CFOC4 pdf- FINAL

502 Appendix O: Care Plan for Children With Special Health Needs Special Health Care Plan To be completed by the Child Care Health Consultant or Health Advocate. The Special Health Care Plan provides information on how to accommodate the special health concerns and needs of this child while attending an early care and educationprogram. Name of Child: Date: / _/ Name of Child Care Program: Description of Health Condition(s) List description each health condition: Team Member Names and Titles (include parents) Parent/Guardian Health Care Provider(MD, NP) On-site CareCoordinator Team Members; Other Support Programs Outside of Child Care (name, program, contact information, frequency) □ Physical Therapist(PT) □ Occupational Therapist (OT) □ Speech & Language Therapist: □ Social Worker: □ MentalHealthProfessional/Consultant: □ Family-ChildAdvocate: Other: Communication The team will communicate: □ Daily □ Weekly □ Monthly Other The team will communicate by: □ Notes, □ Communication log, □ Phone, □ E mail, □ In Person Meetings, □ Other Dates and times Individualized Family Service Plan (IFSP) or Individualized Education Plan (IEP) is attached. □ Yes □ No Staff Training Needs Type of training: Training will beprovided by: Training will bemonitored by: Staff who will receive training: Dates for training: Plan for absences of trained personnel responsible for health-related procedure(s): UCSF School of Nursing, California Childcare Health Program cchp.ucsf.edu Revised 06/2016

503 Appendix O: Care Plan for Children With Special Health Needs Special Health Care Plan Medical Information Medical information from the Health Care Provider is attached: □ Yes □ No Information Exchange Form cchp.ucsf.edu/InfoExchangeForm has been completed by Health Care Provider: □ Yes □ No Medication to be given: □ Yes □ No Medication Administration Form has been completed by health care provider and parents: □ Yes □ No Allergies: □ Yes □ No if yes, list: Safety Strategies to support the child's needs and safety issues while in child care: (e.g., diapering/toileting, outdoor play, circle time, field trips, transportation, nap/sleeping) Special equipment: Positioning requirements: Equipment care/maintenance: Nutrition and Feeding Needs A Nutrition and Feeding Care Plan has been completed □ Yes □ No Allergies to food: □ Yes □ No if yes, list: Other feedingconcerns: Behavior Concerns List specific changes in behavior that arise as a result of the health-related condition/concerns Emergencies Telephone: Telephone: Emergency contact: Health Care Provider: Emergency Information Form Completed □ Yes □ No Follow-up, Updates, and Revisions This Special Health Care Plan is to be updated/revised whenever child's health status changes or at least every months as a result of the collective input from team members. Due date for revision andteam meeting: // . Attach additional information if needed. Include unusual episodes that might arise while the child is in care, how the situation should be handled, and special emergency or medical procedures that may be required. UCSF School of Nursing, California Childcare Health Program cchp.ucsf.edu Revised 06/2016 Reprinted with permission from California Childcare Health Program (CCHP). Copyright © 2018. Copying any portion of this material is not permitted without written permission of CCHP.

504 Appendix O: Care Plan for Children With Special Health Needs Nutrition and Feeding Care Plan The nutrition and feeding care plan defines all members of the care team, communication guidelines (how, when, and how often), and all information on a child’s diet and feeding needs for this child while in child care. Name of Child: _________________________________________________ Date: Facility Name: _________________________________________________ Team Member Names and Titles (parents of the child are to be included) Care Coordinator (responsible for developing and administering Nutrition and Feeding Care Plan): i If training is necessary, then all team members will be trained. ❏ Individualized Family Service Plan (IFSP) attached ❏ Individualized Education Plan (IEP) attached Communication What is the team’s communication goal and how will it be achieved (notes, communication log, phone calls, meetings, etc.): How often will team communication occur: ❏ Daily ❏ Weekly ❏ Monthly ❏ Bi-monthly ❏ Other Date and time specifics: Specific Diet Information v Medical documentation provided and attached: ❏ Yes ❏ No ❏ Not Needed Specific nutrition/feeding-related needs and any safety issues: v Foods to avoid (allergies and/or intolerances): Planned strategies to support the child’s needs: Plan for absences of personnel trained and responsible for nutrition/feeding-related procedure(s): v Food texture/consistency needs: ❏ Yes ❏ No ❏ Not Needed v Special dietary needs: v Other: Eating Equipment/Positioning v Physical Therapist (PT) and/or Occupational Therapist (OT) consult provided Special equipment needed: Specific body positioning for feeding (attach additional documentation as necessary): Page 1 of 2 California Childcare Health Program cchp.ucsf.edu rev. 09/18

Behavior Changes (be specific when listing changes in behavior that arise before, during, or after feeding/eating) 505 Appendix O: Care Plan for Children With Special Health Needs Medical Information ❏ Information Exchange Form completed by Health Care Provider is in child’s file onsite. v Medication to be administered as part of feeding routine: ❏ Yes ❏ No ❏ Medication Administration Form completed by health care provider and parents is in child’s file on-site (including type of medication, who administers, when administered, potential side effects, etc.) Tube Feeding Information Primary person responsible for daily feeding: Additional person to support feeding: ❏ Breast Milk ❏ Formula (list brand information): Time(s) of day: Volume (how much to feed): ____________________ Rate of flow: ____________________ Length of feeding: Position of child: ❏ Oral feeding and/or stimulation (attach detailed instructions as necessary): Special Training Needed by Staff Training monitored by: _________________________________________ 1) Type (be specific): Training done by: _____________________________________________ Date of Training: 2) Type (be specific): Training done by: _____________________________________________ Date of Training: Additional Information (include any unusual episodes that might arise while in care and how the situation should be handled) Emergency Procedures ❏ Special emergency and/or medical procedure required (additional documentation attached) Emergency instructions: Emergency contact: _______________________________________________ Telephone: Follow-up: Updates/Revisions This Nutrition and Feeding Care Plan is to be updated/revised whenever child’s health status changes or at least every ___ months as a result of the collective input from team members. Due date for revision and team meeting: ______________ Page 2 of 2 California Childcare Health Program cchp.ucsf.edu rev. 09/18 Reprinted with permission from California Childcare Health Program (CCHP). Copyright © 2018. Copying any portion of this material is not permitted without written permission of CCHP.

506 PAppendix P: Situations that RequireCMaeridnicgalfAotrteOntuiornCRhigilhdtrAewna:yNational Health and Safety Performance Standards APPENDIX P: SSIiTtuUaAtiToInOsNthSaTt HReAqTuRirEeQMUeIdRicEaMl AEttDeInCtiAoLn ARTigThEt NAwTIaOyN RIGHT AWAY In the two boxes below, you will find lists of common At any time you believe the child’s life may be at risk, medical emergencies or urgent situations you may or you believe there is a risk of permanent injury, seek encounter as a child care provider. To prepare for such immediate medical treatment. Do not hesitate, when situations: in doubt, call EMS. 1) Know how to access Emergency Medical Services Determine contingency plans for times when there (EMS) in your area. See Glossary for definition of may be power outages, transportation issues etc. EMS. Document what happened and what actions were 2) Know how to reach your Poison Center right taken; share verbally and in writing with parents/ away, nationally call 1-800-222-1222. guardians. 3) Educate staff on the recognition of an emergency, Some children may have urgent situations that do not and when in doubt, call EMS. necessarily require ambulance transport but still need medical attention. The box below lists some of these 4) Know how to contact each child’s guardian and more common situations. The legal guardian should primary health care provider. Obtain permission be informed of the following conditions. If you or the from parents/guardians to speak directly to each guardian cannot reach the physician within one hour, child’s health care professional. the child should be brought to a hospital. 5) Develop plans for children with special medical Get medical attention within one hour for: needs together with their family and primary care provider. • Fever* in any age child who looks more than mildly ill. 6) Compile information on when and how to contact public health authorities. • Fever * in a child less than two months (eight weeks) of age. Call Emergency Medical Services (EMS) immediately if: • A quickly spreading purple or red rash. • You believe the child’s life is at risk or there is a risk • A large volume of blood in the stools. of permanent injury. • A cut that may require stitches. • The child is acting strangely, much less alert, or much more withdrawn than usual. • Any medical condition specifically outlined in a child’s care plan requiring parental notification. • The child has difficulty breathing, is having an asthma exacerbation, or is unable to speak. *Fever is defined as a temperature above 101°F (38.3°C) orally, above 102°F (38.9°C) rectally, or 100°F (37.8°C) or • The child’s skin or lips look blue, purple, or gray. higher taken axillary (armpit) or measured by an equivalent method. • The child has rhythmic jerking of arms and legs and a loss of consciousness (seizure). References: • The child is unconscious. 1. Aronson, S. S., ed. 2002. Model child care health policies. 4th ed. Elk Grove Village, IL: American Academy of • The child is less and less responsive. Pediatrics. • The child has any of the following after a head injury: decrease in level of alertness, confusion, headache, vomiting, irritability, or difficulty walking. • The child has increasing or severe pain anywhere. • The child has a cut or burn that is large, deep, and/ or won’t stop bleeding. • The child is vomiting blood. • The child has a severe stiff neck, headache, and fever. • The child is significantly dehydrated: sunken eyes, lethargic, not making tears, not urinating. • Multiple children affected by injury or serious illness at the same time. • When in doubt, call EMS. • After you have called EMS, remember to contact the child’s legal guardian. Appendix P

Caring for Our Children: National Health and Safety Performance Standards Q 507 Appendix Q: Getting Started with MyPlate Getting Started with MyPlate APPENDIX Q: GETTING STARTED WITH MYPLATE • MyPlate is part of a larger communications initiative based on 2010 Dietary Guidelines for Americans to help consumers make better food choices. • MyPlate is designed to remind Americans to eat healthfully; it is not intended to change consumer behavior alone. • MyPlate illustrates the five food groups using a familiar mealtime visual, a place setting. ChooseMyPlate.gov features practical information and tips to help Americans build healthier diets. It features selected messages to help consumers focus on key behaviors. Selected messages include: o Enjoy your food, but eat less. o Avoid oversized portions. o Make half your plate fruits and vegetables. o Switch to fat-free or low-fat (1%) milk. o Make at least half your grains whole grains. o Compare sodium in foods like soup, bread, and frozenmeals - and choose foods with lower numbers. o Drink water instead of sugary drinks. Source: U.S. Department of Agriculture. 2011. MyPlate. http://www.choosemyplate.gov. Appendix Q

508 R: Choose MyPlate: 10CTiapsritnoga GforeratOPluatreChildren: National Health and Safety Performance Standards RAppendix APPENDIX R: CHOOSE MYPLATE: 10 TIPS TO A GREAT PLATE 10 choose MyPlate tips 10 tips to a great plate Nutrition Education Series Making food choices for a healthy lifestyle can be as simple as using these 10 Tips. Use the ideas in this list to balance your calories, to choose foods to eat more often, and to cut back on foods to eat less often. 1balance calories 6switch to fat-free or Find out how many calories YOU need for a day low-fat (1%) milk as a first step in managing your weight. Go to They have the same amount of www.ChooseMyPlate.gov to find your calorie level. Being calcium and other essential nutrients as physically active also helps you balance calories. whole milk, but fewer calories and less 2 enjoy your food, but eat less saturated fat. Take the time to fully enjoy your food as you eat it. Eating 7 make half your grains whole grains too fast or when your attention is To eat more whole grains, substitute a whole-grain elsewhere may lead to eating too product for a refined product—such as eating whole- many calories. Pay attention to hunger wheat bread instead of white bread or brown rice instead of and fullness cues before, during, and after meals. Use white rice. them to recognize when to eat and when you’ve had enough. 8 foods to eat less often Cut back on foods high in solid fats, added sugars, 3 avoid oversized portions and salt. They include cakes, cookies, ice cream, Use a smaller plate, bowl, and glass. Portion out candies, sweetened drinks, pizza, and fatty meats like ribs, foods before you eat. When eating out, choose a sausages, bacon, and hot dogs. Use these foods as smaller size option, share a dish, or take home part of occasional treats, not everyday foods. your meal. 9 compare sodium in foods 4 foods to eat more often Use the Nutrition Facts label Eat more vegetables, fruits, whole grains, and fat-free to choose lower sodium versions or 1% milk and dairy products. These foods have the of foods like soup, bread, and frozen nutrients you need for health—including potassium, calcium, meals. Select canned foods labeled vitamin D, and fiber. Make them the “low sodium,” ”reduced sodium,” or basis for meals and snacks. “no salt added.” 5 make half your plate 10 drink water instead of sugary drinks fruits and vegetables Cut calories by drinking water or unsweetened Choose red, orange, and dark-green vegetables like beverages. Soda, energy drinks, and sports drinks are a major source of added sugar, and calories, in American tomatoes, sweet potatoes, and broccoli, along with other diets. vegetables for your meals. Add fruit to meals as part of main or side dishes or as dessert. Center for Nutrition Go to www.ChooseMyPlate.gov for more information. DG TipSheet No. 1 Policy and Promotion June 2011 USDA is an equal opportunity provider and employer.

S Physical Activity: How MuchApIspenNdiex Se: Pdhyesidca?l Activity: How 509 Much Is Needed? APPENDIX S: PHYSICAL ACTIVITY: HOW MUCH IS NEEDED? Young Children (2 to 5 years) Children ages two to five years should play actively several times each day. Their activ- ity may happen in short bursts of time and not be all at once. Physical activities for young children should be developmentally-appropriate, fun, and offer variety. Children and Adolescents (6 to 17 years) Children and adolescents should do sixty minutes or more of physical activity each day. Most of the sixty minutes should be either moderate- or vigorous-intensity aerobic physical activity, and should include vigorous-intensity physical activity at least three days a week. As part of their sixty or more minutes of daily physical activity, children and adolescents should include muscle-strengthening activities, like climbing, at least three days a week and bone-strengthening activities, like jumping, at least three days a week. Children and adolescents are often active in short bursts of time rather than for sustained periods of time, and these short bursts can add up to meet physical activity needs. Physical activities for children and adolescents should be developmentally-appropriate, fun, and offer variety. What is Meant by “Age-Appropriate” Physical Activities Some physical activity is better-suited for children than adolescents. For example, children do not usually need formal muscle-strengthening programs, such as lifting weights. Young- er children usually strengthen their muscles when they do gymnastics, play outside, or climb on playground structures. Also, the skill and coordination needed for complex physi- cal activities may not allow for younger children to participate safely. It is important for child care facilities to promote a variety of physical activities that are structured and unstructured so children of all ages can enjoy physical activity and increase their likelihood of life-long adherence. Many physical activities fall into several categories (moderate- and vigorous-intensity and muscle- and bone-strengthening), making it possible for children to gain multiple benefits with each type of activity. Sources: U.S. Department of Agriculture. 2011. How much physical activity is needed? http://www.choosemyplate.gov/ foodgroups/physicalactivity_amount.html. Centers for Disease Control and Prevention. 2011. Physical activity for everyone: Aerobic, muscle-, and bone- strengthening: What counts? http://www.cdc.gov/physicalactivity/everyone/guidelines/what_counts.html. Appendix S 466

510 TTAppendix T: Helping Children in FoCstearrCinagre fMoarkOe SuurccCeshsifludlrTerann:sNitiaontisoInntaolCHhieldaCltahreand Safety Performance Standards Caring for Our Children: National Health and Safety Performance Standards APPENDIX T: HELPING CHILDREN IN FOSTER CARE MAKE SUCCESSFUL TRANSITIONS INTO CHILD CARE

Caring for Our Children: National Health and Safety Performance Standards 511 TAppendix T: Helping Children in Foster Care Make Successful Transitions Into Child Care Appendix T

512U Caring for Our Children: National Health and Safety Performance Standards Appendix U: Recommended Safe Minimum Internal Cooking Temperatures RecoAmPPmENenDdIXedU:SRaEfeCOMMinMimENuDmEIDntSeArFnEaMl CINoIoMkUinMg ITNeTmEpReNrAaLtures COOKING TEMPERATURES **Consumers should use a food thermometer to determine internal temperatures of foods. Source: U.S. Department of Agriculture and U.S. Department of Health and Human Services. 2010. Dietary guidelines for Americans, 2010. 7th ed. Washington, DC: U.S. GPO. http://www.health.gov/dietaryguidelines/dga2010/DietaryGuidelines2010.pdf. Appendix U

513 VCaring for Our Children: National Health and Safety Performance Standards Appendix V: Food Storage Chart APPENDIXFoVo:dFOStOorDagSeTOChRaArtGE CHART This chart has information about keeping foods safely in the refrigerator or freezer. It does not include foods that can be stored safely in the cupboard or on the shelves where quality may be more of an issue than safety. Remember this is a guide and you should always follow any “best before” dates that are on the product. FOOD IN REFRIGERATOR IN FREEZER Eggs 3 weeks Don't freeze Fresh, in shell 2-4 days 1 year Raw yolks, whites 1 week Hard-cooked (boiled) 3 days Don't freeze Liquid pasteurized eggs or egg substitutes, 10 days Don't freeze opened Liquid pasteurized eggs or egg substitutes, 2 months 1 year unopened Mayonnaise 3-4 days Don't freeze Commercial, refrigerate after opening 1 day TV Dinners, Frozen Casseroles 3-4 months Keep frozen until ready to heat and serve 1-2 days Deli and Vacuum-Packed Products 2 weeks, unopened Don't freeze Store-prepared or homemade egg, chicken, Don't freeze tuna, ham, macaroni salads 1-2 days Don't freeze Pre-stuffed pork and lamb chops, stuffed 1-2 days Don't freeze chicken breasts Store-cooked convenience meals 1 week 3-4 months Commercial brand vacuum-packed dinners with 2 weeks 3-4 months USDA seal 3-5 days Hamburger, Ground, and Stew Meats (Raw) 2 weeks In freezer wrap, Hamburger and stew meats 2-3 days 1-2 months Ground turkey, chicken, veal pork, lamb, and mixtures of them In freezer wrap, Hotdogs and Lunch Meats* 1-2 months Hotdogs, opened package 1-2 months Hotdogs, unopened package Lunch Meats, opened Lunch Meats, unopened Deli sliced ham, turkey, lunch meats Appendix V

514V Caring for Our Children: National Health and Safety Performance Standards Appendix V: Food Storage Chart Bacon and Sausage 1 week 1 month Bacon 1-2 days 1-2 months Sausage, raw from pork, beef, turkey 1 week 1-2 months Smoked breakfast links or patties 2-3 weeks 1-2 months Hard Sausage-Pepperoni, Jerky Sticks FOOD IN REFRIGERATOR IN FREEZER Ham 6-9 months Don't freeze Canned, unopened, label says keep refrigerated 7 days 1-2 months Fully cooked - whole 3-5 days 1-2 months Fully cooked - half 3-4 days 1-2 months Fully cooked - slices Fresh Meat 3-5 days 6-12 months Steaks, beef 3-5 days 4-6 months Chops, pork 3-5 days 6-9 months Chops, lamb 3-5 days 6-12 months Roasts, beef 3-5 days 6-9 months Roasts, lamb 3-5 days 4-6 months Roasts, pork and veal Fresh Poultry 1-2 days 1 year Chicken or turkey, whole 1-2 days 9 months Chicken or turkey pieces 1-2 days 3-4 months Giblets Fresh Seafood 2 days 2-4 months Fish and shellfish *Uncooked salami is not recommended because recent studies have found that the processing does not always kill the E. coli bacteria. Look for the label to say \"Fully Cooked.\" Benjamin, S. E., ed. 2007. Making food healthy and safe for children. 2nd ed. Chapel Hill, NC: GNraavetiso, nDa.El.,TSruaitionri,nCg.WI.n&stHitoultt,eKf.Ao.r(eCdhs)ilMd aCkianrgeFHooedaHltehalCthoynasnudltSaanfetsfo.r Children: How to Meet the National Health ahndttpS:a/f/entyti.Puenrfco.remdaun/cceoSutrasned_arfdilseGs/uciduerlriinceuslufomr O/nuut toriftiHoonm/me aChkilndgC_afroeoPdro_ghraemalst.hAyr_linagntdon_,sVaAf:eN.patdiof.nal Center for Education in Maternal and Child Health; 1997. Appendix V

515 CarinCgafroinr gOfuorrCOhuilrdCrehnil:dNreanti:oNnatliHoneaalltHheaanltdhSaanfdetSyaPfeetryfoPrmerafonArcmpepaeSntcdaienx dWSa:taSrdanmsdpalredFsood Service Cleaning Schedule W WSAaPmPSEpaNlmeDpFIXloeWoSFad:moSSoSpAeadlMermvSFPpieocLleoreEvdFFCiocSOoleeeOdravCDSincleeieSrnavECginRcleieSVnacCIngChlienESeagdcCnhSuiLncelEeghdAeSuNdclueIhNleeGduSleCHEDULE TASTKASK HOWHOOWFTOEFNT?EN? COMCMOEMNMTESNTS eaAchfteureseaAchfteBuresfeoarcehB&eufesoaeafrtcehr&usaeftDeraily DaWilyeeklWy eenkelcyeAsssnaeryceAsssary RANGRAENGE CleanCglreilalnangdrilgl raenadsegrpeaansse pans √√ CleanCbluerannebrsurners √√ CleanColuetasnidoeutside √√ WipeWouitpeovoeunt oven √√ CleanCeldegaenseadrgoeusnadrohounod hood √√ CleanChloeoand hscoroedensicnrgeeanidnggraenadsegrease √√ trap trap REFRRIGEFERRIAGTEORRATAONRDAFNRDEEFZREEREZER Or whOern wmhoerne mthoarne than DefroDsteffrreoesztefreaenzderclaenadn cshleealnvesshelves Wipe Wouiptseidoeutside √ √1/4-in1ch/4f-rinocsht dfreovsetl-devel- Dust tDoupst top ops oroptesmopretreamtupreerature √√ exceeedxsc0e°eFd. s 0°F. √√ CleanCinlesaidneinshsiedlevesshienlvoersdienrorder √√ MIXEMRIXAENRDACNADNCOAPNENOEPRENER CleanCmleixaenrmbiaxseerabnadseatatnadchamtteancthsments √ √ CleanCalnedanwaipned cwainpeopceaneorpbelnaeder blade √ √ WORWKOSURKRFSAUCREFSACES CleanCalnedansaannidtizseanitize √√ OrganOizregafonrizneefaotrnensesatness √√ WALLWSAALNLSDAWNIDNDWOINWDSOWS WipeWif sipelatiftesrpeladttoerregdreoarsygreasy √√ WipeWwiinpdeowwinsdilolsw sills √√ Wipe Wwiinpdeowwinsdcorewensscreens √√ SINKSSINKS Keep Kcleeapn clean √√ ScrubScrub √√ CARTCSA(RifTaSpp(ilficaapbpleli)cable) Wipe Wdoipwendown √√ SanitizSeanitize √√ GARBGAAGREBAGE √√ Or moOrre mofoteren,often, Take oTuatke out as neeadsende. eded. CleanCclaenan can √√ TABLTEASBALNESDACNHDACIRHSAIRS CleanCalnedansaannidtizseanitize √√ LINELNINS ENS WashWcloasth cnlaoptkhinnsapkins √√ WashWtaabslehctloabthlescalontdhsplaancdemplaatcsemats √ √ √√ if plastificplastic if clothif cloth WashWdiashshcloditshhscloths √√ WashWpoatshhopldoetrhsolders √√ STORSATGOERAAGREAASREAS WipeWshieplevessh, eclavbeisn,ectasb, iannedtsd, raanwdedrrsawers √√ SRGetraafenvrdeeasn,rcSRGdeDetsr:a.afEBeGnvr.ede,uenasSnijd,racudemeDislt:i.ionEnBGre,,.e,usSnCSi.jdf.aouEWemri.lt,.iioOnne&re,du,sHS.tC.2ofo.oEW0fltr.0H,,.O7Ke&o.du.mAMH.t e.2ooa0(fklCet0iH,dnh7Kgsoi.l).dmfAMoMoeC.ada(kaCekhirdniheengsiaglP)dfltoMrhFooCyodagaaokrhrnadieendmagHPsltsarehF.ofyaeoAglaotfrhonaldirdynmHcgsahsateni.ofladedAnrltef,rSholnVirayn.Afc2gaeh:ntnioNdlfddonraEre,St.ndCiVoa.Ahfn2Cei:anlhdNdlfaorCpaeErete.ndCilon:.HhntHCeiiallohrdll,awfrCNpoeeerntColn:E:HtHMdNeiluorlae,cwtfeNioaotrttCntiooEah:lnMedNTuiNaernctaeaiaioMtnttniitionaoahgntlneeTaIrniNlrnsaHataiMintteliuioaantgnlntetehdaIfrnolnasCrHtanihCtelduiaalhdtSnlietldhdaHfofCeaeCrantahCyrldtielhhPdSi;HledaH1ref9Caeeol9attaryh7mrlte.hPCa;Heno1recnf9aseol9utrlh7mta.Cantnoscn. seultants. AppeAnpdpixeWndix W

516 XAppendix X: Adaptive Equipment fCoraCrhinilgdrefonrwOithurSpCechiialldHreanlt:hNCarteioNneaeldHs ealth and Safety Performance Standards APPENDIX X: ADAPTIVE EQUIPMENT FOR CHILDREN WITH Adaptive EquipmenStPEfoCrIACLhHildErAeLnTHwiCthARSEpNecEiEaDl HS ealth Care Needs Children on a gluten-free diet and those with latex Floor mirrors allergies must be protected from ingesting or coming Climbing equipment in contact with equipment/materials that may Small chair and table contain these substances. Check manufacturer’s Scooter board specifications and/or labels of all equipment, feeding Dycem non-slip matting materials, and toys including art supplies. Suspended equipment (see also Adaptive Physical Education Equipment, Balance/Gross Physical Therapy/Occupational Motor Coordination) Therapy Equipment Walkers, sidelyers, proneboards, adapted chairs Adapted tricycles Infants, Ages Birth to Two Toys Equipment Easel Floor mats, 2 to 3 inches of varying firmness Tricycles Therapy balls of varying sizes Ride-on scooters Wedges: 4, 6, 8, and 12 inch Wagon Inflatable mattress Wooden push cart Air compressor (for inflatables) Manipulative toys (puzzles, beads, pegs and Therapy rolls and half rolls of varying sizes pegboard, nesting toys, etc.) Nesting benches, varying heights Fastening boards (zippers, snaps, laces, etc.) Wooden weighted pushcart Paper, crayons, chalk, markers Toddler swing Sand/water table Floor mirror Playdough or clay (consider gluten free and latex Dycem non-slip matting free alternatives) Target activities (beanbags, ring toss) Feeding Playground balls (see under Adaptive Physical Education Equipment, Eye-Hand Coordination) Bottle straws Cut-out cups Speech and Language Development Bottle holders Built-up handled utensils Infants, Ages Birth to Two Scoop bowls Coated spoons Equipment Toys Mirrors, wall and hand-held Assorted spoons, cups, bowls, plates Books Mats and sheets Mirror Preston feeding chairs Ring stack High chair Container toys Pegboard Toys Rattles Squeeze toys Dolls (soft with large features and feeding bathing Tracking toys and daily living equipment) Toys for pushing, swiping, cause and effect Rattles (noisemakers and easy to grasp) Adapted switches Manipulative toys (for pulling, pushing, shaking, Form boards cause and effect) Large beads Assorted picture books (large pictures, one-a- Large crayons page, photographs, simple plot) Building blocks Pre-K, Ages Two to Five Balls/belts Telephone Equipment Stacking rings Shape sorters Floor mats, 2 to 3 inches of varying firmness Xylophone, Drum Therapy balls: 16, 20, 24, and 37 inch diameter Nesting benches Assessments and Books Therapy rolls: 8, 10, and 12 inch diameter Steps Small Wonder Activity Kit Appendix X

Caring for Our Children: National Health and Safety Performance Standards X 517 Appendix X: Adaptive Equipment for Children with Special Health Care Needs Pre-Feeding Skills by Suzanne Morris Assessment of Phonological Processes Parent-Infant Communication Expressive Vocabulary Test-2 Bayley Scales of Infant Development Peabody Picture Vocabulary Test-4 Communication and Symbolic Behavior Scale Movement Assessment in Infants by S. Harris Adaptive Physical and L. Chandler Education Equipment RIDES HAWAII HELP Pre-K, Ages Two to Five Early Learning Accomplishments Profile and Kit (Kaplan) Balance/Gross Motor Coordination Receptive Expressive Emergent Language Test 3 Rosetti Infant/Toddler Language Scale Incline mat Balance beams, 4 and 12 inch wide Pre-K, Ages Two to Five Floor mats, 2 inch Bolsters Equipment Rocking platforms Scooters (sit-on type) Mirrors, wall and hand-held Tunnel (accordion style) Tongue depressors Training stairs Penlight Hurdles, adjustable height Stopwatch Pediatric climbing wall Tape recorder and tapes Toothettes Eye-Hand Coordination Horns and Whistles Balls (to hit, throw, and catch) Toys Beanbags and Target Hula hoops Dolls (with movable parts and removable clothing) Lightweight paddles/rackets Manipulative toys (cars and toys for pushing, Lightweight bats stacking, cause and effect) Traffic cones Building blocks Batting tees Dollhouse Beachballs Pretend play items (dress-up clothes, dishes, sink, food, telephone) Eye-Foot Coordination Playdough or clay (consider gluten free and latex free alternatives) Balls for kicking Puzzles (individual pieces or minimal interlocking Foot placement ladder parts) Footprints or “stepping stones” Picture cards (nouns, actions, etc.) Horizontal ladder Puppets Animals Storybooks with simple plot lines (large pictures and few, if any, words) Assessments and books Clinical evaluation of Language Fundamentals - Pre-School Sequenced Inventory of Communication Test of Auditory Comprehension of Language Goldman Fristore Test of Articulation Pre-School Language Assessment Inventory Appendix X

518 Caring for Our Children: National Health and Safety Performance Standards YAppendix Y: Even Plants Can Be Poisonous APPENDEIXveY:nEPVlEaNntPsLCAaNnTSBCeAPNoiBsEonPoOuISsONOUS Learn the names of your plants and label them. Below is a list of some of the more common indoor and outdoor plants that you may have in your home. This list is not a complete list. If you have a plant around your home that is not on the list, you may call thePoison Center at 1-800-2221222 to find out how poisonous it may be. You must know either the common name or the botanical name in order for the Poison Center to determine if it is poisonous. It is not possible to do plant or berry identifications over the phone, so check with a nursery for identification of all unknown plants. Carefully supervise children playing near poisonous plants. Call 1-800-222-1222 immediately if a child samples a mushroom or possibly poisonous plant. Common Name Non-Poisonous Plants African violet Begonia Botanical Name Christmas cactus Saintpaulia ionantha Coleus Begonia Dandelion Schlumbergera bridgesii Dracaena Coleus Forsythia Taraxacum officinale Impatiens Dracaena Jade Forsythia Marigold Calendula Impatiens Petunia Crassula argentea Poinsettia Tagetes Rose Petunia Spider plant Euphorbia pulcherrima (may cause irritation only) Swedish ivy Rosa Wandering Jew Chlorophytum comosum Wild strawberry Plectranthus australia Tradescantia fluminesis Fragaria virginiensis Appendix Y 470

Caring for Our Children: National Health and Safety Performance Standards 519 YAppendix Y: Even Plants Can Be Poisonous Common Name Poisonous Plants Azalea, rhododendron Botanical Name Caladium Rhododendron Castor bean Caladium Daffodil Ricinis communis Deadly nightshade Narcissus Dumbcane Atropa belladonna Elephant Ear Dieffenbachia Foxglove Colocasia esculenta Fruit pits and seeds Digitalis purpurea Holly contain cyanogenic glycosides Iris Ilex Jerusalem cherry Iris Jimson weed Solanum pseudocapsicum Lantana Datura stramonium Lily-of-the-valley Lantana camara Mayapple Convalleria majalis Mistletoe Podophyllum peltatum Morning glory Viscum album Mountain laurel Ipomoea Nightshade Kalmia iatifolia Oleander Salanum spp. Peace lily Nerium oleander Philodendron Spathiphyllum Pokeweed Philodendron Pothos Phytolacca americana Yew Epipremnum aureum Taxus Source: National Capital Poison Center (www.poison.org). Photos of selected plants in this appendix are available at http://www.poison.org/prevent/plants.asp. 471 Appendix Y

Z520 Caring for Our Children: National Health and Safety Performance Standards Appendix Z: Depth Required for Shock-Absorbing Surfacing Materials for Use Under Play Equipment SUARPPFDAEeNCpIMDtNhIaGXRteMZer:AqiDaTuElEsiPrRefToIdHArLfRUoSErsFQeSOUhURIoRnUcEdSkDeE-rAFUPObNlsRaDoySErHbERiOqnPuCgLiKApS-YmAuEBrefQSnaOUtcIRiPnBMgINEGNT The following fall heights and depth of loose-fill, impact-attenuating surfacing materials have been shown to reduce the risk of life-threatening head injuries. The depths shown assume the materials have been compressed due to use and weathering and are properly maintained to the given level. Reproduced from: U.S. Consumer Product Safety Commission (CPSC). 2010. Public playground safety handbook. http://www.cpsc.gov/cpscpub/pubs/325.pdf. Nine important tips to consider when choosing to use loose-fill materials under play equipment: 1. Loose-fill materials will compress at least 25% over time due to use and weathering (e.g., if the playground will require nine inches of wood chips, then the initial fill level should be twelve inches). Provide a margin of safety when selecting a type and depth of material. 2. Loose-fill surfacing requires frequent maintenance to ensure levels never drop below the minimum depth. Wear mats can be installed to reduce displacement. 3. Provide a method for containing loose-fill materials within the playground. 4. Consider marking equipment supports with the minimum fill level to help with maintaining the required depth of material. 5. Ensure that drainage from the playground is effective. Standing water reduces the effectiveness of the surfacing material by compaction and decomposition. 6. Keep in mind that as the ground freezes in colder months, the safe fall height may be reduced. 7. Never use less than nine inches of loose-fill material except for shredded/recycled rubber (six inches is recommended). 8. Some loose-fill materials may not meet Americans with Disabilities Act accessibility guidelines. Contact the Access Board at http://www.access-board.gov, or refer to ASTM F1951. 9. Wood mulch containing chromated copper arsenate (CCA)-treated wood should not be used. Also, consider the possible toxicity of recycled rubber. Appendix Z 472

Caring for Our Children: National Health and Safety Performance Standards Z 521 Appendix Z: Depth Required for Shock-Absorbing Surfacing Materials for Use Under Play Equipment Note: The fall height is the maximum height of the structure or any part of the structure for all stationary and mobile equipment except swings. For swings, the fall height is the height above the surface of the pivot point where the swing’s suspending elements connect to the supporting structure. Unitary surfacing materials (such as rubber mats, tiles, or a combination of unitary/loose-fill category materials) and loose-fill surfacing materials should be tested and comply with the ASTM International (ASTM) standard F1292 for impact-attenuation of playground surfacing materials. The manufacturer of unitary surfacing materials should provide test data to show a match between the fall height of the equipment to be used and the critical height shock-absorbing characteristics of the surfacing materials. References: U.S. Consumer Product Safety Commission (CPSC). 2010. Public playground safety handbook. http://www.cpsc.gov/cpscpub/pubs/325.pdf. ASTM International (ASTM). 2009. F1292 – 09: Standard specification for impact attenuation of surfacing materials within the use zone of playground equipment. West Conshohocken, PA: ASTM. 473 Appendix Z

522 Appendix AA: Medication Administration Packet APPENDIX AA: MEDICATION ADMINISTRATION PACKET

523 Appendix AA: Medication Administration Packet

524 Appendix AA: Medication Administration Packet

525 Appendix AA: Medication Administration Packet

526 Appendix AA: Medication Administration Packet

BBCaring and 527 for Our Children: National Health SApapfeetnydiPx eBrBf:oErmmeargnecnecySIntafonrdmaartdiosn Form for Children With Special Needs APPENDIX BB: EMERGENCY INFORMATION FORM FOR Last Name:________________________ Emergency InformCaHtIiLoDnRFEoNrmWITfoHrSCPEhCilIdArLenNEWEDitSh Special Needs Date form Revised Initials completed Revised Initials By Whom Name: Birth date: Nickname: Home Address: Parent/Guardian: Home/Work Phone: Signature/Consent*: Primary Language: Emergency Contact Names & Relationship: Physicians: Primary care physician: Phone Number(s): Current Specialty physician: Emergency Phone: Specialty: Fax: Current Specialty physician: Emergency Phone: Specialty: Fax: Anticipated Primary ED: Emergency Phone: Anticipated Tertiary Care Center: Fax: Pharmacy: Diagnoses/Past Procedures/Physical Exam: 1. Baseline physical findings: 2. 3. Baseline vital signs: 4. Synopsis: Baseline neurological status: *Consent for release of this form to health care providers Appendix BB

52B8 B Caring for Our Children: National Health and Safety Performance Standards Appendix BB: Emergency Information Form for Children With Special Needs Diagnoses/Past Procedures/Physical Exam continued: Last Name:________________________ Medications: Significant baseline ancillary findings (lab, x-ray, ECG): 1. 2. 3. 4. Prostheses/Appliances/Advanced Technology Devices: 5. 6. Management Data: Allergies: Medications/Foods to be avoided and why: 1. 2. 3. Procedures to be avoided and why: 1. 2. 3. Immunizations (mm/yy) Dates Dates Hep B DPT Varicella OPV TB status Other MMR HIB Indication: Medication and dose: Antibiotic prophylaxis: Common Presenting Problems/Findings With Specific Suggested Managements Problem Suggested Diagnostic Studies Treatment Considerations Comments on child, family, or other specific medical issues: Physician/Provider Signature: Print Name: CRehwRfileeidtrfhreeernSnecpnewecc:eiitAa:hlmASNmepereeeicrdcaisican.alUnCNsCoeeleodledllgweseg.iteUhoofsPeEfedEmrmmweeirisgtrshgeioenPnncec,yry2mP0Pi1hsh1ysy.ssioiiccniia,an2ns0sa1an1nd.dththeeAAmmeerricicaannAAccadaedmemy yofoPfePdeiadtiraictrsi.cEsm. ©er2g0en0c1y. IEnmforemrgaetinocnyFIonrmforfmoraCtihoinldrFeonrm. for Appendix BB

and Safety Performance StandardsAppendix 529 CCCaring for Our Children: National Health CC: Incident Report Form APPENDIIXncCiCd:eInNtCRIDepEoNrTtRFEoPrOmRT FORM Fill in all blanks and boxes that apply. Name of Program: ____________________________________________ Phone: ___________________________ Address of Facility: _____________________________________________________________________________ Child’s Name: ______________________________ Sex: M F Birthdate: ___/___/___ Incident Date: ___/___/___ Time of Incident: ___:___am/pm Witnesses:_________________________________________________________ Name of Legal Guardian/Parent Notified: ______________ Notified by: ______________ Time Notified: ___:___am/pm EMS (911) or other medical professional Not notified Notified Time Notified: ___:___am/pm Location where incident occurred: Playground Classroom Bathroom Hall Kitchen Doorway Stairway Unknown Other (specify)___________ Gym Office Dining Room Equipment / Product involved: Climber Slide Swing Playground Surface Sandbox Trike/Bike Handtoy (specify): _________________________________________________________ Other Equipment (specify):_____________________________________________________________ Cause of Injury (describe): _______________________________________________________________________ Fall to surface; Estimated height of fall ___feet; Type of surface: ________________________________ Fall from running or tripping Bitten by child Motor vehicle Hit or pushed by child Injured by object Eating or choking Insect sting/bite Animal bite Exposure to cold Other (specify):________________________________________________________________ Parts of body injured: Eye Ear Nose Mouth Tooth Part of face Part of head Neck Arm/Wrist/Hand Leg/Ankle/Foot Trunk Other (specify): _____________ First aid given at the facility (e.g. comfort, pressure, elevation, cold pack, washing, bandage): _____________________ _________________________________________________________________ Treatment provided by: __________________________________________________________________________ No doctor’s or dentist’s treatment required Treated as an outpatient (e.g. office or emergency room) Hospitalized (overnight) # of days: _________ Number of days of limited activity from this incident: _________ Follow-up plan for care of the child: _____________ _________________________________________________________________ Corrective action needed to prevent reoccurrence: ______________________________________________________ Name of Official/Agency notified: __________________________________________________________________ Signature of Staff Member: ______________________________________________ Date: ____________________ Signature of Legal Guardian/Parent:______________________________________ Date: _____________________ RReeffeerreennccee: :AAmmeerirciacnanAcAacdaedmeymoyf PoefdPiaetrdiciast,rPicesn,nPsyelvnannsiaylCvahnapiateCr.h2a0p0t2e.r.M2o0d0e2l .chMildodcaerlechheialdlthcaporelichiees.a4ltthhpeodl.icWieass.h4intghtoend,.DWCa: sNhaintigontoanl A, DssCoc: iNataiotinofnoarl tAhsesEodcuicaattioionnfoofr the EYoduuncgaCtiohnildorfenY,o1u9n9g7.Children. TThhiiss ffoorrmm wwaassddeveevleolpoepdefdorfoMr oMdeoldCehlildCChailrde CHaeraelthHPeoalilctihesP, 2o0li0c2ie, sb,y2th0e02E,arblyy CthheildEhaorolydCEhduhciladthioonoLdinEkdaguecaSytisotenmLi(nEkCaEgLeS)S, yasptreomgra(EmCfEunLdSe),dabyprtohgerPaemnnfsuynlvdaenida by the PDeenpntss.yolvf aHneiaaltDhe&ptPsu.bolifc HWeeallftahre&anPdubcolinctWracetlufaarlley aadnmdicniosntetrreadctbuyatllhyeaPdAmCinhiaspteterer,dAbmyerthiceanPAAcCadheampyteor,f PAemdieartircicasn. Academy of Pediatrics. Appendix CC

530 Appendix DD: Child Injury Report Form for Indoor and Outdoor Injuries Caring for Our Children: National Health and Safety Performance Standards DD APPENDIX DD: CHILD INJURY REPORT FORM FOR Child Injury RIeNpDorOtOFoRrAmNfoDrOInUdToDorOaOnRd OINuJtdUoRoIrEISnjuries 1. Child’s name_________________________________ 3. Grade _______________ 5. ( ) Male ( ) Female 2. School name __________________________________ 4. Date of injury __________ 6. Time of injury ______ 7. Days absent: ___Less than ½ ___1/2 ___1 ___ 1 ½ - 2 ___ 2 ½ - 3 ___Other: ____________________________________ 8. First Aid given: _____ Ice _____Washed wound _____Kept immobile _____Observed _____ Stopped bleeding _____Applied splint _____Applied dressing _____Other Explain: __________________________________________________________________________________________ 9. Body part injured: Head Trunk Extremities Other ___Ear ___Abdomen ___Ankle ___Lower arm ___Eye ___Back ___Elbow ___Lower leg _________________ ___Face ___Chest ___Finger ___Thumb ___Head ___Groin ___Foot ___Toes _________________ ___Neck ___Shoulder ___Hand ___Upper arm ___Scalp ___Trunk ___Hip ___Upper leg _________________ ___Knee ___Wrist 10. Type of injury suspected: _____Laceration/Abrasion _____Bruise/Contusion _____Sprain/Strain _____Dislocation _____Fracture _____Concussion _____Surface cut/Scratch _____Burn _____Other : __________________________________________________________________ 11. Action taken: ______Parent took home ______Transfer to hospital _______Parent took to doctor ______Returned to class ______Called 911 _______Parent took to ER ______Other : _______________________________ _______Time spent in nurse’s office 12. Explanation of accident: _____Collision with obstacle _____Collision with person _____Injury to self _____Hit with object _____Other _____________________________________ _____Fall ________Height of fall 13. Accident location: _____ Classroom _____Playground _____Gym _____Assembly _____Stairs _____Hallway _____Before School _____After school _____ Bus _____P.E. class _____ Other _____________________________ 14. Surface: _____Blacktop ____Dirt ____Grass ____Synthetic surface 15. Activity: _____Carpet ____Pea gravel ____Mats ____Rubber tile _____Concrete ____Ice/Snow ____Sand ____Wood products _____Other: ________________________________________________________________________ _____Depth of loose fill material 1. Baseball/Softball 6. Fighting 11. Playing on bars 16. Soccer 20. Volleyball 2. Basketball 7. Flag/Touch football 12. Running 3. Bicycling 8. Jumping 13. Rough housing 17. Swinging 21. Walking 4. Climbing 9. Kickball 14. Sliding 5. Dodge ball 10. Playground equipment 15. Sliding on ice 18. Throwing rocks 22. Other: _________ or snowballs ________________ 19. Track/Field ________________ 16. Equipment: Was playground equipment involved in injury? ___Yes ___No ___Arch climber ___Slide IF YES, (a) Did equipment appear to be used appropriately? ___Yes ___No Check (b) Was there any apparent malfunction of equipment? ___Yes ___No which ___Cargo net ___Sliding pole piece ___Chinning bar ___Track ride ___Horizontal ladder ___Swing ___See Saw ___Other______ 17. Describe: Describe specifically how the injury happened. ______________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ Signed: _______________________________________ Signed: _________________________________________________ (Person filing report) (Director) AdapAAtedddaafpprttoeemdd ffNrooammtioNNnaattliiooPnnraoalglPrParromoggrfraoamrmPfofloaryrPgPlarlaoyyuggnrordouSundnafdSeStayfa,eft2ey0t.y02.502.10S11.t6uS.dtSeundtutedInnetjnIuntrjIyunrRyjueRrpyeopRroterFpt oFrotmrmF.o.rm.

Caring for Our Children: National Health and Safety Performance Standards 531 DDAppendix DD: Child Injury Report Form for Indoor and Outdoor Injuries CHILD INJURY REPORT FORM INSTRUCTIONS This form is to be completed immediately following the occurrence of any injury that is severe enough to: a. Cause the loss of one-half day or more of school b. Warrant medical attention and treatment (i.e., school nurse, M.D., E.R., etc.), and/or c. Require reporting according to School District policy. Number Description of Each Number 1- 6 7 Self explanatory. 8 -11 Do not file a form until you have filled in days missed. If student is going to be 12 absent for an extended period of time, use parent’s estimate. If no school is missed, check less than ½. 13 14 Self explanatory. Record the amount of time child was in the nurse’s office. 15 Please include H or M. H= hours: M=minutes (i.e., 1h:40m). 16 17 Collision with person includes injuries which result from interactions between players from incidental or intended contact. Hit with object includes that the student got hit by an object (ball, backpacks, etc.) Fall injuries are those when the student falls from equipment or falls while running. Collision with obstacle includes contact when the child collides into an object (playground equipment, fence, etc.) Injury to self occurs when a child got injured because of an action s/he carried out. Height of fall – Report the height from where the child fell. Self explanatory. Describe surface over which injury occurred. In the small box indicate the number of the activity that the child was doing when s/he got injured. Self explanatory. See attached document with pictures of each piece of equipment. Briefly describe specifically how the incident happened. Make sure to include all names of witnesses present. If additional space is needed, continue on another sheet of paper and attach. National Program for Playground Safety School of HPELS University of Northern Iowa Cedar Falls, IA 50614-0618 www.playgroundsafety.org (800) 554 –PLAY : (319) 273-7308 (fax) 2016 National Program for Playground Safety Appendix DD

EE 532 America’s PlaygroundsAppendix EE: America’s Playgrounds Safety Report Card APPENDIX EE: AMSEaRIfCeAt’SyPLRAYeGpROoUrNtDCS SaArFdETY REPORT CARD DOES YOUR PLAYGROUND MAKE THE GRADE? Evaluate your playground using the following criteria. A full explanation of the criteria is on the following page. Yes No SCORING SYSTEM sUPERVISION Total the number of “Yes” answers in the “Total Points” Adults present when children are on equipment Children can be easily viewed on equipment box in the table. Children can be viewed in crawl spaces Rules posted regarding expected behavior 24 – 20 = A aGE-APPROPRIATE DESIGN Congratulations on having a SAFE playground. Please Playgrounds have separate areas for ages 2-5 and 5-12 continue to maintain this Platforms have appropriate guardrails excellence. Platforms allow change of directions to get on/off structure Signage indicating age group for equipment provided 19 – 17 = B Equipment design prevents climbing outside the structure Supporting structure prevents climbing on it Your playground is on its way to providing a safe fALL SURFACING environment for children. Work on the areas checked ‘No’. Suitable surfacing materials provided Height of all equipment is 8 feet or lower 16 – 13 = C Appropriate depth of loose fill provided Six foot use zone has appropriate surfacing Your playground is potentially Concrete footings are covered hazardous for children. Take Surface free of foreign objects corrective measures. eQUIPMENT MAINTENANCE 12 – 8 = D Equipment is free of noticeable gaps Children are at risk on this Equipment is free of head entrapments playground. Start to make Equipment is free of broken parts improvements. Equipment is free of missing parts Equipment is free of protruding bolts 7&=F Equipment is free of rust Equipment is free of splinters Do not allow children on this Equipment is free of cracks/holes playground. Make changes immediately. TOTAL POINTS **If any of the gray boxes are marked ‘NO’, the potential of a life- threatening injury is significantly increased. Contact the owner of the playground. For Additional Resources and Information Contact: National Program for Playground Safety: 1-800-554-PLAY (7529) ~ www.playgroundsafety.org Reference: National Program for Playground Safety, 2016. Appendix EE

Caring for Our Children: National Health and Safety Performance Standards 533 EEAppendix EE: America’s Playgrounds Safety Report Card Explanation of Risk Factor Criteria SUPERVISION *1. Since equipment can’t supervise children, it is important that adult supervision is present when children are playing on the playground. 2. In order to properly supervise, children need to be seen. This question is asking if there are any blind spots where children can hide out of the sight of the supervisor. 3. Many crawl spaces, tunnels, and boxed areas have plexiglas or some type of transparent material present to allow the supervisor to see that a child is inside the space. When blind tunnels are present, children cannot be properly supervised. 4. Rules help reinforce expected behavior. Therefore, the posting of playground rules is recommended. For children, ages 2-5, no more than three rules should be posted. Children over the age of five will remember five rules. These rules should be general in nature, such as “respect each other and take turns.” AGE APPROPRIATE DESIGN *1. It is recommended that playgrounds have separate areas with appropriately sized equipment and materials to serve ages 2-5 and ages 5-12. Further, the intended user group should be obvious from the design and scale of equipment. In playgrounds designed to serve children of all ages, the layout of pathways and the landscaping of the playground should show the distinct areas for the diff erent age groups. The areas should be separated at least by a buffer zone, which could be an area with shrubs or benches. *2. Either guardrails or protective barriers may be used to prevent inadvertent or unintentional falls off elevated platforms. However, to provide greater protection, protective barriers should be designed to prevent intentional attempts by children. 3. Platforms over six feet in height should provide an intermediate standing surface where a decision can be made to halt the ascent or to pursue an alternative means of descent. 4. Signs posted in the playground area can be used to give some guidance to adults as to the age appropriateness of equipment. 5. Children use equipment in creative ways which are not necessarily what the manufacturer intended when designing the piece. Certain equipment pieces, like high tube slides, can put the child at risk if they can easily climb on the outside of the piece. The answer to this question is a judgment on your part as to whether the piece was designed to minimize risk to the child for injury from a fall. 6. Support structures such as long poles, bars, swing frames, etc. become the play activity. The problem is that many times these structures have no safe surfacing underneath and children fall from dangerous heights to hard surfaces. FALL SURFACING *1. Appropriate surfaces are either loose fill (engineered wood fiber, sand, pea gravel, or shredded tires) or unitary surfaces (rubber tiles, rubber mats, and poured in place rubber). Inappropriate surface materials are asphalt, concrete, dirt, and grass. It should be noted that falls from 1 ft. onto concrete could cause a concussion. Falls from a height of eight feet onto dirt is the same as a child hitting a brick wall traveling 30 mph. *2. Research has shown that equipment heights can double the probability of a child getting injured. We recommend that the height of equipment for pre-school age children be no higher than 6 feet and the height of equipment for school age children be limited to 8 feet. *3. Proper loose fill surfacing must be at the appropriate depth to cushion falls. An inch of sand upon hard packed dirt will not provide any protection. We recommend 12 inches of loose fill material under and around playground equipment. *4. Appropriate surfacing should be located directly underneath equipment and extend six feet in all directions with the exception of slides and swings, which have a longer use zone. *5. You should not be able to see concrete footings around any of the equipment. Deaths or permanent disabilities have occurred from children falling off equipment and striking their heads on exposed footings. 6. Glass, bottle caps, needles, trash, etc. can also cause injury if present on playground surfaces. EQUIPMENT MAINTENANCE *1. Strangulation is the leading cause of playground fatalities. Some of these deaths occur when drawstrings on sweatshirts, coats, and other clothing get caught in gaps in the equipment. The area on top of slides is one potential trouble spot. *2. Entrapment places include between guardrails and underneath merry-go-rounds. Head entrapment occurs when the body fits through a space but the child’s head cannot pass through the same space. This occurs because generally, young children’s heads are larger than their bodies. If the space between two parts (usually guardrails) is more than three and a half inches then it must be greater than nine inches to avoid potential entrapment. *3. Broken equipment pieces are accidents waiting to happen. If a piece of equipment is broken, measures need to be taken to repair the piece. In the meantime, children should be kept off the equipment. *4. Missing parts also create a playground hazard. A rung missing from a ladder, which is the major access point onto a piece of equipment, poses an unnecessary injury hazard for the child. 5. Protruding bolts or fixtures can cause problems with children running into equipment or catching clothing. Therefore, they pose a potential safety hazard. 6. Exposed metal will rust. This weakens the equipment and will eventually create a serious playground hazard. 7. Wood structures must be treated on a regular basis to avoid weather related problems such as splinters. Splintering can cause serious injuries to children. 8. Plastic equipment may crack or develop holes due to temperature extremes and/or vandalism. This is a playground hazard. *If these risk factors are missing, the potential for a life-threatening injury is significantly increased. 2016 National Program for Playground Safety Appendix EE

EE534 Caring for Our Children: National Health and Safety Performance Standards Appendix EE: America’s Playgrounds Safety Report Card Playground Safety Report Card Follow-up For any item checked NO on the Playground Safety (PS) Report card, indicate how the item will be remedied and the date of completion. Highlight any item checked NO from the PS Report How item will be fixed Date completed Card sUPERVISION Adults present when children are on equipment Children can be easily viewed on equipment Children can be viewed in crawl spaces Rules posted regarding expected behavior aGE-APPROPRIATE DESIGN Playgrounds have separate areas for ages 2-5 and 5-12 Platforms have appropriate guardrails Platforms allow change of directions to get on/off structure Signage indicating age group for equipment provided Equipment design prevents climbing outside the structure Supporting structure prevents climbing on it fALL SURFACING Suitable surfacing materials provided Height of all equipment is 8 feet or lower Appropriate depth of loose fill provided Six foot use zone has appropriate surfacing Concrete footings are covered Surface free of foreign objects eQUIPMENT MAINTENANCE Equipment is free of noticeable gaps Equipment is free of head entrapments Equipment is free of broken parts Equipment is free of missing parts Equipment is free of protruding bolts Equipment is free of rust Equipment is free of splinters Equipment is free of cracks/holes Adapted from NaƟonal Playground Safety Program. 2016. America’s Playground s Safety Report Card. Appendix EE

535 Appendix FF: Child Health Assessment APPENDIX FF: CHILD HEALTH ASSESSMENT CHILD HEALTH REPORT (55 PA CODE §§3270.131, 3280.131 AND 3290.131) Parent/Provider fill in this part. CHILD’S NAME: (LAST) (FIRST) PARENT/GUARDIAN: DATE OF BIRTH: HOME PHONE: ADDRESS: CHILD CARE FACILITY NAME: FACILITY PHONE: COUNTY: WORK PHONE: † I authorize the child care staff and my child’s health professional to communicate directly if needed to clarify information on this form about my child. PARENT’S SIGNATURE: DO NOT OMIT ANY INFORMATION This form may be updated by a health professional. Initial and date any new data. The child care facility needs a copy of the form. HEALTH HISTORY AND MEDICAL INFORMATION PERTINENT TO ROUTINE CHILD CARE AND DIAGNOSIS/TREATMENT IN EMERGENCY (DESCRIBE, IF ANY): † NONE DESCRIBE ALL MEDICATION AND ANY SPECIAL DIET THE CHILD RECEIVES AND THE REASON FOR MEDICATION AND SPECIAL DIET. ALL MEDICATIONS A CHILD RECEIVES SHOULD BE DOCUMENTED IN THE EVENT THE CHILD REQUIRES EMERGENCY MEDICAL CARE. ATTACH ADDITIONAL SHEETS IF NECESSARY. † NONE CHILD’S ALLERGIES (DESCRIBE, IF ANY): † NONE LIST ANY HEALTH PROBLEMS OR SPECIAL NEEDS AND RECOMMENDED TREATMENT/SERVICES. ATTACH ADDITIONAL SHEETS IF NECESSARY TO DESCRIBE THE PLAN FOR CARE THAT SHOULD BE FOLLOWED FOR THE CHILD, INCLUDING INDICATION OF SPECIAL TRAINING REQUIRED FOR STAFF, EQUIPMENT AND PROVISION FOR EMERGENCIES. † NONE IN YOUR ASSESSMENT, IS THE CHILD ABLE TO PARTICIPATE IN CHILD CARE AND DOES THE CHILD APPEAR TO BE FREE FROM CONTAGIOUS OR COMMUNICABLE DISEASES? † YES † NO IF NO, PLEASE EXPLAIN YOUR ANSWER: Parents may write immunization dates; health professional should verify and complete all data. HAS THE CHILD RECEIVED ALL AGE APPROPRIATE NOTE BELOW IF THE RESULTS OF VISION, HEARING OR LEAD SCREENINGS WERE ABNORMAL. IF SCREENINGS LISTED IN THE ROUTINE PREVENTIVE THE SCREENING WAS ABNORMAL, PROVIDE THE DATE THE SCREENING WAS COMPLETED AND HEALTH CARE SERVICES CURRENTLY RECOMMENDED INFORMATION ABOUT REFERRALS, IMPLICATIONS OR ACTIONS RECOMMENDED FOR THE CHILD BY THE AMERICAN ACADEMY OF PEDIATRICS? (SEE CARE FACILITY. SCHEDULE AT WWW.AAP.ORG) † YES † NO VISION (subjective until age 3) HEARING (subjective until age 4) LEAD RECORD DATES OF IMMUNIZATIONS BELOW OR ATTACH A PHOTOCOPY OF THE CHILD’S IMMUNIZATION RECORD IMMUNIZATIONS DATE DATE DATE DATE DATE COMMENTS HEP-B ROTAVIRUS SIGNATURE OF PHYSICIAN, CRNP OR PHYSICIAN’S ASSISTANT DTAP/DTP/TD HIB PNEUMOCOCCAL POLIO INFLUENZA MMR VARICELLA HEP-A MENINGOCOCCAL OTHER MEDICAL CARE PROVIDER: ADDRESS: TITLE: LICENSE NUMBER: PHONE: DATE FORM SIGNED: CD 51 09/08 Reprinted with permission from Pennsylvania Department of Public Welfare.

536 Appendix GG: Licensing and Public Regulation of Early Childhood Programs APPENDIX GG: LICENSING AND PUBLIC REGULATION OF EARLY CHILDHOOD PROGRAMS A position statement of the National Association for the Education of Young Children Adopted 1983; revised 1992 and 1997 One of the most dramatic changes in American family life in recent • supporting research and development related to child develop- years has been the increased participation of young children in ment and learning and early childhood programs as well as data nonparental child care and early education settings. Between 1970 and gathering for community planning; and 1993 the percentage of children regularly attending these types of arrangements soared from 30 to 70% (Department of Health and • disseminating information to inform consumers, service Human Services n.d.). Much of the demand comes from the need for providers, and the public about ways to promote children’s healthy child care that has accompanied the rapid rise in maternal labor force development and learning, both at home and in out-of-family participation. Increased demand for early childhood care and settings. education services also comes from families who—regardless of parents’ employment status—want their children to experience the While many of these functions can and should occur at multiple levels social and educational enrichment provided by good early childhood of government, the licensing function is established by laws passed by programs. state legislatures, creating offices that traditionally play the primary role in regulating the child care market by defining requirements for Background legal operation. States vary considerably in the methods and scope of regulation, using processes that may be called licensing, registration, Families seeking nonparental arrangements choose among a variety of or certification. These terms can have different meanings from state options: centers (for groups of children in a non-residential setting), to state. small family child care homes (for 6 or fewer children in the home of the care provider), large family or group child care homes (typically for 7 to The importance of an effective system of public regulation 12 children in the home of a care provider who employs a full-time assistant), in-home care (by a nonrelative in the family home), and kith The primary benefit from public regulation of the child care and and kin care (provided by a relative, neighbor, or friend to children of early education market is its help in ensuring children’s rights to care one family only). settings that protect them from harm and promote their healthy development. The importance of these rights is underscored by a The responsibility to ensure that any and all of these settings protect growing body of research evidence that emphasizes the importance and nurture the children in their care is shared among many groups. of children’s earliest experiences to their development and later Families are ultimately responsible for making informed choices about learning (Center for the Future of Children 1995; Hart & Risley 1995; the specific programs that are most appropriate for their own children. Bredekamp & Copple 1997; Kagan & Cohen 1997). Emerging research Early childhood professionals and others engaged in providing or on brain development indicates that the degree of responsive caregiv- supporting early childhood services have an ethical obligation to ing that children receive as infants and toddlers positively affects the uphold high standards of practice. Others within the community, connections between neurons in the brain, the architecture of the including employers and community organizations, who benefit when brain itself (Newberger 1997; Shore 1997). Given the proportion of children and families have access to high-quality early childhood children who spend significant portions of their day in settings outside programs also share in the responsibility to improve the quality and their family, ensuring that these environments promote healthy availability of early childhood services. Government serves development becomes increasingly important. a number of important roles, including • licensing and otherwise regulating so as to define and enforce minimum requirements for the legal operation of programs available to the public; • funding programs and supporting infrastructure, including professional development and supply-building activities; • providing financial assistance to help families with program costs;

537 Appendix GG: Licensing and Public Regulation of Early Childhood Programs Licensing and Public Regulation of Early Childhood Programs page 2 of 8 A position statement of the National Association for the Education of Young Children Research documents that those states with more effective regulatory support can be seen in five broad areas: (1) some states set their basic structures have a greater supply of higher quality programs (Phillips, floor for protection too low, failing to reflect research findings about Howes, & Whitebook 1992; Helburn 1995). Additionally, in such states the factors that create risk of harm; (2) a large number of settings in differences in quality are minimized between service sectors (e.g., some states are exempt from regulation; (3) the licensing office in some nonprofit and proprietary programs) (Kagan & Newton 1989). states is not empowered to adequately enforce the rules; (4) multiple regulatory systems may apply to individual programs, resulting Children who attend higher quality programs consistently demon- sometimes in overlapping or even contradictory requirements; and (5) strate better outcomes. These differences are apparent in many areas: policymakers may view licensing as unnecessary because they believe cognitive functioning and intellectual development (Lazar et al. 1982; it seeks the ideal or imposes an elitist definition of quality rather than Clarke-Stewart & Gruber 1984; Goelman & Pence 1987; Burchinal, establishing a baseline of protection. Each of these issues is discussed Lee, & Ramey 1989; Epstein 1993; Helburn 1995; Peisner-Feinberg & briefly below. Burchinal 1997); language development (McCartney 1984; Whitebook, Howes, & Phillips 1989; Peisner-Feinberg & Burchinal 1997); and 1. Some states set their basic floor for protection too low, with social development (McCartney et al. 1982; Clarke-Stewart 1987; Howes 1988; Whitebook, Howes, & Phillips 1989; Peisner-Feinberg licensing rules that fail to reflect research findings about the factors & Burchinal 1997). The demonstrated outcomes appear in cross- sectional studies conducted at a specific point in time as well as in that promote or hinder children’s healthy development. Clear links longitudinal studies over time (Carew 1980; Howes 1988; Vandell, exist between the quality of early childhood programs in child care Henderson, & Wilson 1988; Howes 1990; Schweinhart et al. 1993; centers and homes and the quality of the public regulatory systems Barnett 1995). The differences in outcomes occur even when other governing these services. Not only is the overall quality level of family variables are controlled for, including maternal education and services provided to children higher in states with more stringent family income level (Helburn 1995; NICHD 1997). licensing systems (Phillips, Howes, & Whitebook 1992; Helburn 1995), but also demonstrable improvements can be seen in program quality in Research is also consistent in identifying the structural factors most states that have worked to improve aspects of their licensing processes related to high quality in early childhood programs: (Howes, Smith, & Galinsky 1995). Despite such compelling evidence • small groups of children with a sufficient number of adults to as to the importance of strong licensing systems, a 1997 study looking provide sensitive, responsive caregiving; at grouping, staff qualifications, and program requirements found • higher levels of general education and specialized preparation that “the majority of states’ child care regulations do not meet basic for caregivers or teachers as well as program administrators; standards of acceptable/appropriate practice that assure the safe and and healthy development of very young children” (Young, Marsland, • higher rates of compensation and lower rates of turnover & Zigler in press). Similar findings also have been reported on licensing standards for the care of four-year-olds (Snow, Teleki, for program personnel (Whitebook, Howes, & Phillips 1989; & Reguero-de-Atiles 1996). Hayes, Palmer, & Zaslow 1990; Galinsky et al. 1994; Helburn 1995; Kagan & Cohen 1997; Whitebook, Sakai, & Howes 2. A large number of settings in some states are exempt from 1997). Many of these factors can be regulated directly or influenced by regulatory policy. regulation. Many children are unprotected because they receive care outside their families in programs that are legally exempt from Despite widespread knowledge of what is needed to provide good regulation. Exemptions affect both centers and family child care homes. quality in early childhood programs, many programs fail to do so. Among centers the most common licensing exemptions are for part-day Two large-scale studies of licensed centers and family child care programs (roughly half of the states) and programs operated by religious homes found that only about 10 to 15% of the settings offered care institutions (nine states) (Children’s Foundation 1997). Programs that promoted children’s healthy development and learning. For operated by or in public schools are sometimes exempt from licensing, infants and toddlers, the situation is grave: as many as 35 to 40% although in some cases public school programs must meet comparable of the settings were found to be inadequate and potentially harmful regulatory standards. Many states exempt family child care providers to children’s healthy development (Galinsky et al. 1994; Helburn 1995). from regulation if they care for fewer children than stipulated as the threshold for regulation. About half of the states set such a threshold, ranging from 4 to 13 children (Child Care Law Center 1996). Support for an effective licensing system falls short An effective licensing system minimizes the potential for harmful care, but regulatory systems in many states receive inadequate support to fully protect children’s healthy development and learning. The lack of

538 page 3 of 8 Appendix GG: Licensing and Public Regulation of Early Childhood Programs Licensing and Public Regulation of Early Childhood Programs A position statement of the National Association for the Education of Young Children 3. States do not always provide the licensing office with sufficient children’s healthy development have sometimes been misrepresented as attempts to impose a “Cadillac” or ideal of quality child care that is funding and power to effectively enforce licensing rules. A 1992 too costly and unrealistic for all programs to achieve. When such report found that “many states face difficulties protecting children misrepresentations succeed, the floor or safety net that licensing from care that does not meet minimum safety and health standards” provides to protect children in out-of-family care is weakened. (General Accounting Office 1992, 3). According to the report, staffing and budget cuts forced many states to reduce on-site monitoring, a key Drawing upon a conceptual framework first espoused by Norris Class oversight activity for effective enforcement. These cutbacks occurred (1969), Morgan (1996) distinguishes multiple levels of standards during a time of tremendous growth in the number of centers and fam- needed to achieve quality in early childhood programs. As the ily child care homes. The number of centers is estimated to have tripled strongest of governmental interventions, licensing must rest on a basis between the mid 1970s and early 1990s, while the number of children of the prevention of harm. Other regulatory methods, including enrolled quadrupled (Willer et al. 1991). An indicator of the growth in approval of publicly operated programs, fiscal control and rate setting, the number of regulated family child care providers is found in the and credentialing and accreditation, provide additional mechanisms recorded increase in the number of home-based participants in the that, building upon the basic floor of licensing, can encourage USDA Child and Adult Care Food Program (regulation being programs to achieve higher standards. a requirement of participation) from 82,000 in 1986 to nearly 200,000 in 1996 (Morawetz 1997). Nonregulatory methods can also promote higher quality services: for example, public and consumer awareness and engagement, profession- Lack of meaningful sanctions makes enforcement of existing regula- al development of teachers/caregivers and administrators, networking tions difficult (Gormley 1997). Licensing offices in all states have the and information sharing among professionals, and dissemination of power to revoke licenses, but some states have a much broader range of information regarding best practices. These standards can interact and enforcement tools. Others lack funding to adequately train licensing be dynamic. For example, licensing rules can reference credentialing personnel and fail to receive appropriate legal backup for effective standards, or fiscal regulation can reflect higher rates for accredited enforcement. programs. Also, greater knowledge of the importance of various factors in preventing harm to children’s healthy development and learning can Although most states require that a facility license be prominently result in changes in licensing rules so as to raise the level of basic posted, many states do not require prominent posting or public protection over time. printing of violation notices when facilities fail inspections. Informa- tion about licensing violations is only available in some states by checking the files in the state licensing office (Scurria 1994). The high demand for child care and early education services can exert pressures to keep even inadequate facilities open (Gormley 1995). 4. Multiple regulatory layers exist, sometimes with overlapping or even contradictory requirements. Different laws have created different inspection systems for different reasons, all affecting child care pro- grams. Programs typically must comply with local zoning, building and fire safety, and health and sanitation codes in addition to licensing. A lack of coordination of requirements can frustrate new and existing providers and undermine the overall effectiveness of the regulatory system. For example, state and local regulatory structures sometimes impose contradictory requirements on family child care providers (Gormley 1995). If providers react by “going underground,” children suffer. 5. Policymakers may view licensing as unnecessary because they believe it seeks the ideal or imposes an elitist definition of quality rather than establishing a baseline of protection. By definition, licensing rules represent the most basic level of protection for children. Licensing constitutes official permission to operate a center or family child care home; without this permission, the facility is operating illegally. Licensing rules combined with other regulatory requirements, such as environmental health codes, zoning provisions, and building and fire safety codes, define the floor for acceptable care that all child care programs must meet. In the current deregulatory climate, efforts to improve licensing rules and provide better basic protections for

539 Appendix GG: Licensing and Public Regulation of Early Childhood Programs Licensing and Public Regulation of Early Childhood Programs page 4 of 8 A position statement of the National Association for the Education of Young Children NAEYC’s position regardless of the length of program day, and regardless of the age of children served. NAEYC explicitly opposes exemption of part-day The National Association for the Education of Young Children programs or programs sponsored by religious organizations because (NAEYC) affirms the responsibility of states to license and regulate the such exemption does not provide an equal level of health and safety early care and education market by regulating centers, schools, and protection for all children. family and group child care homes. The fundamental purpose of public regulation is to protect children from harm, not only threats to their NAEYC’s definition of licensed care specifically excludes care by kith immediate physical health and safety but also threats of long-term and kin when a family engages an individual to care solely for their developmental impairment. children. A family support/education model that provides helpful information and support to individuals caring for children is likely to NAEYC recommends that states continue to adopt and improve be more effective and meaningful in reaching kith-and-kin providers requirements that establish a basic floor of protection below which no than a formal licensing model. Programs targeted to parents of young center, school, or family child care or group home may legally operate. children to help them in their role as their child’s first teacher should Basic protections should, at a minimum, protect children by striving also be accessible to kith-and-kin caregivers. If kith-and-kin providers to prevent the risk of the spread of disease, fire in buildings as well as are paid with public funds, NAEYC supports the application of other structural safety hazards, personal injury, child abuse or neglect, funding standards to these arrangements. and developmental impairment. 2. States should license all facilities that provide services to the Licensing rules should be coordinated statewide and streamlined to focus on those aspects that research and practice most clearly public, including all centers, large family or group child care homes, demonstrate as reducing these types of harm. Licensing rules and procedures should be developed in a context that recognizes other and small family child care homes (i.e., grant permission to operate). strategies and policies that encourage all programs to strive continu- ously for higher standards of quality. Such strategies and policies NAEYC recommends that all centers or schools (serving 10 or more include application of levels of funding standards and rates for the children in a nonresidential setting) be licensed facilities. Facility public purchase or operation of services; maintenance of broadly licensure should include an on-site visit prior to licensure and periodic accessible registries of programs or providers who meet nationally inspections to monitor continued compliance. Licensing rules should recognized standards of quality (such as NAEYC accreditation); focus on the aspects deemed most critical to maintaining children’s provision of a broad array of training and technical assistance safety and their healthy development, both in terms of their immediate programs to meet the varied needs of different types of providers; and physical health and well-being and their long-term well-being in all development and dissemination of model standards or best practices. areas of development. NAEYC supports the use of Stepping Stones to Using “Caring for Our Children” (National Resource Center for Public regulation of early childhood program facilities, including Health and Safety in Child Care 1997) to identify those requirements licensing, represents a basic level of protection afforded to all children in the National Health and Safety Performance Standards (APHA & in settings outside their family. Additional strategies and policies along AAP 1992) most needed for prevention of injury, morbidity, and with licensing are needed to support the provision of high-quality mortality in child care settings. services for all families who want or need them. These strategies and policies, however, cannot substitute for licensing in providing basic Licenses are typically granted to privately administered programs protection. rather than publicly operated programs, although some states do require publicly operated programs (such as those administered by NAEYC’s principles for effective regulation the state department of education) to be licensed. If licensure is not required of publicly operated programs, the administering agency NAEYC offers the following 10 principles for implementing should ensure that the program’s regulatory standards and enforce- an effective regulatory system. ment procedures are at least equivalent to those applied to licensed facilities. Such language should be written into law to empower 1. Any program providing care and education to children from two or the administering agency to develop statewide policies for implementation. more unrelated families should be regulated; there should be no exemptions from this principle. NAEYC believes that all types of care and education programs within the child care market should be regulated to provide basic protections to children. These protections must apply to all programs, without limiting definitions, exemptions, or exceptions. Whenever programs are exempted, not covered, or given special treatment, children are vulnerable and the entire regulatory system is weakened. NAEYC believes that programs should be regulated regardless of sponsorship,

540 page 5 of 8 Appendix GG: Licensing and Public Regulation of Early Childhood Programs Licensing and Public Regulation of Early Childhood Programs A position statement of the National Association for the Education of Young Children States currently vary widely in their definitions and procedures for Multiple licenses are needed because of the diversity of roles regulating family child care homes. NAEYC recommends the adoption and functions fulfilled by program personnel; multiple levels help of consistent definitions of small family child care homes as care of no to establish a career ladder with meaningful opportunities for career more than 6 children by a single caregiver in her home, including the advancement, with higher levels of compensation linked to higher caregiver’s children age 12 or younger; and of large family child care levels of qualification and demonstrated competence. In states in which homes as care in the caregiver’s residence employing a full-time early childhood teacher licensure or certification already exists for assistant and serving 7 to 12 children, including the caregiver’s public school personnel, early childhood personnel licensing should be children age 12 or younger. When infants and toddlers are present in a coordinated with these efforts. Individual licensure efforts may also be small family child care home, no more than three children should be used to provide a form of consumer protection for families using younger than age three, unless only infants and toddlers are in the in-home care by enabling them to check the credentials of a group and the total group size does not exceed four. Large family child potential employee. care homes should meet the same ratios and group sizes recommended for use in centers. 4. Licensing standards should be clear and reasonable and reflect For small family child care homes, NAEYC supports licensing methods current research findings related to regulative aspects that reduce that are designed to achieve full regulatory coverage of all home-based care providers in a state. These methods sometimes do not require an the risk of harm. on-site inspection prior to operation. NAEYC believes that such methods—whether called registration, certification, or another form of Licensing rules reflect public policy, not program specifications. Highly licensing—are viable ways to license small family child care homes detailed descriptions of program implementation are inappropriate for provided that (1) standards are developed and applied; (2) permission inclusion in licensing rules. Such areas are better addressed through to operate may be removed from homes that refuse to comply with the consumer education and professional development. For example, rules; (3) parents are well informed about the standards and the requiring programs to establish a planned program of activities to process; and (4) an effective monitoring process, including on-site enhance children’s development and learning would be an appropriate inspections, is in place. NAEYC believes that large family child care licensing rule; specifying the number of blocks to be available in a homes should be licensed in the same way as centers, with an classroom would not. inspection prior to licensure. NAEYC recommends that the licensing standards address health and 3. In addition to licensing facilities, states should establish safety aspects, group size, adult-child ratios, and preservice qualifica- tions and inservice requirements for staff (referencing individual complementary processes for professional licensing of individuals licensing standards). Periodic review and revision (every five years) are needed to ensure that rules reflect current issues as well as the latest as teachers, caregivers, or program administrators (i.e., grant knowledge and practice. Licensing rules should be widely publicized to parents and the public; these groups, along with service providers, permission to practice). should also participate in the review and revision of the rules. The skills and qualifications of the individuals working in an early childhood program are critically essential to creating environments that promote children’s healthy development and learning. Establish- ing licenses for the various roles included in early childhood centers and family child care homes not only protects children’s healthy development by requiring the demonstration of key competencies but also enhances early childhood professionalism and career development. In addition, individual licensure holds promise for increasing the compensation of staff (Kagan & Cohen 1997). Licen- sing of individuals is also a more cost-effective way of regulating qualifications centrally rather than through a licensing visit. A number of states are implementing career or personnel registries (Azer, Capraro, & Elliott 1997); individual licensure can build upon and complement these efforts. Personnel licensure should provide for multiple levels and roles, such as teacher/caregiver, master or lead teacher/caregiver, family child care provider, master family child care provider, and early childhood administrator. Attaining a license should require demonstration of the skills, knowledge, and competen- cies needed for the specific role. (For further information, see NAEYC’s Guidelines for Preparation of Early Childhood Professionals [NAEYC 1996] and “A Conceptual Framework for Early Childhood Professional Development” [Willer 1994]).

541 Appendix GG: Licensing and Public Regulation of Early Childhood Programs Licensing and Public Regulation of Early Childhood Programs page 6 of 8 A position statement of the National Association for the Education of Young Children 5. Regulations should be vigorously and equitably enforced. 7. Regulatory processes should be coordinated and streamlined to Enforcement is critical to effective regulation. Effective enforcement promote greater effectiveness and efficiency. requires periodic on-site inspections on both an announced and unannounced basis, with meaningful sanctions for noncompliance. Rules and inspections should be coordinated between the licensing NAEYC recommends that all centers and large and small family child agency and those agencies responsible for building and fire safety care homes receive at least one site visit per year. Additional inspec- and health and sanitation codes so that any overlap is reduced to a tions should be completed if there are reasons (such as newness of the minimum and contradictions resolved. In many cases coordination facility, sanction history, recent staff turnover, history of violations, will require reform at a statewide level, as different requirements derive complaint history) to suspect regulatory violations. Unannounced from different laws, are implemented by different agencies, and visits have been shown to be especially effective when targeted to respond to different constituencies (Center for Career Development providers with a history of low compliance (Fiene 1996). 1995). Coordination with funding agencies is also crucial. Licensing personnel can provide program monitoring for the funding agency, Clear, well-publicized processes should be established for reporting, thus eliminating duplicate visits; funding possibly can be withheld in investigating, and appealing complaints against programs. Parents and cases of substantiated violations. consumers especially should be informed of these processes. Staff should be encouraged to report program violations of licensing rules. Other methods for consideration in streamlining the regulatory If whistle-blowing laws do not exist or do not cover early care and process include (1) establishing permanent rather than annual licenses education workers, such legislation should be enacted. Substantiated for centers, allowing for the revocation of the license for cause at any violations should be well publicized at the program site as well as in time, and conducting inspection visits at least annually to determine other venues (such as resource-and-referral agencies, newspapers, continued compliance; (2) coordinating local teams that monitor and public libraries, online, etc.) easily accessible to parents and consum- inspect for licensing and regulation of health, fire, and building safety ers. Lists of programs with exemplary compliance records also should codes; and (3) removing zoning barriers. NAEYC believes that centers be widely publicized along with lists of programs that meet the and family child care homes should be regarded as a needed communi- requirements of recognized systems of quality approval, such as ty service rather than as commercial development and should be NAEYC accreditation. permitted in any residential zone. Planning officials should take into account the need for these services as communities develop new Sanctions should be included in the regulatory system to give binding housing and commercial uses. force to its requirements. Enforcement provisions should provide an array of enforcement options such as the ability to impose fines; to 8. Incentive mechanisms should encourage the achievement of a revoke, suspend, or limit licenses; to restrict enrollment or admissions; and to take emergency action to close programs in circumstances that higher quality of service beyond the basic floor. are dangerous to children. When threats to children’s health and safety are discovered, sanctions should be promptly imposed without a In addition to mandated licensing rules that establish a floor for quality delayed administrative hearing process. The vulnerability of children below which no program is allowed to operate, governments can use mandates the highest level of official scrutiny of out-of-family care and incentive mechanisms to encourage programs to achieve higher levels education environments. of quality. Examples of incentive mechanisms include funding standards, higher payment rates tied to demonstrated compliance with 6. Licensing agencies should have sufficient staff and resources to higher levels of quality, and active publicity on programs achieving higher quality. Given the nature of the early childhood field as severely effectively implement the regulatory process. underfunded, these mechanisms should be implemented in conjunc- tion with funding targeted to help programs achieve and maintain Staffing to handle licensing must be adequate not only to provide for higher levels of quality, or else the strategy simply enlarges the gulf timely processing of applications but also to implement periodic between the haves and have-nots. Differential monitoring strategies, monitoring inspections and to follow up complaints against programs. whereby programs maintaining strong track records and experiencing Licensing agencies must consider a number of factors in determining low turnover in personnel receive shortened inspections or are eligible reasonable caseloads, for example, program size and travel time for longer-term licenses, also may serve as incentives to programs for between programs. NAEYC believes that, on the average, regulators’ providing higher quality care. caseloads should be no more than 75 centers and large family child care homes or the equivalent; NAEYC recommends 50 as a more desirable number. States that do not make on-site inspections prior to licensing small family child care homes may assume larger caseloads, but allow for timely processing of licenses, periodic on-site inspections, and prompt follow-ups to complaints. Regulatory personnel responsible for inspecting and monitoring programs should have preparation and demonstrated competence in early childhood education and child development, program adminis- tration, and regulatory enforcement, including the use of sanctions. These criteria should be included in civil service requirements for licensing staff.

542 page 7 of 8 Appendix GG: Licensing and Public Regulation of Early Childhood Programs Licensing and Public Regulation of Early Childhood Programs A position statement of the National Association for the Education of Young Children 9. Consumer and public education should inform families, providers, References APHA & AAP (American Public Health Association & American Academy of and the public of the importance of the early years and of ways Pediatrics). 1992. Caring for our children—National health and safety performance: to create environments that promote children’s learning and Guidelines for out-of-home child care programs. Washington, DC: APHA. Azer, S.L., L. Capraro, & K. Elliott. 1997. Working toward making a career of it: development. A profile of career development initiatives in 1996. Boston: Center for Career Development in Early Care and Education, Wheelock College. Actively promoting messages about what constitutes good settings for Barnett, W.S. 1995. Long-term effects of early childhood programs on cognitive and young children not only encourages parents to be better consumers of social outcomes. Center for the Future of Children 5 (3):25–50. services in the marketplace but also, because these messages will reach Bredekamp, S., & C. Copple, eds. 1997. Developmentally appropriate practice in early providers outside the scope of regulation (family members and childhood programs. Rev. ed. Washington, DC: NAEYC. in-home providers), may help improve the quality of other settings. Burchinal, M., M.W. Lee, & C.T. Ramey. 1989. Type of day care and preschool Public service announcements, the development and dissemination intellectual development in disadvantaged children. Child Development 60: of brochures and flyers that describe state/local standards, open 128–37. workshops, and ongoing communication with organized parent groups Carew, J. 1980. Experience and development of intelligence in young children at home and well-care programs are all excellent ways for the regulatory agency and in day care. Monographs of the Society for Research in Child Development, to raise the child-caring consciousness of a community. A highly vol. 45, nos. 6–7, ser. no. 187. visible regulatory system also helps to inform potential and existing Center for Career Development in Early Care and Education at Wheelock College. providers of the existence of standards and the need to comply with 1995. Regulation and the prevention of harm. Boston: Author. the law. Center for the Future of Children. 1995. Long-term outcomes of early childhood programs. The Future of Children 5 (3). 10. States should invest sufficient levels of resources to ensure that Child Care Law Center. 1996. Regulation-exempt family child care in the context of publicly subsidized child care: An exploratory study. San Francisco: Author. children’s healthy development and learning are not harmed in early Children’s Foundation. 1997. 1997 Child care licensing study. Washington, DC: Author. care and education settings. Clarke-Stewart, K.A. 1987. Predicting child development from child care forms and features: The Chicago Study. In Quality in child care: What does research tell us? NAEYC believes that public regulation is a basic and necessary D.A. Phillips. Washington, DC: NAEYC. component of government’s responsibility for protecting all children in Clarke-Stewart, K.A., & C. Gruber. 1984. Daycare forms and features. In Quality all programs from the risk of harm and for promoting the conditions variations in daycare, ed. R.C. Ainslie, 35–62. New York: Praeger. that are essential for children’s healthy development and learning and Class, N.E. 1969. Safeguarding day care through regulatory programs: The need must be adequately funded. Additionally, government at every level for a multiple approach. Paper presented at the NAEYC Annual Conference, can and should support early childhood programs by ensuring Seattle, Washington. sufficient funding for high-quality services, opportunities for Epstein, A. 1993. Training for quality: Improving early childhood programs through professional development and technical assistance to service providers, systematic inservice training. Ypsilanti, MI: High/Scope Press. consumer education to families and the general public, and child care Fiene, R. 1996. Unannounced versus announced licensing inspections in monitoring resource-and-referral services to families. child care programs. Paper developed for the Cross-systems licensing project, Pennsylvania State University at Harrisburg and Pennsylvania Department of Early childhood regulation in context Public Welfare. Galinsky, E., C. Howes, S. Kontos, & M. Shinn. 1994. The study of children in family An effective system of public regulation is the cornerstone of an child care and relative care. Highlights and findings. New York: Families and effective system of early childhood care and education services, Work Institute. because it alone reaches all programs in the market. But for the Goelman, H., & A. Pence. 1987. Effects of child care, family and individual regulatory system to be most effective, other pieces of the early characteristics on children’s language development: The Victoria day care research childhood care and education services system also must be in project. In Quality in child care: What does research tell us? ed. D.A. Phillips, place, including (1) a holistic approach to addressing the needs 89–104. Washington, DC: NAEYC. of children and families that stresses collaborative planning Gormley, W.T., Jr. 1995. Everybody’s children: Child care as a public problem. and service integration across traditional boundaries of child care, Washington, DC: Brookings Institution. education, health, employment, and social services; (2) Gormley, W.T., Jr. 1997. Regulatory enforcement: Accommodation and conflict in systems that recognize and promote quality; (3) an effective four states. Public Administration Review 57 (4): 285–93. system of professional development that provides meaningful Hart, B., & T. Risley. 1995. Meaningful differences in the everyday experiences of young opportunities for career advancement to ensure a stable, American children. Baltimore: Paul H. Brookes. well-qualified workforce; (4) equitable financing that ensures Hayes, C.D., J.L. Palmer, & M.J. Zaslow, eds. 1990. Who cares for America’s children? access for all children and families to high-quality services; Child care policy in the 1990s. Washington, DC: National Academy Press. and (5) active involvement of all stakeholders—providers, practitioners, parents, and community leaders from both public and private sectors—in all aspects of program planning and delivery. NAEYC is committed to ensuring that each of these elements is in place. As early childhood educators, we believe that nothing less than the future of our nation—the well-being of its children—is at stake.

543 Appendix GG: Licensing and Public Regulation of Early Childhood Programs Licensing and Public Regulation of Early Childhood Programs page 8 of 8 A position statement of the National Association for the Education of Young Children Helburn, S., ed. 1995. Cost, quality, and child outcomes in child care centers. Phillips, D., C. Howes, & M. Whitebook. 1992. The social policy context of child care: Technical report. Denver: University of Colorado at Denver. Effects on quality. American Journal of Community Psychology 20 (1): 25–51. Howes, C. 1988. Relations between early child care and schooling. Developmental Schweinhart, L.J., H.V. Barnes, & D.P. Weikart with W.S. Barnett & A.S. Epstein. Psychology 24: 53–57. 1993. Significant benefits: The High/Scope Perry Preschool Study through age 27. High/Scope Educational Research Foundation Monograph, no. 10. Ypsilanti, MI: Howes, C. 1990. Can the age of entry into child care and the quality of child care High/Scope Press. predict adjustment in kindergarten? Developmental Psychology 26 (2): 292–303. Scurria, K.L. 1994. Alternative approaches to regulation of child care: Lessons from Howes, C., E. Smith, & E. Galinsky. 1995. The Florida child care quality other fields. Working paper prepared for the Quality 2000: Advancing Early Care improvement study. Interim report. New York: Families and Work Institute. and Education Initiative. Kagan, S.L., & N. Cohen. 1997. Not by chance: Creating an early care and education Shore, R. 1997. Rethinking the brain: New insights into early development. New York: system. New Haven, CT: Bush Center for Child Development and Social Policy, Families and Work Institute. Yale University. Kagan, S.L., & J.W. Newton. 1989. Public policy report. For-profit and nonprofit child Snow, C.W., J.K. Teleki, & J.T. Reguero-de-Atiles. 1996. Child care center licensing care: Similarities and differences. Young Children 45 (1):4–10. standards in the United States: 1981 to 1995. Young Children 51 (6): 36–41. Lazar, I., R. Darlington, H. Murray, J. Royce, & A. Snipper. 1982. Lasting effects of early education: A report from the Consortium for Longitudinal Studies. U.S. Department of Health and Human Services. n.d. Blueprint for action. Healthy Monographs of the Society for Research in Child Development, vol. 47, Child Care America campaign. Washington, DC: Author. ser. no. 201. McCartney, K. 1984. The effect of quality of day care environment upon children’s U.S. General Accounting Office. 1992. Child care: States face difficulties enforcing language development. Developmental Psychology 20: 224–60. standards and promoting quality. GAO/HRD-93-13. Washington, DC: GPO. McCartney, K., S. Scarr, D. Phillips, S. Grajek, & C. Schwarz. 1982. Environmental differences among day care centers and their effects on children’s development. In Vandell, D.L., V.K. Henderson, & K.S. Wilson. 1988. A longitudinal study of children Day care: Scientific and social policy issues, eds. E.G. Zigler & E.W. Gordon. with day-care experiences of varying quality. Child Development 59: 1286–92. Boston: Auburn House. Morawetz, E. 1997. Personal communication in July. Unpublished data, Child and Whitebook, M., C. Howes, & D.A. Phillips. 1989. Who cares? Child care teachers and Adult Care Food Program, U.S. Department of Agriculture, Food and Consumer the quality of care in America. The National Child Care Staffing Study. Oakland, Service, Child Nutrition Division, Alexandria, VA. CA: Child Care Employee Project. Morgan, G. 1996. Licensing and accreditation: How much quality is quality? In NAEYC accreditation: A decade of learning and the years ahead, eds. S. Bredekamp Whitebook, M., L. Sakai, & C. Howes. 1997. NAEYC accreditation as astrategy for & B.A. Willer, 129–38. Washington, DC: NAEYC. improving child care quality, executive summary. Washington, DC: National NAEYC. 1996. Guidelines for preparation of early childhood professionals. Center for the Early Childhood Work Force. Washington, DC: Author. National Resource Center for Health and Safety in Child Care. 1997. Stepping stones Willer, B. ed. 1994. A conceptual framework for early childhood professional to using “Caring for our children: National health and safety performance standards development: NAEYC position statement. In The early childhood career lattice: guidelines for out-of-home child care programs.” Denver: Author. Perspectives on professional development, eds. J. Johnson & J.B. McCracken, 4–23. Newberger, J.J. 1997. New brain development research—A wonderful window of Washington, DC: NAEYC. opportunity to build public support for early childhood education. Young Children 52 (4): 4–9. Willer, B., S.L. Hofferth, E.E. Kisker, P. Divine-Hawkins, E. Farquhar, & F.B. Glantz. NICHD Early Child Care Research Network. 1997. Mother-child interaction and 1991. The demand and supply of child care in 1990. Washington, DC: NAEYC. cognitive outcomes associated with early child care: Results of the NICHD study. Paper presented at the 1997 Biennial Conference of the Society for Research in Young, K., K.W. Marsland, & E.G. Zigler. In press. American Journal of Orthopsychiatry. Child Development, Washington, DC. Peisner-Feinberg, E.S., & M.R. Burchinal. 1997. Relations between preschool children’s child-care experiences and concurrent development: The Cost, Quality, and Outcomes Study. Merrill-Palmer Quarterly 43 (3):451–77. From NAEYC, “Licensing and Public Regulation of Early Childhood Programs,” Position statement, (Washington, DC: NAEYC, 1998). Copyright ©1998 NAEYC. Reprinted with permission. Full text of this position statement is available at www.naeyc.org/files/naeyc/file/positions/PSLIC98.PDF.

Caring for Our Children: National Health and Safety Performance Standards HH 544 Appendix HH: Use Zones and Clearance Dimensions for Single- and Multi-Axis Swings Use ZoAnePsPEaNnDdIXClHeHa:raUnScEeZODNimESenAsNioDnCsLfEoArRSAiNngClEeD- IaMnEdNMSIuOltNi-SAFxOisRSwings SINGLE- AND MULTI-AXIS SWINGS Appendix HH

HH Caring for Our Children: National Health and Safety Performance Standards 545 Appendix HH: Use Zones and Clearance Dimensions for Single- and Multi-Axis Swings Appendix HH

546 Appendix HH: Use Zones and Clearance Dimensions for Single- and Multi-Axis Swings Source: U.S. Consumer Product Safety Commission. 2010. Public playground safety handbook. httttpp:s//:w//wwww.wcp.cspcs.gco.gvo/cvp/s3cf/sp-upbusb/3li2c5/3.p2d5f..pdf Appendix HH Source: U.S. Consumer Product Safety Commission. 2010. Public playground safety handbook. http://www.cpsc.gov/cpsc/pubs/325.pdf. Appendix HH

Community EducaAtpipoenndix II: Bike and 547 Multi-sport Helmets: Quick-Fit Check APPENDIX II: BIKECAoNmDmMunUiLtTyIE-SdPuOcRaTtioHnELMETS: QUICK-FIT CHECK Community Education Use this easy, three-point check to test for a proper helmet fit 1. Eyes 1 2 Helmet sits level on your child’s head and rests low on the forehead, one to two finger widths above 1 2 the eyebrows. A helmet pushed up too high will 1 2 not protect the face or head well in a fall or crash. 3 2. Ears The straps are even, form a “Y” under each 3 earlobe, and lay flat against the head. 3 3. Mouth The “Eyes, Ears, Mouth Test” is courtesy of the Bicycle The buckled chin strap is loose enough so that Coalition of Maine. your child can breathe. There should be enough room so you can insert a finger between the buckle and chin. It should be tight enough that if your child opens their mouth, you can see the helmet pull down on top. Why are helmets needed? Helmets provide the best protection against injury, whether your child is riding a bike, scooter or skateboard, or using skates. Wearing a helmet can prevent about 85 percent of head injuries from bike crashes. However, a helmet will only protect when it fits well. Help your child get in the habit of wearing a helmet by starting when they’re young. Be a good role model and wear a helmet yourself. How do I choose a helmet? • Choose a helmet that meets safety standards. For biking, riding a scooter, recreational rollerskating and in-line skating, look for a helmet with a CPSC (Consumer Product Safety Commission) or Snell sticker inside. www.seattlechildrens.org 1 of 2 www.seattlechildrens.org 1 of 2

548 Appendix II: Bike and Multi-sport Helmets: Quick-Fit Check Bike and Multi-sport Helmets: Quick-Fit Check Bike and Multi-sport Helmets: Quick-Fit Check Safety tips • Teach your child to take their helmet off before • For skateboarding, or aggressive, trick or extreme skating, look for a helmet that has a playing at the playground or climbing on sticker inside saying it meets ASTM F1492. It equipment or trees. The straps can get caught is not enough for the helmet just to look like a on poles or branches and prevent your child skate helmet. from breathing. • Leave hair loose or tie it back at the base of the • There are some helmets that meet both the neck. CPSC and ASTM F1492 standards. They • For skiing or snowboarding, you will need are multi-sport helmets and can be used another type of helmet. for biking, skating, riding a scooter and • Bike helmets are only good for one crash. skateboarding. Don’t be fooled into thinking Replace the helmet after a crash and when the that helmets that look “skate-style” are always manufacturer suggests. Follow the instructions multi-sport. Look for the two safety standard from the manufacturer to know when to labels to be sure they are dual-certified. replace your multi-impact helmet. • Helmet costs vary. Expensive helmets are not always better. Choose one that fits properly, and that your child likes and will wear. • Check used or hand-me-down helmets with care, and never wear a helmet that is cracked or broken. Used helmets may have cracks you cannot see. Older helmets may not meet current safety standards. What are the pads for? Helmets come with fit pads to help ensure a proper fit. Use the pads where there is space at the front, back and/or sides of the helmet to get a snug fit. Move pads around to touch your child’s head evenly all the way around. Replace thick To Learn More pads with thinner ones as your child grows. • www.MakeSureTheHelmetFits.org •TowLweawrn.bMhsoi.roerg, Bicycle Helmet Safety How do I check the fit? • Iwnwstwit.uMteakeSureTheHelmetFits.org If you can move the helmet from side to side, add thicker pads on the sides or adjust the •• wwwwww..cbahssci.aodrge.,oBrgic,yCcalescHaedlme eBticSyacfleetCy lub universal fit ring on the back if the helmet Institute • Your child’s healthcare provider • www.cascade.org, Cascade Bicycle Club has one. • Your child’s healthcare provider When done, the helmet should feel level, fit solidly on your child’s head and be comfortable. If it doesn’t fit, keep working with the fit pads and straps or try another helmet.Seattle Children’s will make this information available in alternate formats upon request. Call Marketing Communications at 206-987-5205. This handout has been reviewed by clinical staff at Seattle Children’s. However, your child’s needs are unique. Before you act 3/16 oSrearettlyleuCphoinldtrheins’sinwfoilrlmmaatkioent,hpisleiansfoertmalaktiwonithavyaoiularbclehiilnd’aslhteeranlathtecaforermpraotvsiudpero.n request. Call Marketing Communications at CE222 ©20169-9958,71-959280, 52.001-2004, 2007, 2009, 2013, 2016 Seattle Children’s Hospital, Seattle, Washington. All rights reserved. This handout has been reviewed by clinical staff at Seattle Children’s. However, your child’s needs are unique. Before you act 2 o3f/126 or rely upon this information, please talk with your child’s healthcare provider. CE222 © 1995, 1998, 2001-2004, 2007, 2009, 2013, 2016 Seattle Children’s Hospital, Seattle, Washington. All rights reserved. 2 of 2

549 Appendix JJ: Our Child Care Center Supports Breastfeeding APPENDIX JJ: OUR CHILD CARE CENTER SUPPORTS BREASTFEEDING

550 Appendix KK: Authorization for Emergency Medical/Dental Care APPENDIX KK: AUTHORIZATION FOR EMERGENCY MEDICAL/DENTAL CARE In cases of illness or injury requiring medical attention and when the parents/guardians cannot be reached, the undersigned authorizes (caregiver/teacher) to call the preferred primary/dental care provider or to take my child (child’s name) to the nearest hospital or preferred primary/dental care provider; and it is understood that if possible, his/her services will be obtained. If the preferred primary/dental care provider cannot be contacted, the caregiver/teacher is authorized to contact another primary/dental care provider. It is also understood that this agreement covers only those situations which, in the best judgment of the caregiver/teacher, are true emergencies. NOTE: Every effort will be made to notify parents/guardians immediately in case of emergency. Child’s Full Name Child’s Date of Birth / / Child’s Address PARENT/GUARDIAN #1 Work Ph. Relationship to Child Name Cell Ph. Home Ph. Relationship to Child PARENT/GUARDIAN #2 Work Ph. Cell Ph. Name Home Ph. Relationship to Child Cell Ph. EMERGENCY CONTACT Name Home Ph. Work Ph. Any known allergies or medical conditions of child: MEDICAL INSURANCE INFORMATION Phone Name of Company Policy # Name of Member Group Number My preferred hospital is: My preferred primary care provider is: Name: Name: Address: Address: Phone: Phone: DENTAL INSURANCE INFORMATION Phone Name of Company Policy # Name of Member Group Number My preferred dental care provider is: Name: Address: Phone: I agree to be responsible for the cost of such emergency medical care. Signature of Parent/Guardian #1: Signature of Parent/Guardian #2: Adapted from the N.C. Department of Health and Human Services, Division of Child Development. 2004. Child’s Health and Emergency Information for Family Child Care Homes. http://ncchildcare.dhhs.state.nc.us/pdf_forms/DCD-0377.pdf.

Acronyms/Abbreviations