlers Early care and education programs should create and 2.1.2.3 Space and Activity to Support Learning of Infants implement written program plans addressing the physical, oral, mental, nutritional, and social and emotional health, and Toddlers physical activity, and safety aspects of each formally struc- 2.1.2.4 Separation of Infants and Toddlers from Older tured activity documented in the written curriculum. These plans should include daily opportunities to learn health Children habits that prevent infection and significant injuries and 2.1.2.5 Toilet Learning/Training health habits that support healthful eating, nutrition edu- 2.1.3.1 Personal Caregiver/Teacher Relationships for cation, physical activity, and sleep. Awareness of healthy and safe behaviors, including good nutrition, physical Three- to Five-Year-Olds activity, and sleep habits, should be an integral part of 2.1.3.2 Opportunities for Learning for Three- to the overall program. Five-Year-Olds RATIONALE 2.1.3.3 Selection of Equipment for Three- to Young children learn better through experiencing an activ- ity and observing behavior than through didactic methods Five-Year-Olds (1). There may be a reciprocal relationship between learning 2.1.3.4 Expressive Activities for Three- to Five-Year-Olds and play so that play experiences are closely related to learn- 2.1.3.5 Fostering Cooperation of Three- to Five-Year-Olds ing (2). Children can accept and follow rules, routines, and 2.1.3.6 Fostering Language Development of Three- to guidelines about health and safety when their personal experience helps them to understand why these rules were Five-Year-Olds created. National guidelines for children birth to age 5 years 2.1.3.7 Body Mastery for Three- to Five-Year-Olds encourage their engagement in daily physical activity that 2.1.4.1 Supervised School-Age Activities promotes movement, motor skills, and the foundations of 2.1.4.2 Space for School-Age Activity health-related fitness (3). Physical activity is important to 2.1.4.3 Developing Relationships for School-Age Children overall health and to overweight and obesity prevention (4). 2.1.4.4 Planning Activities for School-Age Children Healthy sleep habits (e.g., a bedtime routine, an adequate 2.1.4.5 Community Outreach for School-Age Children amount of sleep) (5,6) helps children get the amount of 2.1.4.6 Communication Between Child Care and School uninterrupted sleep their brains and bodies need, which 2.4.1.1 Health and Safety Education Topics for Children is associated with lower rates of overweight and obesity later in life (7-11).
53 Chapter 2: Program Activities for Healthy Development TYPE OF FACILITY care health consultation, nutrition services, mental health Center, Large Family Child Care Home, Small Family services, healthy and safe indoor and outdoor learning Child Care Home environment, health and safety promotion for the staff, and family and community involvement. The guidelines RELATED STANDARDS consist of the following eight interactive components: 1. Health Education: A planned, sequential, curriculum 2.1.1.3 Coordinated Child Care Health Program that addresses the physical, mental, emotional, and social Model dimensions of health. The curriculum is designed to moti- vate and assist children in maintaining and improving 3.1.3.1 Active Opportunities for Physical Activity their health, preventing disease and injury, and reducing health-related risk behaviors (1,2). 3.1.4.4 Scheduled Rest Periods and Sleep 2. Physical Activity and Education: A planned, sequential Arrangements curriculum that provides learning experiences in a variety of activity areas such as basic movement skills, physical fit- 4.5.0.4 Socialization During Meals ness, rhythms and dance, games, sports, tumbling, outdoor learning and gymnastics. Quality physical activity and edu- 4.7.0.1 Nutrition Learning Experiences for Children cation should promote, through a variety of planned phy- sical activities indoors and outdoors, each child’s optimum 4.7.0.2 Nutrition Education for Parents/Guardians physical, mental, emotional, and social development, and should promote activities and sports that all children 4.9.0.8 Supply of Food and Water for Disasters enjoy and can pursue throughout their lives (1,2,6). 3. Health Services and Child Care Health Consultants: Appendix S: Physical Activity: How Much Is Needed? Services provided for child care settings to assess, protect, and promote health. These services are designed to ensure References access or referral to primary health care services or both, foster appropriate use of primary health care services, pre- 1. Stirrup J, Evans J, Davies B. Learning one’s place and position through vent and control communicable disease and other health play: social class and educational opportunity in early years education. Int problems, provide emergency care for illness or injury, J Early Years Educ. 2017;1–18 promote and provide optimum sanitary conditions for a safe child care facility and child care environment, 2. Weisberg D, Hirsh-Pasek K, Golinkoff R, Kittredge A, Klahr D. Guided and provide educational opportunities for promoting play: principles and practices. Curr Dir Psychol Sci. 2016;25(3):177–182 and maintaining individual, family, and community health. Qualified professionals such as child care health 3. Roth K, Kriemler S, Lehmacher W, Ruf KC, Graf C, Hebestreit H. Effects consultants may provide these services (1,2,4,5). of a physical activity intervention in preschool children. Med Sci Sports 4. Nutrition Services: Access to a variety of nutritious Exerc. 2015;47(12):2542–2551 and appealing meals that accommodate the health and nutrition needs of all children. School nutrition programs 4. US Department of Health and Human Services, US Department of reflect the U.S. Dietary Guidelines for Americans and other Agriculture. 2015–2020 Dietary Guidelines for Americans. 8th ed. criteria to achieve nutrition integrity. The school nutrition Washington, DC: US Government Printing Office; 2015. https://health. services offer children a learning laboratory for nutrition gov/dietaryguidelines/2015/resources/2015-2020_Dietary_Guidelines.pdf. and health education and serve as a resource for linkages Published December 2015. Accessed November 14, 2017 with nutrition-related community services (1,2). 5. Mental Health Services: Services provided to improve 5. Sivertsen B, Harvey AG, Reichborn-Kjennerud T, Torgersen L, Ystrom E, children’s mental, emotional, and social health. These Hysing M. Later emotional and behavioral problems associated with sleep services include individual and group assessments, inter- problems in toddlers: a longitudinal study. JAMA Pediatr. ventions, and referrals. Organizational assessment and 2015;169(6):575–582 consultation skills of mental health professionals con- tribute not only to the health of students but also to the 6. Kelly Y, Kelly J, Sacker A. Time for bed: associations with cognitive health of the staff and child care environment (1,2). performance in 7-year-old children: a longitudinal population-based 6. Healthy Child Care Environment: The physical and study. J Epidemiol Community Health. 2013;67(11):926–931 aesthetic surroundings and the psychosocial climate and culture of the child care setting. Factors that influence the 7. Institute of Medicine. Early Childhood Obesity Prevention Policies: physical environment include the building and the area Goals, Recommendations, and Potential Actions. Washington, DC: surrounding it, natural spaces for outdoor learning, any Institute of Medicine; 2011. http://www.nationalacademies.org/hmd/~/ biological or chemical agents that are detrimental to health, media/Files/Report%20Files/2011/Early-Childhood-Obesity-Prevention- indoor and outdoor air quality, and physical conditions Policies/Young%20Child%20Obesity%202011%20Recommendations.pdf. Published June 2011. Accessed November 14, 2017 8. Fatima Y, Doi SA, Mamun AA. Longitudinal impact of sleep on overweight and obesity in children and adolescents: a systematic review and bias-adjusted meta-analysis. Obes Rev. 2015;16(2):137–149 9. Li L, Zhang S, Huang Y, Chen K. Sleep duration and obesity in children: a systematic review and meta-analysis of prospective cohort studies. J Paediatr Child Health. 2017;53(4):378–385 10. Anderson SE, Andridge R, Whitaker RC. Bedtime in preschool-aged children and risk for adolescent obesity. J Pediatr. 2016;176:17–22 11. Lumeng JC, Somashekar D, Appugliese D, Kaciroti N, Corwyn RF, Bradley RH. Shorter sleep duration is associated with increased risk for being overweight at ages 9 to 12 years. Pediatrics. 2007;120(5):1020–1029 NOTES Content in the STANDARD was modified on 5/30/2018 2.1.1.3 Coordinated Child Care Health Program Model Caregivers/teachers should follow these guidelines for implementing coordinated health programs in all early care and education settings. These coordinated health programs should consist of health and safety education, physical activity and education, health services and child
54 Caring for Our Children: National Health and Safety Performance Standards such as temperature, noise, and lighting. Unsafe physical 2.1.1.4 environments include those such as where bookcases are Monitoring Children’s Development/ not attached to walls and doors that could pinch children’s Obtaining Consent for Screening fingers. The psychological environment includes the phy- sical, emotional, and social conditions that affect the Child care settings provide daily indoor and outdoor well-being of children and staff (1,2). opportunities for promoting and monitoring children’s 7. Health Promotion for the Staff: Opportunities for development. Caregivers/teachers should monitor the caregivers/teachers to improve their own health status children’s development, share observations with parents/ through activities such as health assessments, health guardians, and provide resource information as needed for education, help in accessing immunizations, health-related screenings, evaluations, and early intervention and treat- fitness activities, and time for staff to be outdoors. These ment. Caregivers/teachers should work in collaboration to opportunities encourage caregivers/teachers to pursue a monitor a child’s development with parents/guardians and healthy lifestyle that contributes to their improved health in conjunction with the child’s primary care provider and status, improved morale, and a greater personal commit- health, education, mental health, and early intervention ment to the child care’s overall coordinated health program. consultants. Caregivers/teachers should utilize the services This personal commitment often transfers into greater of health and safety, education, mental health, and early commitment to the health of children and creates positive intervention consultants to strengthen their observation role modeling. Health promotion activities have improved skills, collaborate with families, and be knowledgeable of productivity, decreased absenteeism, and reduced health community resources. insurance costs (1,2). Programs should have a formalized system of developmen- 8. Family and Community Involvement: An integrated tal screening with all children that can be used near the child care, parent/guardian, and community approach for beginning of a child’s placement in the program, at least enhancing the health and safety, and well-being of children. yearly thereafter, and as developmental concerns become Parent/guardian-teacher health advisory councils, coali- apparent to staff and/or parents/guardians. The use of tions, and broadly based constituencies for child care health authentic assessment and curricular-based assessments can build support for child care health program efforts. should be an ongoing part of the services provided to all Early care and education settings should actively solicit children (5-9). The facility’s formalized system should parent/guardian involvement and engage community include a process for determining when a health or resources and services to respond more effectively to developmental screening or evaluation for a child is the health-related needs of children (1,2). necessary. This process should include parental/ guardian consent and participation. RATIONALE Parents/guardians should be explicitly invited to: Early care and education settings provide a structure a. Discuss reasons for a health or developmental by which families, caregivers/teachers, administrators, primary care providers, and communities can promote assessment; optimal health and well-being of children (3,4). The coor- b. Participate in discussions of the results of their child’s dinated child care health program model was adapted from the Center for Disease Control and Prevention evaluations and the relationship of their child’s needs (CDC) Division of Adolescent and School Health’s (DASH) to the caregivers’/teachers’ ability to serve that child Coordinated School Health Program (CSHP) model (2). appropriately; c. Give alternative perspectives; TYPE OF FACILITY d. Share their expectations and goals for their child and Center, Large Family Child Care Home have these expectations and goals integrated with any plan for their child; References e. Explore community resources and supports that might assist in meeting any identified needs that child care 1. Centers for Disease Control and Prevention. 2008. Healthy youth! Coor- centers and family child care homes can provide; dinates school health programs. http://www.cdc.gov/healthyyouth/CSHP/. Give written permission to share health information with primary health care professionals (medical home), 2. Cory, A. C. 2007. The role of the child care health consultant in promoting child care health consultants and other professionals health literacy for children, families, and educators in early care and as appropriate; education settings. Paper presented at the annual meeting of the American The facility should document parents’/guardians’ presence School Health Association. at these meetings and invitations to attend. If the parents/guardians do not attend the screening, the 3. Fiene, R. 2002. 13 indicators of quality child care: Research update. caregiver/teacher should inform the parents/guardians of Washington, DC: U.S. Department of Health and Human Services, Office of the results, and offer an opportunity for discussion. Efforts the Assistant Secretary for Planning and Evaluation. http://aspe.hhs.gov/ should be made to provide notification of meetings in the basic-report/13-indicators-qualitychild-care. primary language of the parents/guardians. Formal eval- 4. U.S. Department of health and Human Services, Office of Child Care. 2010. Coordinating child care consultants: Combining multiple disciplines and improving quality in infant/toddler care settings. http://nitcci.nccic.acf.hhs. gov/resources/consultation _brief.pdf. 5. Coordinated Health/Care. Maximize your benefits: FAQs about care coordination. https://www.cchcare.com/router.php?action=about. 6. Friedman, H. S., L. R. Martin, J. S. Tucker, M. H. Criqui, M. L. Kern, C. A. Reynolds. 2008. Stability of physical activity across the lifespan. J Health Psychol 13:1092-1104.
55 Chapter 2: Program Activities for Healthy Development uations of a child’s health or development should also Pediatrics [AAP] list of developmental screening tools be shared with the child’s medical home with parent/ at http://www.medicalhomeinfo.org/downloads/pdfs/ guardian consent. DPIPscreeningtoolgrid.pdf). The caregiver/teacher should Programs are encouraged to utilize validated screening explain the results to parents/guardians honestly, with tools to monitor children’s development, as well as various sensitivity, and without using technical jargon (11). measures that may inform their work facilitating children’s development and providing an enriching indoor and out- Resources for implementing a program that involves a door environment, such as authentic-based assessment, formalized system of developmental screening are available work sampling methods, observational assessments, and at the Centers for Disease Control and Prevention (CDC) assessments intended to support curricular implementation at http://www.cdc.gov/ncbddd/actearly/ and the AAP at (5,9). Programs should have clear policies for using reliable http://www.healthychildcare.org. and valid methods of developmental screening with all chil- dren and for making referrals for diagnostic assessment Scheduling meetings at times convenient for parent/guardian and possible intervention for children who screen positive. participation is optimal. Those conducting an evaluation, and All programs should use methods of ongoing developmen- when subsequently discussing the findings with the family, tal assessment that inform the curricular approaches used should consider parents’/guardians’ input. Parents/guardians by the staff. Care must be taken in communicating the have both the motive and the legal right to be included in results. Screening is a way to identify a child at risk of a decision-making and to seek other opinions. developmental delay or disorder. It is not a diagnosis. If the screening or any observation of the child results A second, independent opinion could be provided by the in any concern about the child’s development, after con- program’s child care health consultant or the child’s primary sultation with the parents/guardians, the child should care provider. be referred to his or her primary care provider (medical home), or to an appropriate specialist or clinic for further TYPE OF FACILITY evaluation. In some situations, a direct referral to the Center, Large Family Child Care Home Early Intervention System in the respective state may also be required. RELATED STANDARDS 1.3.2.5 Additional Qualifications for Caregivers/Teachers RATIONALE Seventy percent of children with developmental disabilities Serving Children Three to Five Years of Age and mental health problems are not identified until school 1.3.2.7 Qualifications and Responsibilities for Health entry (10). Daily interaction with children and families in early care and education settings offers an important Advocates opportunity for promoting children’s development as well 3.1.4.5 Unscheduled Access to Rest Areas as monitoring developmental milestones and early signs of 9.4.1.3 Written Policy on Confidentiality of Records delay (1-3). Caregivers/teachers play an essential role in the early identification and treatment of children with develop- References mental concerns and disabilities (6-8) because of their knowledge in child development principles and milestones 1. Copple, C., S. Bredekamp. 2009. Developmentally appropriate practice in and relationship with families (4). Coordination of obser- early childhood programs serving children at birth through age 8. vation findings and services with children’s primary care 3rd ed. Washington, DC: National Association for the Education of Young providers in collaboration with families will enhance Children. children’s outcomes (6). 2. Dworkin, P. H. 1989. British and American recommendations for COMMENTS developmental monitoring: The role of surveillance. Pediatrics 84:1000- Parents/guardians need to be included in the process of 1010. considering, identifying and shaping decisions about their children, (e.g., adding, deleting, or changing a service). 3. Brothers, K. l., F. Glascoe, N. Robertshaw. 2008. PEDS: Developmental To provide services effectively, facilities must recognize milestones - An accurate brief tool for surveillance and screening. Clinical parents’/guardians’ observations and reports about the Pediatrics 47:271-79. child and their expectations for the child, as well as the family’s need of child care services. A marked discrepancy 4. Kostelnik, M. J., A. K. Soderman, A. P. Whiren. 2006. Developmentally between professional and parent/guardian observations appropriate curriculum best practices in early childhood education. Upper of, or expectations for, a child necessitates further dis- Saddle River, NJ: Prentice Hall. cussion and development of a consensus on a plan of action. Consideration should be given to utilizing parent/ 5. Squires, J., D. Bricker. 2009. Ages and stages questionnaires. Baltimore: guardian- completed screening tools, such as the Ages and Brookes Publishing. Stages Questionnaire (ASQ) (for a list of validated develop mental screening tools, see the American Academy of 6. Centers for Disease Control and Prevention. Learn the signs. Act early. http://www.cdc.gov/ncbddd/actearly/. 7. American Academy of Pediatrics, Council on Children With Disabilities, Section on Developmental Behavioral Pediatrics, Bright Futures Steering Committee and Medical Home Initiatives for Children With Special Needs Project Advisory Committee. 2006. Identifying infants and young children with developmental disorders in the medical home: An alogorithm for developmental surveillance and screening. Pediatrics 118:405-20. 8. Hagan, J. F., J. S. Shaw, P. M. Duncan, eds. 2008. Bright futures: Guidelines for health supervision of infants, children, and adolescents. 3rd ed. Elk Grove Village, IL: American Academy of Pediatrics. 9. Gilliam, W. S., S. Meisels, L. Mayes. 2005. Screening and surveillance in early intervention systems. In A developmental systems approach to early intervention: National and international perspectives, ed. M. J. Guralnick, 73-98. Baltimore, MD: Brookes Publishing. 10. Glascoe, F. P. 2005. Screening for developmental and behavioral problems. Mental Retardation Develop Disabilities 11:173-79. 11. O’Connor, S., et al. 1996. ASQ: Assessing school age child care quality. Wellesly, MA: Center for Research on Women.
56 Caring for Our Children: National Health and Safety Performance Standards 2.1.1.5 f. Where a family is experiencing separation due to a mili- Helping Families Cope with Separation tary deployment, collaborate with the parent/guardian at home to address changes in children’s behavior that The staff of the facility should engage strategies to help a may be related to the deployment, providing parents/ child and parents/guardians cope with the experience of guardians with information about activities in care and separation and reunion, such as death of family members, at home may help promote their child’s positive adjust- divorce, or placement in foster care. ment throughout the deployment cycle (connect parents/ For the child, this should be accomplished by: guardians with services/resources in the community a. Encouraging parents/guardians to spend time in the that can help to support them); facility with the child and supporting the separation g. Requesting assistance from early childhood mental health transition; consultants, mental health professionals, developmental- b. Providing a comfortable setting both indoors and behavioral pediatricians, parent/guardian counselors, outdoors for parents/guardians to be with their children etc. when a child’s adjustment continues to be problem- to transition or to have conversation with staff; atic over time. c. Having established routines for drop-off and pick-up times to assist with transition; RATIONALE d. Enabling the child to bring to child care tangible In childhood, some separation experiences facilitate reminders of home/family (such as a favorite toy or a psychological growth by mobilizing new approaches for picture of self and parent/guardian); learning and adaptation. Other separations are painful e. Encouraging parents/guardians to reassure the child of and traumatic. The way in which influential adults provide their return and to calmly say “goodbye”; support and understanding, or fail to do so, will shape f. Helping the child play out themes of separation and the child’s experience (1). reunion; Many parents/guardians who prefer to care for their young g. Frequently exchanging information between the child’s children only at home may have no other option than to parents/guardians and caregivers/teachers, including place their children in out-of-home child care before three activities and routine care information particularly months of age. Some parents/guardians prefer combining during greeting and departing; out-of-home child care with parental/guardian care to pro- h. Reassuring the child about the parent’s/guardian’s return; vide good experiences for their children and support for i. Ensuring the caregivers/teachers are consistent both other family members to function most effectively. Whether within the parts of a day and across days; parents/guardians view out-of-home child care as a neces- j. Requesting assistance from early childhood mental sary accommodation to undesired circumstances or a bene- health consultants, mental health professionals, fit for their family, parents/guardians and their children developmental-behavioral pediatricians, parent/ need help from the caregivers/teachers to accommodate guardian counselors, etc. when a child’s adjustment the transitions between home and out-of-home settings (2). continues to be problematic over time; Many parents/guardians experience distress at separation. k. When a family is experiencing separation due to a mili- For most parents/guardians, the younger their child and tary deployment, explore changes in children’s behavior the less experience they have had with sharing the care of that may be related to feelings of anger, fear, sadness, or their children with others, the more intense their distress uncertainty related to changes in family structure as a at separation (3). result of deployment. Work with the parent/guardian at Although children’s responses to deployment separation will home to help the child adjust to these changes, including vary depending on age, personality, and support received, providing activities that help the child remain connected children will be aware of a parent’s/guardian’s long-term to the deployed parent/guardian and manage their absence and may mourn. Children may feel uncertain, sad, emotions throughout the deployment cycle. afraid, or angry. These feelings can manifest as increased For the parents/guardians, this should be accomplished by: clinginess, aggression, withdrawal, changes in sleeping a. Validating their feelings as a universal human or eating patterns, regression or other behaviors. Young experience; children don’t often have the vocabulary to express their b. Providing parents/guardians with information about emotions, and may need support to express their feelings in the positive effects for children of high quality facilities healthy and safe ways (2). Additionally, the parent/guardian with strong parent/guardian participation; at home may be experiencing stress, anxiety, depression, or c. Encouraging parents/guardians to discuss their feelings; fear. These parents/guardians may benefit from additional d. Providing parents/guardians with evidence, such as outreach from caregivers/teachers, who are part of their photographs, that their child is being cared for and is community support system, and can help them with strate- enjoying the activities of the facility; gies to promote children’s adjustment and connect them e. Ask parents/guardians to bring pictures from home with resources in the community (3). that may be placed in the room or cubby and displayed throughout the indoor and outdoor learning/play environment at the child’s eye level;
57 Chapter 2: Program Activities for Healthy Development COMMENTS 2.1.1.6 Depending on the child’s developmental stage, the impact Transitioning within Programs and Indoor of separation on the child and parent/guardian will vary. and Outdoor Learning/Play Environments Child care facilities should understand and communicate this variation to parents/guardians and work with parents/ Caregivers/teachers should take into consideration the guardians to plan developmentally appropriate coping individual needs of children when transitioning them to a strategies for use at home and in the child care setting. For new indoor and outdoor learning/play environment. The example, a child at eighteen to twenty-four months of age transitioning child/children should be offered the opportu- is particularly vulnerable to separation issues and may nity to visit the new space with a familiar caregiver/teacher show visible distress when experiencing separation from with enough time to allow them to display comfort in the parents/guardians. Entry into child care at this age may new space. The program should allow time for communica- trigger behavior problems, such as difficulty sleeping. tion with the families regarding the process and for each Even for the child who has adapted well to a child care child to follow through a comfortable time line of adaptation arrangement before this developmental stage, such diffi- to the new indoor and outdoor learning/play environment, culties can occur as the child continues in care and enters caregiver/teachers, and peers. this developmental stage. For younger children, who are Children need time to manipulate, explore and familiarize working on understanding object permanence (usually themselves with the new space and caregivers/teachers. This around nine to twelve months of age), parents/guardians should be done before they are part of a new group to allow who sneak out after bringing their children to the child them time to explore to their personal satisfaction. Eating care facility may create some level of anxiety in the child is a primary reinforcer and need. The opportunity to share throughout the day. Sneaking away leaves the child unable food within the new space will help reassure a child and help to discern when someone the child trusts will leave with- adults assess how the transition is going. Toileting involves out warning. Parents/guardians and caregivers/teachers another level of trust. Diapering/toileting should be intro- reminding a child that the parent/guardian returned as duced in the new space with a familiar teacher. promised reinforces truthfulness and trust. Parents/ New routines should be introduced by the new staff with guardians of children of any age should be encouraged a familiar caregiver/teacher present to support the child/ to visit the facility together before the child care officially children. Transitions to the indoor and outdoor learning/ begins. Parents/guardians of infants may benefit from play environment, especially if the space is different than feeling assured by the caregivers/teachers themselves. the one from which they are familiar, should follow similar Depending on the child’s temperament and prior care procedures as moving to another indoor space. Parents/ experience, several visits may be recommended before guardians should be part of the transition as they too are enrolling as well opportunities to practice the process and in the process of learning to trust a new indoor and outdoor consistency of a separation experience in the first weeks of learning/play environment for their child. Primary needs entering the child care. Using a phasing-in period can also need to be met to support a smooth transition. be helpful (e.g., spend only a part of the day with parents/ Transitions should be planned in advance, based on the guardians on the first day, half-day on the second day, child’s readiness. A written plan should be developed and and parents/guardians leave earlier, etc.) shared with parents/guardians, describing how and when the transition will occur. Children should not be moved to TYPE OF FACILITY a new indoor and outdoor learning/play environment for Center, Large Family Child Care Home the sole purpose of maintaining child: staff ratios. RELATED STANDARDS RATIONALE 1.1.2.1 Minimum Age to Enter Child Care Supporting the achievement of developmental tasks for 1.6.0.3 Early Childhood Mental Health Consultants young children is essential for their social and emotional 2.3.1.1 Mutual Responsibility of Parents/Guardians health. Establishing trust with caregivers/teachers and suc- cessful adaptation to a new indoor and outdoor learning/ and Staff play environment is a critical component of quality care. Young children need predictability and routine. They need References to feel secure and to understand the expectations of their environment. By taking time to allow them to familiarize 1. Blecher-Sass, H. 1997. Good-byes can build trust. Young Child 52:12-14. themselves with their new caregivers/teachers and environ- 2. Kim, A. M., J. Yeary. 2008. Making long-term separations easier for children ment, they are better able to handle the emotional, cognitive, and social requirements of their new space (1-5). and families. Young Children 63:32-37. 3. Gonzalez-Mena, J. 2007. Separation: Helping children and families. In 50 TYPE OF FACILITY Center, Large Family Child Care Home Early childhood strategies for working and communicating with diverse families, 96-97. Upper Saddle River, NJ: Prentice Hall. RELATED STANDARD 2.1.2.5 Toilet Learning/Training
58 Caring for Our Children: National Health and Safety Performance Standards References learning/play environments should have an array of toys, materials, posters, etc. that reflect diverse cultures and 1. Erikson, E. H. 1950. Childhood and society. New York: W.W. Norton and Co. ethnicities. Stereotyping of any culture must be avoided. 2. Gorski, P. A., S. P. Berger. 2005. Emotional health in child care. In Health in RATIONALE child care: A manual for health professionals, ed. J. R. Murph, S. D. Palmer, Children who participate in programs that reflect and show D. Glassy, 173-86. Elk Grove Village, IL: American Academy of Pediatrics. respect for the cultural diversity of their communities learn 3. Lally, R. L., L. Y. Torres, P. C. Phelps. 1994. Caring for infants and toddlers to understand and value cultural diversity. This learning in groups: Necessary considerations for emotional, social, and cognitive in early childhood enables their healthy participation in development. Zero to Three 14:1-8. a democratic pluralistic society (peaceful coexistence of 4. Mahler, M., F. Pine, A. Bergman. 1975. The Psychological birth of the different interests, convictions, and lifestyles) throughout human infant. New York: Basic Books. life (1-3,11,12). By facilitating the expression of cultural 5. Maslow, A. 1943. A theory of human motivation. Psychological Review development or ethnic identity and by encouraging famil- 50:370-96 iarity with different groups and practices through ordinary interaction and activities integrated into a developmentally 2.1.1.7 appropriate curriculum, a facility can foster children’s abil- Communication in Native Language ity to relate to people who are different from themselves, Other Than English their sense of possibility, and their ability to succeed in a diverse society, while also promoting feelings of belonging At least one member of the staff should be able to commu- and identification with a tradition. nicate with the parents/guardians and children in the fami- ly’s native language (sign or spoken), or the facility should COMMENTS work with parents/guardians to arrange for a translator to Sharing information about the child on a daily basis with communicate with parents/guardians and children. Efforts the children’s families shows respect for the children’s should be made to support a child’s and family’s native cultures by creating an opportunity to learn more about language while providing resources and opportunities for the families’ background, beliefs, and traditions (5-9). learning English (2). Children should not be used as trans- Materials, displays, and learning activities must represent lators. They are not developmentally able to understand the cultural heritage of the children and the staff to instill the meaning of all words as used by adults, nor should they a sense of pride and positive feelings of identification in all participate in all conversations that may be regarding children and staff members (4). In order to enroll a diverse the child. group, the facility should market its services in a culturally RATIONALE sensitive way and should make sincere efforts to employ The future development of the child depends on his/her staff members that represent the culture of the children and command of language (1). Richness of language increases as their families (10). Children need to see members of their a result of experiences as well as through the child’s verbal own community in positions of influence in the services interaction with adults and peers. Basic communication they use. Scholarships and tuition assistance can be used with parents/guardians and children requires an ability to to increase the diversity among enrolled children. speak their language. Learning English while maintaining a family’s native language enriches child development and TYPE OF FACILITY strengthens family cultural traditions. Center, Large Family Child Care Home COMMENTS For resources on bilingual and dual language learning, References see the American Academy of Pediatrics Section on Developmental and Behavioral Pediatrics (SODBP) at 1. Wardle, F. 1998. Meeting the needs of multicultural and multiethnic http://www.aap.org/sections/dbpeds/. children in early childhood settings. Early Child Education J 26:7-11. TYPE OF FACILITY Center, Large Family Child Care Home 2. Ramsey, P. G. 1998. Teaching and learning in a diverse world: Multicultural References education for young children. 2nd ed. New York: Teachers College Press. 1. Moerk, E. L. 2000. The guided acquisition of first language skills. Advances 3. Ramsey, P. G. 1995. Growing up with the contradictions of race and class. Applied Dev Psychol 20:248. Young Child 50:18-22. 2. Olsen, L. 2006. Ensuring academic success of English learners. 2006. U.C. 4. Maschinot, B. 2008. The changing face of the United States: The influence of Linguistic Minority Research Institute 15:1-7. culture on early child development. Washington, DC: Zero to Three. http:// www.zerotothree.org/site/DocServer/Culture_book.pdf?docID=6921. 2.1.1.8 Diversity in Enrollment and Curriculum 5. Williams, K. C., M. H. Cooney. 2006. Young children and social justice. Young Children 61:75-82. Programs should work to increase understanding of cul- tural, ethnic, and other similarities and differences by 6. Gonzalex-Mena, J. 2008. Diversity in early care and education: Honoring enrolling children who reflect the cultural and ethnic differences. 5th ed. Boston: McGraw-Hill. diversity of the community. Programs should provide cultural curricula that engage children and families and 7. Gonzalez-Mena, J. 2007. 50 early childhood strategies for working and teach multicultural learning activities. Indoor and outdoor communicating with diverse families. Upper Saddle River, NJ: Pearson Merrill Prentice Hall. 8. Bradely, J., P. Kibera. 2006. Closing the gap: Culture and promotion of inclusion in child care. Young Children 61:34-40. 9. Romero, M. 2008. Promoting tolerance and respect for diversity in early childhood: Toward a research and practice agenda. Report of the Promoting Tolerance and Respect for Diversity in Early Childhood Meeting, Brooklyn, NY, June 25, 2007. http://www.nccp.org/publications/pdf/text_812.pdf.
59 Chapter 2: Program Activities for Healthy Development 10. Matthews, H. 2008. Supporting a diverse and culturally competent impact on future school success (6). Richness of the child’s workforce: Charting progress for babies in child care. Charting Progress language increases as it is nurtured by verbal interactions for Babies in Child Care: A CLASP Child Care and Early Education and learning experiences with adults and peers. Basic com- Project, Washington, DC. http://www.clasp.org/babiesinchildcare/ munication with parents/guardians and children requires recommendations?id=0005. an ability to speak their language. Discussing the impact of actions on feelings for the child and others helps to 11. Parent Services Project (PSP). Making room in the circle. Training develop empathy. Curriculum, PSP, San Rafael, CA. TYPE OF FACILITY Center, Large Family Child Care Home 12. Fox, R. K. 2007. One of the hidden diversities in schools: Families with References parents who are Lesbian or Gay. Childhood Education 83:277-81. 1. Mayr, T., M. Ulich. 1999. Children’s well-being in day care centers: An 2.1.1.9 exploratory empirical study. Int J Early Years Education 7:229-39. Verbal Interaction 2. Baron, N., L. W. Schrank. 1997. Children learning language: How adults can The child care facility should assure that a rich environ- help. Lake Zurich, IL: Learning Seed. ment of spoken language by caregivers/teachers surrounds and includes all children with opportunities to expand their 3. Szanton, E. S., ed. 1997. Creating child-centered programs for infants and language communication skills. Each child should have at toddlers, birth to 3 year olds, step by step: A Program for children and least one speaking adult person who engages the child in families. New York: Children’s Resources International, Inc. frequent verbal exchanges linked to daily events and expe- riences. To encourage the development of language, the 4. Kontos, S., A. Wilcox-Herzog. 1997. Teachers’ interactions with children: caregiver/teacher should demonstrate skillful verbal Why are they so important? Young Child 52:4-12. communication and interaction with the child. a. For infants, these interactions should include responses 5. Moerk, E. L. 2000. The guided acquisition of first language skills. Advances in Applied Dev Psychol 20:248. to, and encouragement of, soft infant sounds, as well as identifying objects, feelings, and desires by the care- 6. Pikulski, J. J., Templeton, S. 2004. Teaching and developing vocabulary: Key giver/teacher. to long-term reading success. Geneva, IL: Houghton Mifflin Company. b. For toddlers, the interactions should include naming of http://www.eduplace.com/state/author/pik_temp.pdf. objects, feelings, listening to the child and responding, along with actions and supporting, but not forcing, the 2.1.2 child to do the same. PROGRAM ACTIVITIES FOR INFANTS AND c. For preschool and school-age children, interactions should include respectful listening and responses to TODDLERS FROM THREE MONTHS TO what the child has to say, amplifying and clarifying the LESS THAN THIRTY-SIX MONTHS child’s intent, and not reinforcing mispronunciations (e.g., Wambulance instead of Ambulance). 2.1.2.1 d. Frequent interchange of questions, comments, and Personal Caregiver/Teacher Relationships responses to children, including extending children’s for Infants and Toddlers utterances with a longer statement, by teaching staff. e. For children with special needs, alternative methods The facility should practice a relationship-based philosophy of communication should be available, including but that promotes consistency and continuity of caregivers/ not limited to: sign language, assistive technology, pic- teachers for infants and toddlers (1-3). Facilities should ture boards, picture exchange communication systems implement continuity of care practices into established (PECS), FM systems for hearing aids, etc. Communica- policies and procedures as a means to foster strong, positive tion through methods other than verbal communica- relationships that will act as a secure basis for exploration tion can result in the same desired outcomes. and learning in the classroom (1-4). Child–caregiver rela- tionships based on high-quality care are central to brain f. Profanity should not be used at any time. development, emotional regulation, and overall learning (5). The facility should encourage practices of continuity of RATIONALE care that give infants and toddlers the added benefit of the Conversation with adults is one of the main channels same caregiver for the first three years of life of the child or through which children learn about themselves, others, during the time of enrollment (6). The facility should limit and the world in which they live. While adults speaking to the number of caregivers/teachers who interact with any children teaches the children facts and relays information, one infant or toddler (1). the social and emotional communications and the atmos- The caregiver/teacher should: phere of the exchange are equally important. Reciprocity of a. Use a variety of safe and appropriate individualized expression, response, and the initiation and enrichment of dialogue are hallmarks of the social function and signifi- soothing methods of holding and comforting infants cance of the conversations (1-4). The future development and toddlers who are upset (7). of the child depends on his/her command of language (5). b. Engage in frequent, multiple, and rich social inter- Research suggests that language experiences in a child’s changes, such as smiling, talking, appropriate forms early years have a profound influence on that child’s lan- of touch, singing, and eating. guage and vocabulary development, which in turn has an c. Be play partners as well as protectors.
60 Caring for Our Children: National Health and Safety Performance Standards d. Be attuned to infants’ and toddlers’ feelings and reflect Appendix M: Recognizing Child Abuse and Neglect: Signs them back. and Symptoms e. Communicate consistently with parents/guardians. Appendix N: Protective Factors Regarding Child Abuse f. Interact with infants and toddlers and develop a and Neglect relationship in the context of everyday routines References (eg, diapering, feeding). 1. Zero to Three. Primary caregiving and continuity of care. https://www. Opportunities should be provided for each infant and tod- zerotothree.org/resources/85-primary-caregiving-and-continuity-of-care. dler to develop meaningful relationships with caregivers. Published February 8, 2010. Accessed January 11, 2018 The facility’s touch policy should be direct in addressing 2. National Scientific Council on the Developing Child. The Science of that children may be touched when it is appropriate for, Neglect: The Persistent Absence of Responsive Care Disrupts the respectful to, and safe for the child. Caregivers/teachers Developing Brain: Working Paper 12. https://46y5eh11fhgw3ve3ytpwxt9r- should respect the wishes of children, regardless of their wpengine.netdna-ssl.com/wp-content/uploads/2012/05/The-Science-of- age, for physical contact and their comfort or discomfort Neglect-The-Persistent-Absence-of-Responsive-Care-Disrupts-the- with it. Caregivers/teachers should avoid even “friendly” Developing-Brain.pdf. Published December 2012. Accessed January 11, contact (eg, touching the shoulder or arm) with a child if 2018 the child expresses that he or she is uncomfortable. 3. Harvard University Center on the Developing Child. Three principles RATIONALE to improve outcomes for children and families. https://developingchild. When children trust caregivers and are comfortable in the harvard.edu/resources/three-early-childhood-development-principles- environment that surrounds them, they are allowed to improve-child-family-outcomes. Accessed January 11, 2018 focus on educational discoveries in their physical, social, and emotional development. 4. Recchia SL. Caregiver–child relationships as a context for continuity in child care. Early Years. 2012;32(2):143–157 Holding, and hugging, in a positive, respectful, and safe manner is an essential part of providing care for infants 5. US Department of Health and Human Services, Child Care State Capacity and toddlers. Building Center. Six essential program practices. Program for infant/ toddler care. https://childcareta.acf.hhs.gov/sites/default/files/public/ Quality caregivers/teachers provide care and learning pitc_rationale_-_continuity_of_care_508_0.pdf. Published January 2017. experiences that play a key role in a child’s development as Accessed January 11, 2018 an active, self-knowing, self-respecting, thinking, feeling, and loving person (8). Limiting the number of adults with 6. Ruprecht K, Elicker J, Choi J. Continuity of care, caregiver–child whom an infant or a toddler interacts fosters reciprocal interactions, toddler social competence and problem behaviors. Early understanding of communication cues that are unique to Educ Dev. 2015;27:221–239 each infant or toddler. This leads to a sense of trust of the adult by the infant or toddler that the infant’s or toddler’s 7. Kim Y. Relationship-based developmentally supportive approach to infant needs will be understood and met promptly (5,6). Studies childcare practice. Early Child Dev Care. 2015:734-749 of infant behavior show that infants have difficulty forming trusting relationships in settings where many adults inter- 8. Understanding children’s behavior. In: Miller DF. Positive Child act with infants (eg, in hospitalization of infants when Guidance. 8th ed. Boston, MA: Cengage Learning; 2016 shifts of adults provide care) (9). 9. Sandstrom H, Huerta S. The negative effects of instability on child Sexual abuse in the form of inappropriate touching is an development: a research synthesis. Urban Institute Web site. https://www. act that induces or coerces children in a sexually suggestive urban.org/research/publication/negative-effects-instability-child- manner or for the sexual gratification of the adult, such as development-research-synthesis. Published September 18, 2013. sexual penetration and/or overall inappropriate touching Accessed January 11, 2018 or kissing (10). 10. Al Odhayani A, Watson WJ, Watson L. Behavioural consequences of child TYPE OF FACILITY abuse. Can Fam Physician. 2013;59(8):831–836 Center, Large Family Child Care Home, Small Family Child Care Home NOTES Content in the STANDARD was modified on 05/30/2018. RELATED STANDARDS 2.1.2.2 3.4.4.1 Recognizing and Reporting Suspected Interactions with Infants and Toddlers Child Abuse, Neglect, and Exploitation Caregivers/teachers should provide consistent, continuous 3.4.4.2 Immunity for Reporters of Child Abuse and inviting opportunities to talk, listen to, and otherwise and Neglect interact with young infants throughout the day (indoors and outdoors) including feeding, changing, playing with, 3.4.4.3 Preventing and Identifying Shaken Baby and cuddling them. Syndrome/Abusive Head Trauma RATIONALE 3.4.4.4 Care for Children Who Have Been Abused/ Richness of language increases by nurturing it through Neglected verbal interactions between the child and adults and peers. Adults’ speech is one of the main channels through which children learn about themselves, others, and the world in which they live. While adults speaking to children teach the children facts, the social and emotional communications and the atmosphere of the exchange are equally important. Reciprocity of expression, response, the initiation and enrichment of dialogue are hallmarks of the social func- tion and significance of the conversations (2-5). Infants and toddlers learn through meaningful relationships and interaction with consistent adults and peers. The future development of the child depends on his/her command of language (1). Richness of language increases as
61 Chapter 2: Program Activities for Healthy Development it is nurtured by verbal interactions of the child with adults c. Help the child practice resolving conflicts; and peers. Basic communication with parents/guardians d. Use symbols (words, numbers, etc.); and children requires an ability to speak their language. e. Manipulate objects; A language-rich environment and warm, responsive inter- f. Exercise physical skills; actions between staff and children are among the elements g. Encourage language development; that produce positive impacts (6). h. Foster self-expression; COMMENTS i. Strengthen the child’s identity as a member of a family Live, real-time interaction with caregivers/teachers is pre- ferred. For example, caregivers/teachers naming objects in and a cultural community; the indoor and outdoor learning/play environment or sing- j. Promote sensory exploration. ing rhymes to all children supports language development. Children’s stories and poems presented on recordings with For infants and toddlers the curriculum should be based a fixed speed for sing-along can actually interfere with a on the child’s development at the time and connected to child’s ability to participate in the singing or recitation. a sound understanding as to where they are in their With fixed-speed activities, the pace may be too fast for developmental course. some children, and the activity may have to be repeated for some children or the caregiver/teacher will need to RATIONALE try a different method for learning. Opportunities to be an active learner are vitally important TYPE OF FACILITY for the development of motor competence and awareness Center, Large Family Child Care Home of one’s own body and person, the development of sensory RELATED STANDARD motor skills, the ability to demonstrate initiative through 2.2.0.3 Screen Time/Digital Media Use active outdoor and indoor play, and feelings of mastery and successful coping. Coping involves original, imaginative, References and innovative behavior as well as previously learned strategies. 1. Moerk, E. L. 2000. The guided acquisition of first language skills. Advances Applied Dev Psychol 20:248. Learning to resolve conflicts constructively in childhood is essential in preventing violence later in life (1,2). A physical 2. Baron, N., L. W. Schrank. 1997. Children learning language: How adults can and social environment that offers opportunities for active help. Lake Zurich, Ill: Learning Seed. mastery and coping enhances the child’s adaptive abilities (3,4,9). The importance of play for developing cognitive skills, 3. Szanton, E. S., ed. 1997. Creating child-centered programs for infants and for maintaining an affective and intellectual equilibrium, toddlers, birth to 3 year olds, step by step: A Program for children and and for creating and testing new capacities is well recog- families. New York: Children’s Resources International. nized (8). Play involves a balance of action and symboliza- tion, and of feeling and thinking (5-7). Children need access 4. Kontos, S., A. Wilcox-Herzog. 1997. Teachers’ interactions with children: to age-appropriate toys and safe household objects. Why are they so important? Young Child 52:4-12. COMMENTS 5. Snow, C. E., M. S. Burns, P. Griffin. 1999. Language and literacy For more information regarding appropriate play materials environments in preschools. ERIC Digest (January). for young children, see “Which Toy for Which Child: A Con- sumer’s Guide for Selecting Suitable Toys” from the U.S. 6. National Forum on Early Childhood Program Evaluation, National Consumer Product Safety Commission (CPSC) and “The Scientific Council on the Developing Child. 2007. A science-based Right Stuff for Children Birth to 8: Selecting Play Materials framework for early childhood policy: Using evidence to improve outcomes to Support Development” from the National Association in learning, behavior, and health for vulnerable children. Cambridge, MA: for the Education of Young Children (NAEYC). For infor- Center on the Developing Child, Harvard University. http://developingchild. mation regarding appropriate materials for outdoor play, harvard.edu/index.php/library/reports_and_working_papers/policy_ see POEMS: Preschool Outdoor Environment framework/. Measurement Scale (10). 2.1.2.3 TYPE OF FACILITY Space and Activity to Support Learning Center, Large Family Child Care Home of Infants and Toddlers RELATED STANDARDS The facility should provide a safe and clean learning envi- 3.1.3.1 Active Opportunities for Physical Activity ronment, both indoors and outdoors, colorful materials 5.1.2.1 Space Required per Child and equipment arranged to support learning. The indoor 5.2.9.14 Shoes in Infant Play Areas and outdoor learning/play environment should encourage 5.3.1.1 Safety of Equipment, Materials, and Furnishings and be comfortable with staff on the floor level when inter- 5.3.1.5 Placement of Equipment and Furnishings acting with active infant crawlers and toddlers. The indoor and outdoor play and learning settings should provide opportunities for the child to act upon the environment by experiencing age-appropriate obstacles, frustrations, and risks in order to learn to negotiate environmental challenges. The facility should provide opportunities for play that: a. Lessen the child’s anxiety and help the child adapt to reality and resolve conflicts; b. Enable the child to explore and experience the natural world;
62 Caring for Our Children: National Health and Safety Performance Standards References RATIONALE Infants need quiet, calm environments, away from the 1. Massey, M. S. 1998. Early childhood violence prevention. ERIC Digest stimulation of older children. Younger infants should be (October). cared for in rooms separate from the more boisterous toddlers. In addition to these developmental needs of 2. Levin, D. E. 1994. Teaching young children in violent times: Building a infants, separation is important for reasons of disease peaceable classroom, A preschool-grade 3 violence prevention and conflict prevention. Rates of hospitalization for all forms of acute resolution guide. Cambridge, MA: Educators for Social Responsibility. infectious respiratory tract diseases are highest during the first year of life, indicating that respiratory tract illness 3. Mayr, T., M. Ulich. 1999. Children’s well-being in day care centers: An becomes less severe as the child gets older (1). Therefore, exploratory empirical study. Int J Early Years Education 7:229-39. infants should be a focus for interventions to reduce the incidence of respiratory tract diseases. Handwashing and 4. Cartwright, S. 1998. Group trips: An invitation to cooperative learning. sanitizing practices are key. Depending on the tempera- Child Care Infor Exch 124:95-97. ment of the child, an increase in transitions can increase anxiety in young children by reducing the opportunity for 5. Evaldsson, A., W. A. Corsaro. 1998. Play and games in the peer cultures of routine and predictability (2), and it increases basic health preschool and preadolescent children: An interpretative approach. and safety concerns of cross contamination with older Childhood 5:377-402. children who have more contact with the environment. COMMENTS 6. Petersen, E. A. 1998. The amazing benefits of play. Child Family 17:7-8. This separation of younger children from older children 7. Pica, R. 1997. Beyond physical development: Why young children need to ideally should be implemented in all facilities, but may be less feasible in small or large family child care homes. move. Young Child 52:4-11. Separation of groups of children by low partitions that 8. Tepperman, J., ed. 2007. Play in the early years: Key to school success, divide a single common space is not acceptable. Without sound attenuation, limitation of shared air pollutants a policy brief. El Cerrito, CA: Early Childhood Funders. including airborne infectious disease agents, or control http://www.4children.org/images/pdf/play07.pdf. of interactions among the caregivers/teachers who are 9. Torelli, L., C. Durrett. 1996. Landscape for learning: The impact of working with different groups, the separate smaller classroom design on infants and toddlers. Early Childhood News 8 groups are essentially one large group. (March-April): 12-17. http://www.spacesforchildren.com/landc1.pdf. TYPE OF FACILITY 10. DeBord, K., L. Hestenes, R. Moore, N. Cosco, J. McGinnis. 2005. Center Preschool outdoor environment measurement scale. Lewisville, NC: RELATED STANDARDS Kaplan Early Learning Co. 3.2.2.2 Handwashing Procedure Appendix K: Routine Schedule for Cleaning, Sanitizing, 2.1.2.4 Separation of Infants and Toddlers and Disinfecting from Older Children References Infants and toddlers younger than three years of age should be cared for in a closed room(s) that separates them from 1. Izurieta, H. S., W. W. Thompson, P. Kramarz, et al. 2000. Influenza and the older children, except in small family child care homes rates of hospitalization for respiratory disease among infants and young with closed groups of mixed aged children. children. New England J Med 342:232-39. In facilities caring for three or more children younger than three years of age, activities that bring children younger 2. Poole, C. 1998. Routine matters. Scholastic Parent Child (August September). than three years of age in contact with older children should be prohibited, unless the younger children already have 2.1.2.5 regular contact with the older children as part of a group. Toilet Learning/Training Pooling, as a practice in larger settings where the infants/ toddlers are not part of the group all day—as in home The facility should develop and implement a plan that care—should be avoided for the following reasons: teaches each child how and when to use the toilet. Toilet a. Unfamiliarity with caregivers/teachers if not the learning/training, when initiated, should follow a pre- scribed, sequential plan that is developed and coordinated primary one during the day; with the parent’s/guardian’s plan for implementation in b. Concerns of noise levels, space ratios, social-emotional the home environment. Toilet learning/training should be based on the child’s developmental level rather than well-being, etc.; chronological age. c. Occurs at times when children are least able to handle To help children achieve bowel and bladder control, caregivers/teachers should enable children to take an active transitions; role in using the toilet when they are physically able to do d. Increases the number of transitions for children, so and when parents/guardians support their children’s e. Increases the number of adults caring for infants and learning to use the toilet. toddlers, a practice to be avoided if possible. Caregivers/teachers of infants should not be responsible for the care of older children who are not a part of the infants’ closed child care group. Groups of younger infants should receive care in closed room(s) that separates them from other groups of toddlers and older children. When partitions are used, they must control interaction between groups, provide separated ventilation of the spaces and control sound transmission. The acoustic controls should limit significant transmission of sound from one group’s activity into other group environments.
63 Chapter 2: Program Activities for Healthy Development Diapering/toilet training should not be used as rationale for COMMENTS not spending time outdoors. Practices and policies should The area of toilet learning/training for children with special be offered to address diapering/toileting needs outdoors health care needs is difficult because there are no age-related, such as providing staff who can address children’s needs, disability-specific rules to follow. As a result, support and or provide outdoor diapering and toileting that meets all counseling for parents/guardians and caregivers/teachers are sanitation requirements. required to help them deal with this issue. Some children Caregivers/teachers should take into account the prefer- with multiple disabilities do not demonstrate any requisite ences and customs of the child’s family. skills other than being dry for a few hours. Establishing a For children who have not yet learned to use the toilet, toilet routine may be the first step toward learning to use the facility should defer toilet learning/training until the the toilet, and at the same time, improving hygiene and skin child’s family is ready to support this learning and the care. The child care health consultant should be considered child demonstrates: a resource to assist is supporting special health care needs. a. An understanding of the concept of cause and effect; Sometimes children need to increase their fluid intake to b. An ability to communicate, including sign language; help a medical condition and this can lead to increased c. The physical ability to remain dry for up to two hours; urination. Other conditions can lead to loose stools. Chil- d. An ability to sit on the toilet, to feel/understand the dren should be given unrestricted access to toileting facilities, especially in these situations. Children who are recovering sense of elimination; from gastrointestinal illness might temporarily lose conti- e. A demonstrated interest in autonomous behavior. nence, especially if they are recently toilet trained, and may For preschool and school-age children, an emphasis should need to revert to diapers or training pants for a short period be placed on appropriate handwashing after using the toilet of time. Children who are experiencing stress (e.g., a new and they should be provided frequent and unrestricted infant in the family) may regress and also return to using opportunities to use the toilet. diapers for a period of time. Children with special health care needs may require spe- cific instructions, training techniques, adapted toilets, and/ For more information on toilet learning/training, see or supports or precautions. Some children will need to be “Toilet Training: Guidelines for Parents,” available from the taught special techniques like catheterization or care of American Academy of Pediatrics (AAP) at http://www.aap. ostomies. This can be provided by trained staff or older org and the AAP Section on Developmental and Behavioral children can sometimes learn self-care techniques. Any Pediatrics at http://www.aap.org/sections/dbpeds/. special techniques should be documented in a written care plan. The child care health consultant can provide training TYPE OF FACILITY or coordinate resources necessary to accommodate special Center, Large Family Child Care Home toileting techniques while in child care. Cultural expectations of toilet learning/training need to be RELATED STANDARDS recognized and respected. 3.2.1.5 Procedure for Changing Children’s Soiled RATIONALE Underwear/Pull-Ups and Clothing A child’s achievements of motor and cognitive or develop- 5.4.1.1 General Requirements for Toilet and mental skills assist in determining when s/he is ready for toilet learning/training (1). Physical ability/neurological Handwashing Areas function also includes the ability to sit on the toilet and 5.4.1.2 Location of Toilets and Privacy Issues to feel/understand the sense of elimination. 5.4.1.3 Ability to Open Toilet Room Doors Toilet learning/training is achieved more rapidly once 5.4.1.4 Preventing Entry to Toilet Rooms by Infants expectations from adults across environments are consis- tent (3). The family may not be prepared, at the time, to ex- and Toddlers tend this learning/training into the home environment (2). 5.4.1.5 Chemical Toilets School-age and preschool children may not respond when 5.4.1.6 Ratios of Toilets, Urinals, and Hand Sinks to their bodies signal a need to use the toilet because they are involved in activities or embarrassed about needing to use Children the toilet. Holding back stool or urine can lead to con- 5.4.1.7 Toilet Learning/Training Equipment stipation and urinary tract problems (4). Also, unless 5.4.1.8 Cleaning and Disinfecting Toileting Equipment reminded, many children forget to correctly wash their 5.4.1.9 Waste Receptacles in the Child Care Facility and hands after toileting. in Child Care Facility Toilet Room(s) References 1. Mayo Clinic. 2009. Potty training: How to get the job done. http://www. mayoclinic.com/health/potty-training/CC00060/. 2. American Academy of Pediatrics. 2009. When is the right time to start toilet training? http://www.aap.org/publiced/BR_ToiletTrain.htm. 3. Anthony-Pillai, R. 2007. What’s potty about early toilet training? British Med J 334:1166. 4. Schmitt, B. D. 2004. Toilet training problems: Underachievers, refusers, and stool holders. Contemporary Pediatrics 21:71-77.
64 Caring for Our Children: National Health and Safety Performance Standards 2.1.3 2.1.3.2 PROGRAM ACTIVITIES FOR Opportunities for Learning for Three- to THREE- TO FIVE-YEAR-OLDS Five-Year-Olds 2.1.3.1 Programs should provide children a balance of guided and Personal Caregiver/Teacher Relationships self-initiated play and learning indoors and outdoors. These for Three- to Five-Year-Olds should include opportunities to observe, explore, order and reorder, to make mistakes and find solutions, and to move Facilities should provide opportunities for each child to from the concrete to the abstract in learning. build long-term, trusting relationships with a few caring caregivers/teachers by limiting the number of adults the RATIONALE facility permits to care for any one child in child care to a The most meaningful learning has its source in the child’s maximum of eight adults in a given year and no more than self-initiated activities. The learning environment that three primary caregivers/teachers in a day. Children with supports individual differences, learning styles, abilities, special health care needs may require additional specialists and cultural values fosters confidence and curiosity in to promote health and safety and to support learning; how- learners (1,2). ever, relationships with primary caregivers/teachers should be supported. TYPE OF FACILITY RATIONALE Center, Large Family Child Care Home Children learn best from adults who know and respect them; who act as guides, facilitators, and supporters within References a rich learning environment; and with whom they have established a trusting relationship (1,2). When the facility 1. Rodd, J. 1996. Understanding young children’s behavior: A guide for early allows too many adults to be involved in the child’s care, childhood professionals. New York: Teacher’s College Press. the child does not develop a reciprocal, sustained, respon- sive, and trusting relationship with any of them. Children 2. Ritchie, S., B. Willer. 2008. Teaching: A guide to the NAEYC early should have continuous friendly and trusting relationships childhood standard and related accreditation criteria. Washington, DC: with several caregivers/teachers who are reasonably con- National Association for the Education of Young Children. sistent within the child care facility. Young children can extract from these relationships a sense of themselves with a 2.1.3.3 capacity for forming trusting relationships and self-esteem. Selection of Equipment for Three- to Relationships are fragmented by rapid staff turnover, staffing Five-Year-Olds reassignment, or if the child is frequently moved from one room to another or one child care facility to another. The program should select, for both indoor and outdoor COMMENTS play and learning, developmentally appropriate equipment Compliance should be measured by staff and parent/ and materials, for safety, for its ability to provide large and guardian interviews. Turnover of staff lowers the quality small motor experiences, and for its adaptability to serve of the facility. High quality facilities maintain low turnover many different ideas, functions, and forms of creative through their wage policies, training and support for staff (3). expression. TYPE OF FACILITY Center, Large Family Child Care Home RATIONALE References An aesthetic, orderly, appropriately stimulating, child- oriented indoor and outdoor learning/play environment 1. Rodd, J. 1996. Understanding young children’s behavior: A guide for early contributes to the preschooler’s sense of well-being and childhood professionals. New York: Teacher’s College Press. control (1,2,4,5). 2. Greenberg, P. 1991. Character development: Encouraging self-esteem and COMMENTS self-discipline in infants, toddlers, and two-year-olds. Washington, DC: “Play and learning settings that motivate children to be National Association for the Education of Young Children. physically active include pathways, trails, lawns, loose parts, anchored playground equipment, and layouts that 3. Whitebook, M., D. Bellm. 1998. Taking on turnover: An action guide for stimulate all forms of active play” (3). If traditional play- child care center teachers and directors. Washington, DC: Center for the ground equipment is used, caregivers/teachers may want Child Care Workforce. to consult with an early childhood specialist or a certified playground inspector for recommendations on develop- mentally appropriate play equipment. For more informa- tion on play equipment also contact the National Program for Playground Safety (http://www.uni.edu/playground/). TYPE OF FACILITY Center, Large Family Child Care Home RELATED STANDARDS 5.2.9.9 Plastic Containers and Toys 5.2.9.12 Treatment of CCA Pressure-Treated Wood
65 Chapter 2: Program Activities for Healthy Development References TYPE OF FACILITY Center, Large Family Child Care Home 1. Torelli, L., C. Durrett. 1996. Landscape for learning: The impact of Reference classroom design on infants and toddlers. Early Child News 8:12-17. 1. Pica, R. 1997. Beyond physical development: Why young children need to 2. Center for Environmental Health. The safe playgrounds project. move. Young Child 52:4-11. http://www.safe2play.org. 2.1.3.6 3. DeBord, K., L. Hestenes, R. Moore, N. Cosco, J. McGinnis. 2005. Preschool Fostering Language Development of outdoor environment measurement scale. Lewisville, NC: Kaplan Early Three- to Five-Year-Olds Learning Co. The indoor and outdoor learning/play environment should 4. Banning, W., G. Sullivan. 2009. Lens on outdoor learning. St. Paul, MN: be rich in first-hand experiences that offer opportunities Red Leaf Press. for language development. They should also have an abun- dance of books of fantasy, fiction, and nonfiction, and pro- 5. Keeler, R. 2008. Natural playscapes: Creating outdoor play environments vide chances for the children to relate stories. Caregivers/ for the soul. Redmond, WA: Exchange Press. teachers should foster language development by: a. Speaking with children rather than at them; 2.1.3.4 b. Encouraging children to talk with each other by helping Expressive Activities for Three- to Five-Year-Olds them to listen and respond; c. Giving children models of verbal expression; Caregivers/teachers should encourage and enhance expres- d. Reading books about the child’s culture and history, which sive activities that include play, painting, drawing, storytell- ing, sensory play, music, singing, dancing, and dramatic play. would serve to help the child develop a sense of self; RATIONALE e. Reading to children and re-reading their favorite books; Expressive activities are vehicles for socialization, con- f. Listening respectfully when children speak; flict resolution, and language development. They are vital g. Encouraging interactive storytelling; energizers and organizers for cognitive development (2). h. Using open-ended questions; Stifling the preschooler’s need to play damages a natural i. Provide opportunities during indoor and outdoor learn- integration of thinking and feeling (1). TYPE OF FACILITY ing/play to use writing supplies and printed materials; Center, Large Family Child Care Home j. Provide and read books relevant to their natural environ- References ment outdoors (for example, books about the current 1. Cooney, M., L. Hutchinson, V. Costigan. 1996. From hitting to tattling to season, local wildlife, etc.); communication and negotiation: The young child’s stages of socialization. k. Provide settings that encourage children to observe Early Child Education J 24:23-27. nature, such as a butterfly garden, bird watching station, etc.; 2. Tepperman, J., ed. 2007. Play in the early years: Key to school success, l. Providing opportunities to explore writing, such as a policy brief. El Cerrito, CA: Early Childhood Funders. http:// through a writing area or individual journals. www.4children.org/images/pdf/play07.pdf. RATIONALE Language reflects and shapes thinking. A curriculum 2.1.3.5 created to match preschoolers’ needs and interests enhances Fostering Cooperation of Three- to language skills. First-hand experiences encourage children Five-Year-Olds to talk with each other and with adults, to seek, develop, and use increasingly more complex vocabulary, and to use Programs should foster a cooperative rather than a com- language to express thinking, feeling, and curiosity (1-3). petitive indoor and outdoor learning/play environment. COMMENTS RATIONALE Compliance with development should be measured by As three-, four-, and five-year-olds play and work together, structured observation. Examples of verbal encouragement they shift from almost total dependence on the adult to of verbal expression are: “ask Johnny if you may play with seeking social opportunities with peers that still require him”; “tell him you don’t like being hit”; “tell Sara what you adult monitoring and guidance. The rules and responsibili- saw downtown yesterday;” “can you tell Mommy about what ties of a well-functioning group help children of this age you and Johnny played this morning?” These encouraging to internalize impulse control and to become increasingly statements should be followed by respectful listening, responsible for managing their behavior. A dynamic curric- without pressuring the child to speak. ulum designed to include the ideas and values of a broad TYPE OF FACILITY socioeconomic group of children will promote socialization. Center, Large Family Child Care Home The inevitable clashes and disagreements are more easily RELATED STANDARD resolved when there is a positive influence of the group 2.3.2.3 Support Services for Parents/Guardians on each child (1). COMMENTS Encouraging communication skills and attentiveness to the needs of individuals and the group as a whole supports a cooperative atmosphere. Adults need to model cooperation.
66 Caring for Our Children: National Health and Safety Performance Standards References 2.1.4 PROGRAM ACTIVITIES FOR 1. Szanton, E. S., ed. 1997. Creating child-centered programs for infants and toddlers, birth to 3 year olds, step by step: A Program for children and SCHOOL-AGE CHILDREN families. New York: Children’s Resources International. 2.1.4.1 2. Snow, C. E., M. S. Burns, P. Griffin. 1999. Language and literacy Supervised School-Age Activities environments in preschools. ERIC Digest (January). The facility should have a program of supervised activities 3. Maschinot, B. 2008. The changing face of the United States: The influence of designed especially for school-age children, to include: culture on early child development. Washington, DC: Zero to Three. http:// a. Free choice of play; www.zerotothree.org/site/DocServer/Culture_book.pdf?docID=6921. b. Opportunities, both indoors and outdoors, for vigorous 2.1.3.7 physical activity which engages each child daily for at Body Mastery for Three- to Five-Year-Olds least sixty minutes and are not limited to opportunities to develop physical fitness through a program of focused The caregivers/teachers should offer children opportunities, activity that only engages some of the children in indoors and outdoors, to learn about their bodies and how the group; their bodies function in the context of socializing with c. Opportunities for concentration, alone or in a group, others. Caregivers/teachers should support the children in indoors and/or outdoors; their curiosity and body mastery, consistent with parental/ d. Time to read or do homework, indoors and/or outdoors; guardian expectations and cultural preferences. Body mas- e. Opportunities to be creative, to explore the arts, tery includes feeding oneself, learning how to use the toilet, sciences, and social studies, and to solve problems, running, skipping, climbing, balancing, playing with peers, indoors and/or outdoors; displaying affection, and using and manipulating objects. f. Opportunities for community service experience RATIONALE (museums, library, leadership development, elderly Achieving the pleasure and gratification of feeling physi- citizen homes, etc.); cally competent on a voluntary basis is a basic component g. Opportunities for adult-supervised skill-building and of developing self-esteem and the ability to socialize with self-development groups, such as scouts, team sports, adults and other children inside and outside the family (1-5). and club activities (as transportation, distance, and COMMENTS parental permission allow); Self-stimulatory behaviors, such as thumb sucking or h. Opportunities to rest; masturbation, should be ignored. If the masturbation is i. Opportunities to seek comfort, consolation, and excessive, interferes with other activities, or is noticed by understanding from adult caregivers/teachers; other children, the caregiver/teacher should make a brief j. Opportunities for exercise and exploration out of doors. non-judgmental comment that touching of private body RATIONALE parts is normal, but is usually done in a private place (7,8). Programs organized for older children after school or After making such a comment, the caregiver/teacher should during vacation time should provide indoor and outdoor offer friendly assistance in going on to other activities. These learning/play environments that meet the needs of these behaviors may be signs of stress in the child’s life, or simply children for physical activity, recreation, responsible a habit. If the child’s sexual play is more explicit or forceful completion of school work, expanding their interests, toward other children or the child witnessed or was ex- learning cultural sensitivity, exploring community posed to adult sexuality, the caregiver/teacher may need resources, and practicing pro-social skills (1,2). to consider that abuse is possible (6). COMMENTS TYPE OF FACILITY For more information on school-age standards, see [The Center, Large Family Child Care Home NAA Standards for Quality School-Age Care,] available References from the National AfterSchool Association (NAA). TYPE OF FACILITY 1. Botkin, D., et al. 1991. Children’s affectionate behavior: Gender differences. Center, Large Family Child Care Home Early Education Dev 2:270-86. RELATED STANDARD 3.1.3.1 Active Opportunities for Physical Activity 2. Mayr, T., M. Ulich. 1999. Children’s well-being in day care centers: An References exploratory empirical study. Int J Early Years Education 7:229-39. 1. Coltin, L. 1999. Enriching children’s out-of-school time. ERIC Digest (May). 3. Cartwright, S. 1998. Group trips: An invitation to cooperative learning. 2. Fashola, O. S. 1999. Implementing effective after-school programs. Child Care Infor Exch 124:95-97. Here’s How 17:1-4 4. Rodd, J. 1996. Understanding young children’s behavior: A guide for early childhood professionals. New York: Teacher’s College Press. 5. Cooney, M., L. Hutchinson, V. Costigan. 1996. From hitting to tattling to communication and negotiation: The young child’s stages of socialization. Early Child Education J 24:23-27. 6. Kellogg, N., American Academy of Pediatrics Committee on Child Abuse and Neglect. 2005. Clinical report: The evaluation of sexual abuse in children. Pediatrics 116:506-12. 7. Johnson, T. C. 2007. Understanding children’s sexual behaviors: What’s natural and healthy. San Diego: Institute on Violence, Abuse and Trauma. 8. Friedrich, W. N., J. Fisher, D. Broughton, M. Houston, C. R. Shafran. 1998. Normative sexual behavior in children: A contemporary sample. Pediatrics 101: e9.
67 Chapter 2: Program Activities for Healthy Development 2.1.4.2 2.1.4.5 Space for School-Age Activity Community Outreach for School-Age Children The facility should provide a space for indoor and outdoor The facility should provide opportunities for school-age activities for children in school-age child care. children to participate in community outreach and involve- RATIONALE ment, such as field trips and community improvement A safe and secure environment that fosters the growing projects. independence of school-age children is essential for their RATIONALE development (1,2). Active connection with nature promotes As the world of the school-age child encompasses the larger children’s sensitivity, confidence, exploration, and community, facility activities should reflect this stage of self-regulation. development. Field trips and other opportunities to explore TYPE OF FACILITY the community should enrich the child’s experience (1). Center, Large Family Child Care Home TYPE OF FACILITY References Center, Large Family Child Care Home 1. Greenspan, S. L. 1997. Building children’s minds: Early childhood Reference development for a better future. Our Child 23:6-10. 1. Taras, H. L. 2005. School-aged child care. In Health in child care: A manual 2. Maxwell, L. E. 1996. Designing early childhood education environments: for health professionals, ed. J. R. Murph, S. D. Palmer, D. Glassy, 411-21. 4th A partnership between architect and educator. Education Facility Planner ed. Elk Grove Village, IL: American Academy of Pediatrics. 33:15-17. 2.1.4.6 2.1.4.3 Communication Between Developing Relationships for School-Age Child Care and School Children Facilities that accept school-age children directly from school The facility should offer opportunities to school-age should arrange a system of communication with children for developing trusting, supportive relationships the child’s school teacher. Families should be included in this with the staff and with peers. communication loop. RATIONALE RATIONALE Although school-age children need more independent This communication may be facilitated by phone or email experiences, they continue to need the guidance and between the child’s teacher and the school-age child care support of adults. Peer relationships take on increasing facility. School-age child care programs should include importance for this age group. Community service parent/guardian permissions which allow school teachers opportunities can be valuable for this age group. to communicate relevant information to caregivers/teachers. TYPE OF FACILITY Parents/guardians should also be notified of any significant Center, Large Family Child Care Home event so that a system of communication is established between and among family, school, and caregivers/teachers. 2.1.4.4 The child’s school teacher and a staff member from the Planning Activities for School-Age Children facility should meet at least once to exchange telephone numbers and to offer a contact in the event relevant The facility should offer a program based on the needs information needs to be shared. and interests of the age group, as well as of the individuals TYPE OF FACILITY within it. Children should participate in planning the Center, Large Family Child Care Home program activities. Parents/guardians should be engaged RELATED STANDARD and their work commitments should be honored when 9.4.1.3 Written Policy on Confidentiality of Records planning program activities. RATIONALE Reference A child care facility for school-age children should provide an enriching contrast to the formal school program, but 1. National Association of Elementary School Principals, National AfterSchool also offer time for children to complete homework assign- Association. Leading a new day for learning. http://www.naaweb.org/ ments. Programs that offer a wide range of activities (such downloads/Principal Documents/leading_joint_statement-r3_.pdf. as team sports, cooking, dramatics, art, music, crafts, games, open time, quiet time, outdoor play and learning, and use of community resources) allow children to explore new interests and relationships. TYPE OF FACILITY Center, Large Family Child Care Home
68 Caring for Our Children: National Health and Safety Performance Standards 2.2 The importance of supervision is not only to protect chil- SUPERVISION AND DISCIPLINE dren from physical injury, but from harm that can occur from topics discussed by children or by teasing/bullying/ 2.2.0.1 inappropriate behavior. It is the responsibility of caregivers/ Methods of Supervision of Children teachers to monitor what children are talking about and intervene when necessary. Caregivers/teachers should directly supervise infants, Children like to test their skills and abilities. This is partic- toddlers, and preschoolers by sight and hearing at all times, ularly noticeable around playground equipment. Even if the even when the children are going to sleep, napping or sleep- highest safety standards for playground layout, design and ing, are beginning to wake up, or are indoors or outdoors. surfacing are met, serious injuries can happen if children School-age children should be within sight or hearing at all are left unsupervised. Adults who are involved, aware, and times. Caregivers/teachers should not be on one floor level appreciative of young childrens’ behaviors are in the best of the building, while children are on another floor or position to safeguard their well-being. Active and positive room. Ratios should remain the same whether inside supervision involves: or outside. a. Knowing each child’s abilities; School-age children should be permitted to participate in b. Establishing clear and simple safety rules; activities off the premises with appropriate adult supervi- c. Being aware of and scanning for potential safety hazards; sion and with written approval by a parent/guardian and by d. Placing yourself in a strategic position so you are able the caregiver. If parents/guardians give written permission for the school-age child to participate in off-premises activi- to adapt to the needs of the child; ties, the facility would no longer be responsible for the child e. Scanning play activities and circulating around the area; during the off-premises activity and not need to provide f. Focusing on the positive rather than the negative to teach staff for the off-premises activity. Caregivers/teachers should regularly count children a child what is safe for the child and other children; (name to face on a scheduled basis, at every transition, and g. Teaching children the developmentally appropriate and whenever leaving one area and arriving at another), going indoors or outdoors, to confirm the safe whereabouts of safe use of each piece of equipment (e.g., using a slide every child at all times. Additionally, they must be able correctly—feet first only—and teaching why climbing to state how many children are in their care at all times. up a slide can cause injury, possibly a head injury). Developmentally appropriate child:staff ratios should be met Primary caregiving systems, small group sizes, and low during all hours of operation, including indoor and outdoor child:staff ratios unique to infant/toddler settings support play and field trips, and safety precautions for specific areas staff in properly supervising infants and toddlers. These and equipment should be followed. No center-based facility practices encourage responsive interactions and under- or large family child care home should operate with fewer standing each child’s strengths and challenges. When than two staff members if more than six children are in staff connect deeply with the children in their care, they care, even if the group otherwise meets the child:staff ratio. are more in tune to children’s needs and whereabouts. Although centers often downsize the number of staff for Ultimately, carefully planned environments; staffing that the early arrival and late departure times, another adult supports nurturing, individualized, and engaged care- must be present to help in the event of an emergency. The giving; and well-planned, responsive care routines support supervision policies of centers and large family child care active supervision in infant and toddler environments. homes should be written policies. Children are going to be more active in the outdoor learning/ RATIONALE play environment and need more supervision rather than Supervision is basic to safety and the prevention of injury less outside. Playground supervisors need to be designated and maintaining quality child care. Parents/guardians have and trained to supervise children in play areas (1). Super- a contract with caregivers/teachers to supervise their chil- vision of the playground is a strategy of watching all the dren. To be available for supervision or rescue in an emer- children within a specific territory and not engaging in gency, an adult must be able to hear and see the children. prolonged dialog with any one child or group of children In case of fire, a supervising adult should not need to climb (or other staff). Other adults not designated to supervise stairs or use a ramp or an elevator to reach the children. may facilitate outdoor learning/play activities and engage Stairs, ramps, and elevators may become unstable because in conversations with children about their exploration and they can be pathways for fire and smoke. Children who are discoveries. Facilitated play is where the adult is engaged in presumed to be sleeping might be awake and in need of helping children learn a skill or achieve specific outcome adult attention. A child’s risk-taking behavior must be of an activity. Facilitated play is not supervision (2). detected and illness, fear, or other stressful behaviors Children need spaces, indoors and out, in which they must be noticed and managed. can withdraw for alone-time or quiet play in small groups. However, program spaces should be designed with visibility that allows constant unobtrusive adult supervision. To protect children from maltreatment, including sexual abuse, the environment layout should limit situations in
69 Chapter 2: Program Activities for Healthy Development which an adult or older child is left alone with a child Harms, T., D. Cryer, R. M. Clifford. 2005. Infant/toddler without another adult present (3,4). environment rating scale, revised ed. Frank Porter Graham Many instances have been reported where a child has hid- Child Development Institute, University of North Carolina. den when the group was moving to another location, or http://ers.fpg.unc.edu/node/84/. where the child wandered off when a door was opened for Chen, X., M. Beran, R. Altkorn, S. Milkovich, K. Gruaz, G. another purpose. Regular counting of children (name to Rider, A. Kanti, J. Ochsenhirt. 2006. Frequency of caregiver face) will alert the staff to begin a search before the child supervision of young children during play. Intl J Injury gets too far, into trouble, or slips into an unobserved location. Control and Safety Promotion 14:122-24. Caregivers/teachers should record the count on an atten- Schwebel, D. C., A. L. Summerlin, M. L. Bounds, B. A. dance sheet or on a pocket card, along with notations of any Morrongiello. 2006. The stamp-in-safety program: A children joining or leaving the group. Caregivers/teachers behavioral intervention to reduce behaviors that can lead to should do the counts before the group leaves an area and unintentional playground injury in a preschool setting. J when the group enters a new area. The facility should assign Pediatric Psychology 31:152-62. and reassign counting responsibility as needed to maintain U.S. Consumer Product Safety Commission (CPSC). 2010. a counting routine. Facilities might consider counting sys- Public playground safety handbook. http://www.cpsc.gov/ tems such as using a reminder tone on a watch or musical cpscpub/pubs/325.pdf. clock that sounds at timed intervals (about every fifteen minutes) to help the staff remember to count. TYPE OF FACILITY Caregivers/teachers should be ready to provide help and Center, Large Family Child Care Home guidance when children are ready to use the toilet correctly and independently. Caregivers/teachers should make sure RELATED STANDARDS children correctly wash their hands after every use of the 1.1.1.1 Ratios for Small Family Child Care Homes toilet, as well as monitor the bathroom to make sure that 1.1.1.2 Ratios for Large Family Child Care Homes and the toilet is flushed, the toilet seat and floor are free from stool or urine, and supplies (toilet paper, soap, and paper Centers towels) are available. 1.1.1.3 Ratios for Facilities Serving Children with Special Older preschool children and school-age children may use toilet facilities without direct visual observation but must Health Care Needs and Disabilities remain within hearing range in case children need assis- 1.1.1.4 Ratios and Supervision During Transportation tance and to prevent inappropriate behavior. If toilets are 1.1.1.5 Ratios and Supervision for Swimming, Wading, not on the same floor as the child care area or within sight or hearing of a caregiver/teacher, an adult should accom- and Water Play pany children younger than five years of age to and from 3.4.4.5 Facility Layout to Reduce Risk of Child Abuse the toilet area. Younger children who request privacy and have shown capability to use toilet facilities properly and Neglect should be given permission to use separate and private 5.4.1.2 Location of Toilets and Privacy Issues toilet facilities. Planning must include advance assignments, monitoring, References and contingency plans to maintain appropriate staffing. During times when children are typically being dropped 1. National Program for Playground Safety. 2006. Playground supervision off and picked up, the number of children present can vary. training for childcare providers. University of Northern Iowa. http://www. There should be a plan in place to monitor and address playgroundsafety.org/training/online/childcare/course_supervision.htm. unanticipated changes, allowing for caregivers/teachers to receive additional help when needed. Sufficient staff 2. National Program for Playground Safety. 2006. NPPS Website. http://www. must be maintained to evacuate the children safely in case playgroundsafety.org. of emergency. Compliance with proper child:staff ratios should be measured by structured observation, by counting 3. National Association for the Education of Young Children. 1996. Position caregivers/teachers and children in each group at varied Statement. Prevention of child abuse in early childhood programs and the times of the day, and by reviewing written policies. responsibilities of early childhood professionals to prevent child abuse. COMMENTS 4. Fiene, R. 2002. 13 indicators of quality child care: Research update. Washington, DC: U.S. Department of Health and Human Services, Office of Additional Readings the Assistant Secretary for Planning and Evaluation. http://aspe.hhs.gov/ Harms, T., R. M. Clifford, D. Cryer. 2005. Early childhood basic-report/13-indicators-quality-child-care. environment rating scale, revised ed. Frank Porter Graham Child Development Institute, University of North Carolina. 2.2.0.2 http://ers.fpg.unc.edu/node/82/. Limiting Infant/Toddler Time in Crib, High Chair, Car Seat, Etc. A child should not sit in a high chair or other equipment that constrains his/her movement (1,2) indoors or outdoors for longer than fifteen minutes, other than at meals or snack time. Children should never be left out of the view and attention of adult caregivers/teachers while in these types of equipment/furniture. A least restrictive environ- ment should be encouraged at all times. Children should not be left to sleep in equipment, such as car seats, swings, or infant seats that does not meet ASTM International (ASTM) product safety standards for sleep equipment.
70 Caring for Our Children: National Health and Safety Performance Standards RATIONALE For children of all ages, digital media and devices should Children are continually developing their physical skills. not be used during meal or snack time, or during nap/rest They need opportunities to use and build on their physical times and in bed. Devices should be turned off at least one abilities. This is especially true for infants and toddlers who hour before bedtime. When offered, digital media should are eagerly using their bodies to explore their environment. be free of advertising and brand placement, violence, and Extended periods of time in the crib, high chair, car seat, or sounds that tempt children to overuse the product. other confined space limits their physical growth and also Caregivers/teachers should communicate with parents/ affects their social interactions. Injuries and Sudden Infant guardians about their guidelines for home media use. Death Syndrome (SIDS) have occurred when children have Caregivers/teachers should take this information into been left to sleep in car seats or infant seats when the straps consideration when planning the amount of media use have entrapped body parts, or the children have turned the at the child care program to help in meeting daily seats over while in them. Sleeping in a seated position can recommendations (1). restrict breathing and cause oxygen desaturation in young Programs should prioritize physical activity and increased infants (3). Sleeping should occur in equipment manufac- personal social interactions and engagement during the tured for this activity. When children are awake, restricting program day. It is important for young children to have them to a seat may limit social interactions. These social active social interactions with adults and children. Media interactions are essential for children to gain language use can distract children (and adults), limit conversations skills, develop self-esteem, and build relationships (4). and play, and reduce healthy physical activity, increasing the risk for overweight and obesity. Media should be turned TYPE OF FACILITY off when not in use since background media can be distrac- Center, Large Family Child Care Home ting, and reduce social engagement and learning. Overuse of media can also be associated with problems with behavior, RELATED STANDARDS limit-setting, and emotional and behavioral self-regulation; 3.1.3.1 Active Opportunities for Physical Activity therefore, caregivers/teachers should avoid using media to 3.1.4.1 Safe Sleep Practices and Sudden Unexpected calm a child down (1). Note: The guidance above should not limit digital media Infant Death (SUID)/SIDS Risk Reduction use for children with special health care needs who require 5.3.1.10 Restrictive Infant Equipment Requirements and consistently use assistive and adaptive computer tech- 5.4.5.1 Sleeping Equipment and Supplies nology (2). However, the same guidelines apply for enter- 5.4.5.2 Cribs tainment media use. Consultation with an expert in assistive communication may be necessary. References * Designed with child psychologists and educators to meet specific educational goals 1. Kornhauser Cerar, L., C.V. Scirica, I. Stucin Gantar, D. Osredkar, D. Neubauer, T.B. Kinane. 2009. A comparison of respiratory patterns in RATIONALE healthy term infants placed in care safety seats and beds. Pediatrics The first two years of life are critical periods of growth and 124:e396-e402. development for children’s brains and bodies, and rapid brain development continues through the early childhood 2. Benjamin, S.E., S.L. Rifas-Shiman, E.M. Taveras, J. Haines, J. Finkelstein, K. years. To best develop their cognitive, language, motor, and Kleinman, M.W. Gillman. 2009. Early child care and adiposity at ages 1 and social-emotional skills, infants and toddlers need hands-on 3 years. Pediatrics 124:555-62. exploration and social interaction with trusted caregivers (1). Digital media viewing do not promote such skills 3. Bass, J. L., M. Bull. 2008. Oxygen desaturation in term infants in car safety development as well as “real life”. seats. Pediatrics 110:401-2. Excessive media use has been associated with lags in achievement of knowledge and skills, as well as negative 4. New York State Office of Children and Family Services. Website. http:// impacts on sleep, weight, and social/emotional health. (1). www.ocfs.state.ny.us/main/. For example, among 2-year-olds, research has shown that body mass index (BMI) increases for every hour per week 2.2.0.3 of media consumed (3). Screen Time/Digital Media Use COMMENTS Please note: For the purposes of this standard “screen time/ Digital media is not without benefits, including learning digital media” refers to media content viewed on cell/ from high-quality content, creative engagement, and social mobile phone, tablet, computer, television (TV), video, film, interactions. However, especially in young children, real- and DVD. It does not include video-chatting with family. life social interactions promote greater learning and reten- Screen time/digital media should not be used with children tion of knowledge and skills. When limited digital media ages 2 and younger in early care and education settings. For are used, co-viewing and co-teaching with an engaged adult children ages 2 to 5 years, total exposure (in early care and promotes more effective learning and development. education and at home combined) to digital media should be limited to 1 hour per day of high-quality programming,* and viewed with an adult who can help them apply what they are learning to the world around them (1). Children ages 5 and older may need to use digital media in early care and education to complete homework. However, caregivers/teachers should ensure that entertainment media time does not displace healthy activities such as exercise, refreshing sleep, and family time, including meals.
71 Chapter 2: Program Activities for Healthy Development Because children may use digital media before and after 4. American Academy of Pediatrics. Council on Early Childhood. Literacy attending early care and education settings, limiting promotion: an essential component of primary care pediatric practice. digital media use in early care and education settings and Pediatrics. 2014;134(2):1-6. http://pediatrics.aappublications.org/content/ substituting developmentally appropriate play and other early/2014/06/19/peds.2014-1384. hands-on activities can better promote learning and skills development. Such an activity is reading. Caregivers/ 5. American Academy of Pediatrics Council on Communications and Media. teachers should begin reading to children at infancy (4) Media use in school-aged children and adolescents. Pediatrics. and facilities should make age-appropriate books available 2016;138(5):e20162592. http://pediatrics.aappublications.org/content/138/5/ for each cognitive stage of development that can be co-read e20162592. and discussed with an adult. See the American Academy of Pediatrics’ “Books Build Connections Toolkit” at https:// Additional References littoolkit.aap.org/forprofessionals/Pages/home.aspx for more information. The American Academy of Pediatrics American Academy of Pediatrics Council on Communica-tions and has developed a Family Media Use Plan tool, available at Media. Children and adolescents and digital media. Pediatrics. https://www.healthychildren.org/English/media/Pages/ 2016;138(5): e20162593. http://pediatrics.aappublications.org/content/ default.aspx, which can help parents/guardians, caregivers, pediatrics/early/2016/10/19/peds.2016-2593.full.pdf. and families identify healthy activities for each child, and American Academy of Pediatrics. Media and children communication toolkit. prioritize them ahead of limited digital media use (5). Aap.org Web site. https://www.aap.org/en-us/advocacy-and-policy/aap-health- initiatives/pages/media-and-children.aspx. Accessed October 12, 2017. Caregivers/teachers serve as role models for children in Campaign for a Commercial-Free Childhood. Screenfree.org Web site. early care and education settings by not using or being dis- http://www.screenfree.org/. Accessed October 12, 2017. tracted by digital media during care hours. In addition, if Common Sense Education. Commonsense.org Web site. https://www. adults view media such as news in the presence of children, commonsense.org/education/toolkit/audience/device-free-dinner- children may be exposed to inappropriate language or vio- educator-resources. Accessed October 12, 2017. lent or frightening images that can cause emotional upset Fred Rogers Center for Early Learning and Children’s Media at Saint or increase aggressive thoughts and behavior. Caregivers/ Vincent College. How am I doing? A teachers should be discouraged from using digital media checklist for identifying exemplary uses of technology and interactive media for for personal use while actively engaging with and super- early learning. Fredrogerscenter.org Web site. http://www.fredrogerscenter. vising the children in their care. Instead, opportunities org/2014/02/25/how-am-i-doing-checklist-exemplary-uses-of-technology- for collaborative activities are preferred. early-learning/. Updated February 25, 2014. Accessed October 12, 2017. National Association for the Education of Young Children. Technology and It is important to safeguard privacy for children on the interactive media as tools in early childhood programs serving children from internet and digital media. Pictures and videos of children birth through age 8. Position Statement. NAEYC.org Web site. http://www. should never be posted on social media without parent/ naeyc.org/files/naeyc/PS_technology_WEB.pdf. January 2012. Accessed guardian consent. Caregivers/teachers should know and October 12, 2017. follow their program’s policy for taking, sharing, or posting pictures and videos. NOTES Content in the STANDARD was modified on 10/12/2017. TYPE OF FACILITY Center, Large Family Child Care Home 2.2.0.4 Supervision Near Bodies of Water RELATED STANDARDS Constant and active supervision should be maintained when 2.1.2.1 Personal Caregiver/Teacher Relationships for any child is in or around water (1). During any swimming/ Infants and Toddlers wading/water play activities where either an infant or a toddler is present, the ratio should always be one adult to 2.1.3.1 Personal Caregiver/Teacher Relationships for one infant/toddler. Children ages thirteen months to five Three- to Five-Year-Olds years of age should not be permitted to play in areas where there is any body of water, including swimming pools, 2.1.4.3 Developing Relationships for School-Age ponds and irrigation ditches, built-in wading pools, tubs, Children pails, sinks, or toilets unless the supervising adult is within an arm’s length providing “touch supervision”. 2.2.0.1 Methods of Supervision of Children Caregivers/teachers should ensure that all pools meet the Virginia Graeme Baker Pool and Spa Safety Act, requiring 3.1.3.1 Active Opportunities for Physical Activity the retrofitting of safe suction-type devices for pools and spas to prevent underwater entrapment of children in such Appendix S: Physical Activity: How Much Is Needed? locations with strong suction devices that have led to deaths of children of varying ages (2). References RATIONALE Small children can drown within thirty seconds, in as little 1. American Academy of Pediatrics Council on Communications and Media. as two inches of liquid (3). In a comprehensive study of Media and young minds. Pediatrics. 2016;138(5):e20162591. http:// drowning and submersion incidents involving children pediatrics.aappublications.org/content/pediatrics/138/5/e20162591.full.pdf under five years of age in Arizona, California, and Florida, the U.S. Consumer Product Safety Commission (CPSC) 2. Reid CY, Radesky J, Christakis D, et al., American Academy of Pediatrics found that: Council on Communications and Media. Children and adolescents and digital media. Pediatrics. 2016;138(5):e2016593. http://pediatrics. aappublications.org/content/early/2016/10/19/peds.2016-2593. 3. Wen LM, Baur LA, Rissel C, Xu H, Simpson, JM. Correlates of body mass index and overweight and obesity of children aged 2 years: finding from the healthy beginnings trial. Obesity. 2014;22(7):1723-1730.
72 Caring for Our Children: National Health and Safety Performance Standards a. Submersion incidents involving children usually happen The Centers for Disease Control (CDC) National Center for in familiar surroundings; Injury Prevention and Control recommends that whenever young children are swimming, playing, or bathing in water, b. Pool submersions involving children happen quickly, an adult should be watching them constantly. The supervis- 77% of the victims had been missing from sight for five ing adult should not read, play cards, talk on the telephone, minutes or less; mow the lawn, or do any other distracting activity while watching children (1,9). c. Child drowning is a silent death, and splashing may not occur to alert someone that the child is in trouble (4). COMMENTS “Touch supervision” means keeping swimming children Drowning is the second leading cause of unintentional within arm’s reach and in sight at all times. Flotation devices injury-related death for children ages one to fourteen (5). should never be used as a substitute for supervision.Know- In 2006, approximately 1,100 children under the age of ing how to swim does not make a child drown-proof. The twenty in the U.S. died from drowning (11). A national need for constant supervision is of particular concern in study that examined where drowning most commonly dealing with very young children and children with sig- takes place concluded that infants are most likely to drown nificant motor dysfunction or developmental delays. in bathtubs, toddlers are most likely to drown in swimming Supervising adults should be CPR-trained and should pools and older children and adolescents are most likely to have a telephone accessible to the pool and water area drown in freshwater (rivers, lakes, ponds) (11). at all times should emergency services be required. While swimming pools pose the greatest risk for toddlers, about one-quarter of drowning among toddlers are in TYPE OF FACILITY freshwater sites, such as ponds or lakes. Center, Large Family Child Care Home The American Academy of Pediatrics (AAP) recommends: a. Swimming lessons for children based on the child’s RELATED STANDARDS 1.1.1.5 Ratios and Supervision for Swimming, Wading, frequency of exposure to water, emotional maturity, physical limitations, and health concerns related to and Water Play swimming pools; 1.4.3.3 CPR Training for Swimming and Water Play b. “Touch supervision” of infants and young children 6.3.1.1 Enclosure of Bodies of Water through age four when they are in the bathtub or 6.3.1.7 Pool Safety Rules around other bodies of water; c. Installation of four-sided fencing that completely References separates homes from residential pools; d. Use of approved personal flotation devices (PFDs) when 1. U.S. Consumer Product Safety Commission. 2009. CPSC warns of in- riding on a boat or playing near a river, lake, pond, home drowning dangers with bathtubs, bath seats, buckets. Release or ocean; #10-008. Washington, DC: CPSC. http://www.cpsc.gov/cpscpub/prerel/ e. Teaching children never to swim alone or without adult prhtml10/10008.html. supervision; f. Stressing the need for parents/guardians and teens to 2. U.S. Congress. 2007. Virginia Graeme Baker Pool and Spa Safety Act. 15 learn first aid and cardiopulmonary resuscitation USC 8001. http://www.cpsc.gov/businfo/vgb/pssa.pdf. (CPR) (3). Deaths and nonfatal injuries have been associated with 3. American Academy of Pediatrics, Committee on Injury, Violence, and infant bathtub “supporting ring” devices that are supposed Poison Prevention. 2010. Policy statement-prevention of drowning. to keep an infant safe in the tub. These rings usually con- Pediatrics 126: 178-85. tain three or four legs with suction cups that attach to the bottom of the tub. The suction cups, however, may release 4. U.S. Consumer Product Safety Commission. 2002. How to plan for the suddenly, allowing the bath ring and infant to tip over. An unexpected: Preventing child drownings. Publication #359. Washington, infant also may slip between the legs of the bath ring and DC: CPSC. http://www.cpsc.gov/CPSCPUB/PUBS/359.pdf. become trapped under it. Caregivers/teachers must not rely on these devices to keep an infant safe in the bath and 5. Centers for Disease Control and Prevention (CDC). 2010. Unintentional must never leave an infant alone in these bath support drowning: Fact sheet. http://www.cdc.gov/HomeandRecreationalSafety/ rings (1,6,7). Water-Safety/waterinjuries-factsheet.html. Thirty children under five years of age died from drowning in buckets, pails, and containers from 2003-2005 (10). Of 6. U.S. Consumer Product Safety Commission. 1994. Drowning hazard all buckets, the five-gallon size presents the greatest hazard with baby “supporting ring” devices. Document #5084. Washington, DC: to young children because of its tall straight sides and its CPSC. http://www.cpsc.gov/cpscpub/pubs/5084.html. weight with even just a small amount of liquid. It is nearly impossible for top-heavy (their heads) infants and toddlers 7. Rauchschwalbe, R., R. A. Brenner, S. Gordon. 1997. The role of bathtub to free themselves when they fall into a five-gallon bucket seats and rings in infant drowning deaths. Pediatrics 100:e1. head first (8). 8. U.S. Consumer Product Safety Commission. 1994. Infants and toddlers can drown in 5-gallon buckets: A hidden hazard in the home. Document #5006. Washington, DC: CPSC. http://www.cpsc.gov/cpscpub/pubs/5006.html. 9. U.S. Consumer Product Safety Commission. 1997. CPSC reminds pool owners that barriers, supervision prevent drowning. Release #97-152. Washington, DC: CPSC. http://www.cpsc.gov/CPSCPUB/PREREL/ PRHTML97/97152.html. 10. Gipson, K. 2008. Submersions related to non-pool and non-spa products, 2008 report. Washington, DC: U.S. Consumer Product Safety Commission. http://www.cpsc.gov/library/FOIA/FOIA09/OS/nonpoolsub2008.pdf. 11. American Academy of Pediatrics Committee on Injury, Violence, and Poison Prevention, J. Weiss. 2010. Technical report: Prevention of drowning. Pediatrics 126: e253-62.
73 Chapter 2: Program Activities for Healthy Development 2.2.0.5 child’s lead, playing with the child, and responding to Behavior Around a Pool the child’s needs; b. Basing expectations on children’s developmental level; When children are in or around a pool, caregivers/teachers c. Establishing simple rules children can understand should teach age-appropriate behavior and safety skills (e.g., you can’t hurt others, our things, or yourself) and including not pushing each other, holding each other under being proactive in teaching and supporting children in water, or running at the poolside. Children should be learning the rules; shown the depth of the water at different part of the pool. d. Adapting the physical indoor and outdoor learning/ They should be taught that when going into a body of water, play environment or family child care home to encour- they should go in feet first the first time to check the depth. age positive behavior and self regulation by providing Children should be instructed what an emergency would be engag- ing materials based on children’s interests and and to only call for help only in a real/genuine emergency. ensuring that the learning environment promotes active They should be taught to never dive in shallow water. participation of each child. Well-designed child care RATIONALE environments are ones that are supportive of appropri- Caregivers/teachers should take the opportunities to ate behavior in children, and are designed to help chil- explain how certain behaviors could injure other children. dren learn about what to expect in that environment Also, such behavior can distract caregivers/teachers from and to promote positive interactions and engagement supervising other children, thereby placing the other with others; children at risk (1). e. Modifying the learning/play environment (e.g., schedule, TYPE OF FACILITY routine, activities, transitions) to support the child’s Center, Large Family Child Care Home appropriate behavior; f. Creating a predictable daily routine and schedule. Reference When a routine is predictable, children are more likely to know what to do and what is expected of them. This 1. U.S. Department of Health and Human Services, Maternal and Child may decrease anxiety in the child. When there is less Health Bureau. 1999. Basic emergency lifesaving skills (BELS): A framework anxiety, there may be less acting out. Reminders need for teaching emergency lifesaving skills to children and adolescents. to be given to the children so they can anticipate and Newton, MA: Children’s Safety Network, Education Development prepare themselves for transitions within the schedule. Center. http://bolivia.hrsa.gov/emsc/Downloads/BELS/BELS.htm. Reminders should be individualized such that each child understands and anticipates the transition; 2.2.0.6 g. Using encouragement and descriptive praise. When Discipline Measures clear encouragement and descriptive praise are used to give attention to appropriate behaviors, those behaviors Reader’s Note: The word discipline means to teach and are likely to be repeated. Encouragement and praise guide. Discipline is not punishment. The discipline stan- should be stated positively and descriptively. Encourage- dard therefore reflects an approach that focuses on prevent- ment and praise should provide information that the ing behavior problems by supporting children in learning behavior the child engaged in was appropriate.Examples: appropriate social skills and emotional responses. “I can tell you are ready for circle time because you are Caregivers/teachers should guide children to develop sitting on your name and looking at me.” “Your friend self-control and appropriate behaviors in the context of looked so happy when you helped him clean up his relationships with peers and adults. Caregivers/teachers toys.” “You must be so proud of yourself for putting on should care for children without ever resorting to physical your coat all by yourself.” Encouragement and praise punishment or abusive language. When a child needs assis- should label the behaviors, not the child (e.g., good tance to resolve a conflict, manage a transition, engage in a listening, good eating, instead of good boy); challenging situation, or express feelings, needs, and wants, h. Using clear, direct, and simple commands. When clear the adult should help the child learn strategies for dealing commands are used with children, they are more likely with the situation. Discipline should be an ongoing process to follow them. The caregiver/teacher should tell the to help children learn to manage their own behavior in a child what to do rather than what NOT to do. The socially acceptable manner, and should not just occur in caregiver/teacher should limit the number of commands. response to a problem behavior. Rather, the adult’s guid- The caregiver/teacher should use if/then and when/then ance helps children respond to difficult situations using statements with logical and natural consequences. These socially appropriate strategies. To develop self-control, practices help children understand they can make children should receive adult support that is individual choices and that choices have consequences; to the child and adapts as the child develops internal i. Showing children positive alternatives rather than just controls. This process should include: telling children “no”; a. Forming a positive relationship with the child. When j. Modeling desired behavior; children have a positive relationship with the adult, they are more likely to follow that person’s directions. This positive relationship occurs when the adult spends time talking to the child, listening to the child, following the
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