CFOC4 pdf- FINAL

553 Acronyms/Abbreviations Acronyms/Abbreviations AAA American Automobile Association ASME American Society of Mechanical Engineers AAFP AAHE American Academy of Family Physicians ASTM ASTM International, formerly named American Society for Testing and Materials AAOS American Association for Health Education BPA Bisphenol A AAP AAPD American Academy of Orthopedic CPR Cardiopulmonary Resuscitation AARST Surgeons CACFP Child and Adult Care Food Program Chromated copper arsenate ABCT American Academy of Pediatrics CCA Child Care Development Fund CCDF Child Care Health Consultant ABT American Academy of Pediatric Dentistry CCHC Cough and Cold Medication ACE CCM Child Care Special Interest Group ACEI American Association of Radon Scientists CCSIG Child Care Workforce and Technologists CCW Child Development Associate ACIP CDA Community Development Block Grant Association for Behavioral and Cognitive CDBG Centers for Disease Control and ACMI Therapies Prevention ADA CDC Compact Fluorescent Light ADA Abusive Head Trauma Caring for Our Children: National Health ADAAG CFL and Safety Standards; Guidelines for Adverse Childhood Experiences CFOC Early Care and Education Programs ADHD Code of Federal Regulations AFMA Association for Childhood Education CFR Current Good Manufacturing Practices International CGMP Center for Health Environment and Justice AGA CHEJ Certified Health Education Specialist AHA U.S. Public Health Service Advisory CHES Children’s Health Insurance Program AHAM Committee on Immunization Practices Childhood Immunization Support CHIP Program AIDS Art and Creative Materials Institute CISP Cytomegalovirus ALA U.S. Consumer Product Safety ANA American Dietetic Association CMV Commission ANSI CPSC Canadian Standards Association APHA Americans with Disabilities Act Children with Special Health Care Needs APRN CSA Coordinated School Health Program APSP Americans with Disabilities Act CSHCN Children with Special Needs AQI Accessibility Guidelines Cardiovascular Disease ASHRAE CSHP Attention-deficit Hyperactivity Disorder CSN ASQ CVD American Furniture Manufacturers Association American Gas Association American Heart Association Association of Home Appliance Manufacturers Acquired Immunodeficiency Syndrome American Lung Association American Nurses Association American National Standards Institute American Public Health Association Advanced Practice Registered Nurse Association of Pool and Spa Professionals Air Quality Index American Society of Heating, Refrigerating, and Air-conditioning Engineers Ages and Stages Questionnaire

554 Acronyms/Abbreviations DASH Division of Adolescent and School Health IEP Individualized Education Program db Decibel IFSP Individual Family Service Plan N,N-diethyl-meta-toluamide IGRA Interferon-gamma Release Assay DEET Diethylhexyladepate IPM Integrated Pest Management DEHA ITERS Infant/Toddler Environment Rating Scale IVIG Intravenous Immune Globulin ECE/CD Early Childhood Education/Child Development JPMA Juvenile Products Manufacturers ECERS Association ECMHC Early Childhood Environment Rating Scale LCR Lead and Copper Rule EEI Early Childhood Mental Health Consultant LDPE Low-density polyethylene EMS Light Emitting Diode EMSC Edison Electric Institute LED Licensed Practical Nurse EPA LPN Latent Tuberculosis Infection EPSDT Emergency Medical Services LTBI Emergency Medical Services for Children U.S. Environmental Protection Agency Early Periodic Screening, Diagnosis, and Treatment FDA U.S. Food and Drug Administration MCH Maternal and Child Health FEMA Federal Emergency Management Agency MHC Mental Health Consultant FERPA Family Educational Rights and Privacy Act MMR Measles, Mumps, and Rubella MMRV MMR Vaccine GED General Educational Development MRSA Methicillin-resistant Staphylococcus aureus GFCI Ground-fault Circuit-interrupter MSDS Material Safety Data Sheet MSW Municipal Solid Waste GIS Geographic Information System HAV Hepatitis A Virus NAA National AfterSchool Association HBV NACCRRA HCV Hepatitis B Virus National Association of Child Care HDPE NAEYC Resource and Referral Agencies HEPA Hepatitis C Virus HHS NAFCC National Association for the Education of High-density Polyethylene NAPNAP Young Children HHV-6 HIC High-efficiency Particulate Air NAP-SACC National Association for Family Child Care HIV U.S. Department of Health and Human NASCD National Association of Pediatric Nurse HRSA Services NASN Practitioners NASPE HUD Human Herpesvirus Six Nutrition and Physical Activity Self- HVAC NCCA assessment for Child Care Head Injury Criterion NCHEC National Association for Sick Child Daycare Human Immunodeficiency Virus NCPS NEC National Association of School Nurses Health Resources and Services Administration National Association for Sport and Physical Education Housing and Urban Development National Child Care Association Heating, Ventilation, Air-conditioning, and Cooling National Commission for Health Education Credentialing ICC Interagency Coordinating Council IDEA National Center for Playground Safety IEEE Individuals with Disabilities Education Act National Electrical Code Institute of Electrical and Electronics Engineers

555 Acronyms/Abbreviations NEC Necrotizing enterocolitis QRIS Quality Rating and Improvement Systems NECPA QRS Quality Rating Systems National Early Childhood Program NEISS Accreditation RN Registered Nurse NHTSA National Electronic Injury Surveillance SBA Safe Building Alliance NNii System SBS SCHIP Shaken baby syndrome NOAA National Highway Traffic Safety Association SIDS SPF State Children’s Health Insurance Program NOWRA National Network for Immunization SPMTA Information Sudden infant death syndrome NPPS STIPDA NRA National Oceanic and Atmospheric Sun Protection Factor NRC Administration SVRS Swimming Pool Manufacturers Trade NRPA National On-site Wastewater Recycling Association NSF Association NTI State and Territorial Injury Prevention National Program for Playground Safety Directors’ Association NTNCWS National Rehabilitation Association Safety Vacuum Release System NWR NWS National Resource Center for Health and TANF Temporary Assistance for Needy Families Safety in Child Care and Early Education TCA Tricyclic Antidepressants TST Tuberculin Skin Test National Recreation and Parks Association UCHR Universal Child Health Record National Sanitation Foundation UF Urea-formaldehyde UL Underwriters Laboratories National Training Institute for Child Care U.S. Department of Agriculture Health Consultants USDA Ultra-violet UV Non-transient, Non-community Water System NOAA Weather Radio National Weather Service OPIM Other Potential Infectious Materials VNA Visiting Nurse Association OSERS VOC Volatile Organic Compound Office of Special Education and OSG Rehabilitative Services WIC Women, Infants, and Children OSHA Office of the Surgeon General OTC Occupational Safety and Health Administration Over-the-counter PBDE Polybrominated diphenyl ethers PC Polycarbonate Para-dichlorobenzene PDCB Pediatric First Aid for Caregivers and PedFACTS Teachers Polyethylene terephthalate PETE Polypropylene PP Polystyrene PS Polyvinyl chloride PVC



Glossary



559 Glossary Glossary See Also Acronyms/Abbreviations Anaphylaxis – An allergic reaction to a specific substance (food, pollen, pets, mold, medication, etc.) that causes danger- Note: Some of these definitions were contained in the first ous and possibly fatal complications, including the swelling and edition in which they were reprinted with permission from closure of the airway that can lead to an inability to breathe. Infectious Diseases in Child Care Settings and Schools, a Anemia – Having too little hemoglobin (hemoglobin carries manual with information for directors, caregivers/teachers, oxygen from the lungs throughout the body). The terms anemia, and parents/guardians, by the Epidemiology Departments of iron deficiency, and iron deficiency anemia often are used inter- Hennepin County Community Health, St. Paul Division of changeably but are equivalent. Public Health, Minnesota Department of Health, Washington Ref: Centers for Disease Control and Prevention. 2011. Iron and County Public Health, and Bloomington Division of Health. iron deficiency. http://www.cdc.gov/nutrition/everyone/basics/ Other definitions are from the resources referenced at the vitamins/iron.html. end of the definition. Others were supplied by our Technical Antibiotic prophylaxis – Medicine that is prescribed to prevent Panels. Please see the Acknowledgments section for a list infections in infants and children in situations associated with of the Technical Panels’ members. an increased risk of serious infection with a specific disease. Ref: Pickering, L. K., C. J. Baker, D. W. Kimberlin, S. S. Long, Abrasion – An injury (such as a scrape) that occurs when eds. 2009. Red book: 2009 report of the Committee on Infectious the top layer of skin is removed, with little blood loss. Diseases. 28th ed. Elk Grove Village, IL: American Academy Ref: American Academy of Pediatrics (AAP). 2005. Pediatric of Pediatrics. first aid for caregivers and teachers. Ed. S. S. Aronson. Boston: Antibody – A protein substance produced by the body’s Jones and Bartlett; Elk Grove Village, IL: AAP. http://www. immune defense system in response to something foreign. pedfactsonline.com. Antibodies help protect against infections. Acute – Adjective describing an illness that has a sudden Antiseptic – Antimicrobial substances that are applied to onset and is of short duration. the skin or surfaces to reduce the number of microbial Ref: Donoghue, E. A., C. A. Kraft, eds. 2010. Managing chronic flora. Examples include alcohols, chlorhexidine, chlorine, health needs in child care and schools: A quick reference guide. hexachlorophene, iodine, chloroxylenol (PCMX), quaternary Elk Grove Village, IL: American Academy of Pediatrics. ammonium compounds, and triclosan. Acrocyanosis – Blueness or pallor of the extremities usually Ref: Boyce, J. M., D. Pittet. 2002. Guideline for hand hygiene associated with pain and numbness and caused by vasomotor in healthcare settings: Recommendations of the Healthcare disturbances. Infection Control Practices Advisory Committee and the Adaptive equipment – Equipment (such as eye glasses, hear- HICPAC/SHEA/ APIC/IDSA Hand Hygiene Task Force. ing aids, wheelchairs, crutches, prostheses, oxygen tanks) that MMWR 51(RR16): 1-44. http://www.cdc.gov/mmwr/preview/ helps children with special health care needs adapt to and mmwrhtml/rr5116a1.htm. function within their surroundings. See also Appendix X. Antigen – Any substance that is foreign to the body. An antigen Aflatoxin – A naturally occurring mycotoxin (fungus). This is capable of causing a response from the immune system. toxic metabolite occurs in soil, decaying vegetation, hay, and Antisiphon ballcock – An automatic valve in the toilet tank, grains undergoing microbiological deterioration. Favorable the opening and closing of which is controlled by a spherical conditions include high moisture content and high float at the end of a lever. The antisiphon ballcock does not temperature. allow dirty water to be admixed with clean water. Ref: Cornell University Department of Animal Science. 2009. Asbestos – A mineral fiber that can pollute air or water and Aflatoxins: Occurrence and health risks. http://www.ansci. cause cancer or asbestosis when inhaled. cornell.edu/plants/toxicagents/aflatoxin/aflatoxin.html. Friable asbestos – Any material containing more than one- Age-appropriate physical activity – See Physical activity percent asbestos, and that can be crumbled or reduced to Age-appropriate solid foods – Also known as complementary powder by hand pressure. (May include previously non- foods, foods introduced at the correct age to infants. Examples friable material which becomes broken or damaged by are iron-fortified infant cereals and pureed meats for infants. mechanical force.) AIDS – See Human Immunodeficiency virus (HIV) Ref: U.S. Environmental Protection Agency. 2009. Terms Air Quality Index (AQI) – A tool used by EPA and other of environment: Glossary, abbreviations and acronyms. agenciesto describe how clean the air is and whether or not http://www.epa.gov/glossary/. the public should be concerned for their health. The AQI Asphyxial crib death – Death attributed to an item within is focused on health effects that can happen within a few the crib that caused deprivation of oxygen or obstruction to hours or days after breathing polluted air. normal breathing of an infant. Ref: Agency for Toxic Substances and Disease Registry. 2009. Asphyxiation – Death or unconsciousness due to inadequate The air quality index. http://www.atsdr.cdc.gov/general/theair. oxygenation, the presence of noxious agents, or other obstruc- html#indic. tions to normal breathing. Allergens – A substance (food, pollen, pets, mold, medication, Aspiration – The inhalation of food, liquid, or a foreign body etc.) that causes an allergic reaction. into a person’s airway which results in choking/respiratory Ambient measurements – Measurements that help assess distress. the amount of air pollutants, noise, or lighting within a specific area.

560 Glossary Assessment – An in-depth appraisal conducted to diagnose a Botulism – A severe illness of the nervous system. Three condition or determine the importance or value of a procedure. distinct, naturally occurring forms of human botulism exist: Asymptomatic – Without symptoms. For example, a child may foodborne, wound, and infant. not have symptoms of hepatitis infection, but may still shed Ref: Pickering, L. K., C. J. Baker, D. W. Kimberlin, S. S. Long, hepatitis A virus in the stool and may be able to infect others. eds. 2009. Red book: 2009 report of the Committee on Infectious Autism spectrum disorders – A group of developmental Diseases. 28th ed. Elk Grove Village, IL: American Academy disabilities associated with problems in the brain. Children of Pediatrics. with ASDs have trouble in three core areas of their develop- BPA (BISPHENOL A) – An organic compound used to manu- ment: language difficulties, especially no apparent desire to facture polycarbonate plastics. This type of plastic is used to communicate, social interaction, restricted interests and make some types of beverage containers, compact disks, plastic behaviors that are repeated over and over again. dinnerware, impact-resistant safety equipment, automobile Ref: Donoghue, E. A., C. A. Kraft, eds. 2010. Managing chronic parts, and toys. BPA epoxy resins are used in the protective health needs in child care and schools: A quick reference guide. linings of food cans, in dental sealants, and in other products. Elk Grove Village, IL: American Academy of Pediatrics. Ref: Centers for Disease Control and Prevention. 2009. Automous behavior – Behavior that is independent, free, National report on human exposure to environmental and self-directing. chemicals. Fact sheet: Bisphenol A. http://www.cdc.gov/ Ref: Merriam-Webster. 2009. Autonomy. Medline Plus exposurereport/BisphenolA_Fact Sheet.html. Medical Dictionary. http://www2.merriam-webster.com/ Bronchitis – A bacterial or viral infection that leads to swelling cgi-bin/mwmednlm?book=Medical&va=autonomy. of the tubes (bronchioles) leading to the lungs. Axillary – Pertaining to the area under the arm (armpit). Cadmium – An extremely toxic metal commonly found in Ref: American Academy of Pediatrics. 2009. How to take industrial workplaces, particularly where any ore is being a child’s temperature. Healthy Children. http://www. processed or smelted. healthychildren.org/English/health-issues/conditions/ Ref: Occupational Safety and Health Administration. 2009. fever/pages/How-to-Take-a-Childs-Temperature.aspx. Safety and health topics: Cadmium. http://www.osha.gov/ Background screenings – The process of checking the SLTC/cadmium/. history of adults before they are allowed to care for children. Campylobacter – A bacterium that causes diarrhea. See Standard 1.2.0.2 for detail on what should be included Campylobacteriosis – A diarrheal infection caused by the in a background screening. Campylobacter bacterium. Bacteria (Plural of bacterium) – Organisms that may be Capture velocity – Airflow that will collect the pollutant responsible for localized or generalized diseases and can (such as dust or fumes) that you want removed. survive in and out of the body. They are much larger than Cardiopulmonary resuscitation (CPR) – Emergency measures viruses and can usually be treated effectively with antibiotics. performed by a person on another person whose breathing or Balusters – Vertical stair railings that support a horizontal heart activity has stopped. Measures include closed chest handrail. cardiac compressions in a regular sequence. Bleach solution – See Appendix J: Selecting an Appropriate Care coordinator – An individual assigned to work with the Sanitizer or Disinfectant. child’s family or alternative caretaker to assist in coordinating Bloodborne pathogens – Infectious microorganisms present services, either internally within an agency directly provid- in blood that can cause disease in humans. These pathogens ing services or with other service providers for the child and include, but are not limited to, hepatitis B virus (HBV), family. This term is also used by some agencies or caregivers hepatitis C virus (HCV), and human immunodeficiency in place of, or in association with, the term case manager virus (HIV), the virus that causes AIDS. Care Plan – A document that provides specific health care Ref: Occupational Safety and Health Administration. 2011. information, including any medications, procedures, pre- OSHA factsheet: OSHA’s bloodborne pathogens standard. cautions, or adaptations to diet or environment that may be http://www.osha.gov/OshDoc/data_BloodborneFacts/ needed to care for a child with chronic medical conditions bbfact01.pdf. or special health care needs. Care Plans also describe signs BMI – See Body Mass Index (BMI) and symptoms of impending illness and outline the response Body fluids – Urine, feces, saliva, blood, nasal discharge, eye needed to those signs and symptoms. A Care Plan is completed discharge, and injury or tissue discharge. by a health care professional and should be updated on a Body Mass Index (BMI) – Measurement of weight in kilograms regular basis. divided by height in meters squared. Overweight and obesity Ref: Donoghue, E. A., C. A. Kraft, eds. 2010. Managing chronic can be defined by the BMI for age measurement. health needs in child care and schools: A quick reference guide. Ref: Hagan, J. F., J. S. Shaw, P. M. Duncan, eds. 2008. Bright Elk Grove Village, IL: American Academy of Pediatrics. futures: Guidelines for health supervision of infants, children Caregiver/Teacher – The primary person who works directly and adolescents. 3rd ed. Elk Grove Village, IL: American with the children in the center and in small and large family Academy of Pediatrics. child care homes. Bottle propping – Bottle-feeding an infant by leaning the Carrier – A person or animal who carries within his/her body bottle against the infant’s mouth and leaving the infant alone a specific disease causing organism, who has no symptoms of rather than holding the bottle by hand. disease, and who can spread the disease to others. For example, some children may be carriers of Haemophilus influenzae or giardia and have no symptoms. Case manager – See Care coordinator

561 Glossary Catheterization – The process of inserting a hollow tube into Children with special health care needs – Children who have an organ of the body, either for an investigative purpose or to or are at increased risk for chronic physical, developmental, give some form of treatment (such as to remove urine from behavioral, or emotional conditions who require health and the bladder of a child with neurologic disease). related services of a type or amount beyond that required by CCA (chromated copper arsenate) – A chemical wood preser- children generally. vative containing chromium, copper, and arsenic. CCA is used Ref: Maternal and Child Health Bureau. Achieving and in pressure treated wood to protect wood from rotting due to measuring success: A national agenda for children with insects and microbial agents. special health care needs. http://mchb.hrsa.gov/programs/ Ref: U.S. Environmental Protection Agency. 2008. Pesticides: specialneeds/measure success.htm. Regulating pesticides. Chromated Copper Arsenate (CCA). Children’s Health Insurance Program (CHIP) – A program that http://www.epa.gov/oppad001/reregistration/cca/. provides free or low-cost health coverage for children up to age Ceftriaxone – An antibiotic often prescribed for those exposed nineteen. CHIP covers U.S. citizens and eligible immigrants. to an infection caused by Haemophilus influenzae type b (Hib) Chronic – Describing a disease or illness of long duration or or Neisseria meningitidis (meningococcus). frequent recurrence, often having a slow progressive course Celiac disease – A digestive disease that damages the small of indefinite duration. intestine and interferes with absorption of nutrients from Ref: Merriam-Webster. 2010. Chronic. Medline Plus Medical food. People who have celiac disease cannot tolerate gluten, Dictionary. http://www.merriam-webster.com/medlineplus/ a protein in wheat, rye, and barley. Gluten is found mainly chronic/. in foods but may also be found in everyday products such Ciprofloxacin – An antibiotic often prescribed for those as medicines, vitamins, and lip balms. exposed to an infection caused by Haemophilus influenzae Ref: National Digestive Diseases Information Clearinghouse. type b (Hib) or Neisseria meningitidis (meningococcus). 2008. Celiac disease. http://digestive.niddk.nih.gov/ddiseases/ Clean – To remove dirt and debris by scrubbing and washing pubs/ celiac/#what/. with a detergent solution and rinsing with water. Center – A facility that provides care and education of any CMV – See Cytomegalovirus number of children in a nonresidential setting, or thirteen Communicable disease – See Infectious disease or more children in any setting if the facility is open on a Complementary foods – Solid foods that are age-appropriate regular basis. for infants such as iron-fortified infant cereals and pureed Certification (as it relates to a form of licensing) – meats. Designation as having met the requirements to operate or Compliance – The act of carrying out a recommendation, practice in a specific sector. policy, regulation, or procedure. Ref: Merriam-Webster. 2009. Certify. Medline Plus Medical Congenital – Existing from the time of birth. Dictionary. http://www.merriam-webster.com/medlineplus/ Conjunctivitis – Also known as “Pink eye,” inflammation certify. (redness and swelling) of thin tissue covering the white part Certified playground safety inspector (CPSI) – Individuals of the eye and the inside of the eyelids. who have attained a measured level of competency to inspect Ref: Aronson, S. S., T. R. Shope, eds. 2009. Managing infectious playgrounds for safety hazards and to ensure compliance with diseases in child care and schools: A quick reference guide. 2nd national standards set by ASTM International (ASTM) and ed. Elk Grove Village, IL: American Academy of Pediatrics. the U.S. Consumer Product Safety Commission (CPSC). Contact dermatitis – A skin inflammation that results when Ref: National Recreation and Park Association. 2009. Certified the skin comes in direct contact with substances that can Playground Safety Inspector (CPSI) certification. http://www. cause an allergic or inflammatory reaction. nrpa.org/Content.aspx?id=413. Contamination – The presence of infectious microorganisms Child abuse and neglect – See Appendix M for definitions of in or on the body, on environmental surfaces, on articles of types of abuse and neglect. clothing, or in food or water. Child and Adult Care Food Program (CACFP) – The U.S. Contraindication – Something (as a symptom or condition) Department of Agriculture’s sponsored program whose that makes a particular treatment or procedure inadvisable. child care component provides nutritious meals to children Contractual relationship – A relationship based on a signed enrolled in centers and family child care homes throughout and written contract between parents/guardians and caregivers/ the country. teachers that documents child care agreements involving poli- Child care health consultant (CCHC) – A licensed health cies and procedures and educational programming goals. professional with education and experience in child and Corporal punishment – Physical harm inflicted on the body community health and early care and education, preferably (such as spanking). specialized training in child care health consultation. CPR – See Cardiopulmonary resuscitation Child Development Associate (CDA) – A credential awarded Croup – Spasms of the airway that cause difficult breathing to those who have completed a list of requirements, including and a cough sounding like a seal’s bark. Croup can be caused 120 hours of training, set forth by the Council for Professional by various bacteria and viruses. Recognition. Cryptosporidium – A parasite that causes cryptosporidiosis, Child:staff ratio – The amount of staff required, based on the a diarrheal illness. number of children present and the ages of these children. See also Group size.

562 Glossary “Cue” feeding – Feeding an infant based on their “cues” such Diabetes – A disorder that affects the way the body uses or con- as opening the mouth, making suckling sounds and moving verts food for energy and growth. Type 1 diabetes is a disease the hands at random, as well as discontinuing feeding by in which the immune system destroys the cells in the pancreas observing cues that they are full. that make insulin. Children with type 1 diabetes need to take Cytomegalovirus (CMV) – A viral infection common to insulin injections to live. Type 2 diabetes is a condition in which children. In most cases, CMV causes no symptoms. When the pancreas produces insulin, but the body cannot use it, often symptoms are experienced, they typically consist of fever, because of obesity; this is known as insulin resistance. swollen glands, and fatigue. CMV can infect a pregnant Ref: Donoghue, E. A., C. A. Kraft, eds. 2010. Managing chronic woman who is not immune and damage the fetus, leading to health needs in child care and schools: A quick reference guide. mental retardation, hearing loss, and other nervous system Elk Grove Village, IL: American Academy of Pediatrics. problems in the unborn child. Diarrhea – An illness in which an individual develops more Daily health check – Assessment of a child’s health each day watery and more frequent stools than is typical for that person. through observation of the child, talking with the parent/ Ref: Aronson, S. S., T. R. Shope, eds. 2009. Managing infectious guardian, and if applicable, with the child. See Standard 3.1.1.1 diseases in child care and schools: A quick reference guide. 2nd for details. ed. Elk Grove Village, IL: American Academy of Pediatrics. Decibel (db) – The unit of measure of the loudness of sounds; Disease surveillance – Close observation for the occurrence of one decibel is the lowest intensity of sound at which a given a disease or infection. Surveillance is performed to discover a note can be heard. The decibel level is the number of decibels disease problem early, to understand a disease problem better, of noise perceived or measured in a given place. and to evaluate the methods used to control the disease. DEET (N,N-Diethyl-meta-toluamide) – An ingredient in many Disinfect – See Appendix J: Selecting an Appropriate Sanitizer insect repellents. See Standard 3.4.5.2 for instructions on use. or Disinfectant Delegation of medication administration – Delegation is Drop-in care facility – Program where children are cared a tool that may be used by the health professional to allow for over short periods of time on a one-time, intermittent, unlicensed assistive personnel to administer medication unscheduled and/or occasional basis. It is often operated in under the supervision of the health professional’s guidance connection with a business (e.g., health club, hotel, shopping and assessment of the unique needs of the individual and center, or recreation centers). the suitability of delegation of specific tasks. Dyslipidemia – A condition marked by abnormal concentra- Ref: American Academy of Pediatrics, Council on School tions of lipids or lipoproteins in the blood, consisting of one or Health. 2009. Policy statement: Guidance for the administra- a combination of high LDL, low HDL, and high triglycerides. tion of medication on school. Pediatrics 124:1244-51. E. coli – See Shiga toxin-producing E. coli (STEC) Demand feeding – The feeding of infants whenever they Early childhood education consultant (ECEC) – Education indicate that they need to be fed, rather than feeding accord- professionals within the early childhood community who ing to a clock schedule. See also “Cue” feeding. are trained in literacy, child development, curriculum Dental caries – A disease process that leads to holes in the development, instruction, and coaching. teeth (commonly called dental cavities). Ref: Chester County Intermediate Unit. Training and con- Ref: Aronson, S. S., T. R. Shope, eds. 2009. Managing infectious sultation (TaC). http://www.cciu.org/22251042710361673/ diseases in child care and schools: A quick reference guide. 2nd site/default.asp. ed. Elk Grove Village, IL: American Academy of Pediatrics. Egress – A place or means of going out. An exit. Dental Home – The ongoing relationship between the dentist Ref: Merriam-Webster. 2010. Egress. Merriam-Webster Online. and the patient, inclusive of all aspects of oral health care http://www.merriam-webster.com/dictionary/egress/. delivered in a comprehensive, continuously accessible, Electret test device – Equipment used to measure the short- coordinated and family-centered way. term and long-term concentrations of radon in the air. Ref: American Academy of Pediatrics, Section on Pediatric Ref: U.S. Environmental Protection Agency, Indoor Environ- Dentistry. 2003. Policy statement: Oral health risk assessment ments Division. 2009. A citizen’s guide to radon: The guide to timing and establishment of the dental home. Pediatrics protecting yourself and your family from radon. http://www. 111:1113-16. epa.gov/radon/pdfs/citizensguide.pdf. Dental sealants – Clear protective coatings that cover tooth Emergency/Disaster plan – An action plan that lets affected surfaces and prevent bacteria and food particles from settling individuals know what to do in particular disaster situations into the pits and grooves. Dental sealants are usually applied and how to be prepared in advance. See Standard 9.2.4.3 for after a child reaches the age of six when the first permanent specific components. molars come in. Dental sealants last for four to five years Ref: American Red Cross. 2007. Family disaster plan. http:// and can be reapplied when they wear off. www.redcross.org/images/pdfs/code/family_disaster_plan.pdf. Dermatitis – An inflammation of the skin. Emergency medical services (EMS) – A system of care for Ref: Merriam-Webster. 2011. Dermatitis. Medical Dictionary. victims of sudden and serious injury or illness. http:// www.merriam-webster.com/medlineplus/dermatitis/. Ref: Rural Assistance Center. 2008 Emergency medical Developmental screening – The use of standardized tools to services. http://www.raconline.org/info_guides/ems/. identify a child at risk of a developmental delay or disorder. Emergency response plan – Procedures used to call for emer- Ref: American Academy of Pediatrics, Healthy Child Care gency medical assistance, to reach parents/guardians or emer- America. 2009. Developmental screening in early childhood gency contacts, to arrange for transfer to medical assistance, systems: Summary report. http://www.healthychildcare.org/ and to render first aid to the injured person. See also pdf/DSECSreport.pdf. Emergency/Disaster plan.

563 Glossary Emphysema – A lung disease that causes breathing-related Ref: American Academy of Pediatrics, Committee on School problems by destroying the air sacs in the lungs (alveoli). Health. 2008. Policy statement: Out-of-school suspension Ref: Centers for Disease Control and Prevention. 2009. Chronic and expulsion. Pediatrics 122:450. obstructive pulmonary disease. http://www.cdc.gov/copd/. Facilitated play – Appropriate play experiences which are set- Encephalitis – Inflammation (redness and swelling) of the up by, but do not involve interaction from the caregiver/teacher, brain, which can be caused by a number of viruses, including that facilitate development in all domains and promote auton- mumps, measles, and varicella. omy, competency and a sense of joy in discovery and learning. Endotracheal suctioning – The mechanical aspiration and Ref: Liske, V., L. Bell. Play and the impaired child. Playworks. removal of mucous from a person’s airway through a tracheos- http:// www.playworks.net/article-play-and-impaired-child.html. tomy (an artificial opening in the trachea). Facility – The buildings, the grounds, the equipment, and the Enteric – Describes the location of infections affecting the people involved in providing child care of any type. intestines (often with diarrhea) or the liver. Facility for children who are mildly ill – A facility providing Enterovirus – A common virus infection spread by fecal-oral care of one or more children who are mildly ill, children who and respiratory routes. A common enterovirus infection in are temporarily excluded from care in their regular child care young children is “hand-foot-and-mouth disease” in which setting; 1) Integrated or small group care for children who are fever and blister-like eruptions in the mouth and/or a rash mildly ill: A facility that has been approved by the licensing (usually on the palms and soles) may occur. agency to care for well children and to include up to six children Ref: American Academy of Pediatrics (AAP). 2009. Entero- who are mildly ill; 2) Special facility for children who are mildly virus(non-poliovirus) infections. In Red book: 2009 report ill: A facility that cares only for children who are mildly ill, or of the Committee on Infectious Diseases. 28th ed. Elk Grove a facility that cares for more than six children who are mildly Village, IL: AAP. ill at a time. Environmental audit – Evaluation of a location site and build- Failure to Thrive – Failure of a child to develop physically. ings to determine if healthy and safe for humans to occupy. Family child care – The setting where early care and education Assessments include: Potential air, soil, and water contamina- is provided in the home of the caregiver/teacher. tion on facility sites and outdoor play spaces; potential toxic or Small family child care provides care and education for one to hazardous materials in building construction; and potential six children, including the caregiver’s/teacher’s own children. safety hazards in the community surrounding the site. Family members or other helpers may be involved in assisting Epidemic – Affecting or tending to affect an atypically large the caregiver/teacher, but often, there is only one caregiver/ number of individuals within a population, community, or teacher present at any one time. region at the same time. Large family child care provides care and education for seven Ref: Merriam-Webster. 2010. Epidemic. Medline Plus Medical to twelve children, including the caregiver/teacher’s own chil- Dictionary. http://www.merriam-webster.com/medlineplus/ dren. One or more qualified adult assistants are present to epidemic/. meet child:staff ratio requirements. Epidemiology – The scientific study of the occurrence and Fecal coliform – Bacteria in stool that normally inhabit the gas- distribution of diseases. trointestinal tract and are used as indicators of fecal pollution. EpiPen – A registered trade name for an automatic epinephrine They denote the presence of intestinal pathogens in water or food. injector. Epinephrine is administered in response to some Fever – An elevation of body temperature. Temperature allergic reactions. above 101°F (38.3°C) orally, above 102°F (38.9°C) rectally, Ref: Donoghue, E. A., C. A. Kraft, eds. 2010. Managing chronic or 100°F (37.8°C) or higher taken axillary (armpit) or health needs in child care and schools: A quick reference guide. measured by an equivalent method. Elk Grove Village, IL: American Academy of Pediatrics. Fifth disease – A common viral infection with rash occurring EPSDT – Abbreviation for Medicaid’s Early Periodic Screening one to three weeks after infection, also known as Parvovirus B19. and Diagnostic Treatment program, which provides health Ref: Aronson, S. S., T. R. Shope, eds. 2009. Managing infectious assessments and follow up services to income-eligible children. diseases in child care and schools: A quick reference guide. 2nd Ergot – A toxic fungus found as a parasite on grains of rye and ed. Elk Grove Village, IL: American Academy of Pediatrics. other grains. Consumption of food contaminated with ergots First aid – See Pediatric first aid may cause vomiting, diarrhea and may lead to gangrene in Foodborne illness/disease – An illness or disease transmitted serious cases. through food products. Erythromycin – An antibiotic medication used to treat many Foot-candles – The amount of illumination produced by a upper respiratory illnesses. It is often prescribed for people standard candle at a distance of one foot. exposed to pertussis. Formaldehyde – A colorless, flammable gas at room tempera- Evaluation – Impressions and recommendations formed after ture that has a pungent, distinct odor and may cause a burning a careful appraisal and study. sensation to the eyes, nose, and lungs at high concentrations. Exclusion – Denying admission of a child or staff member to a Ref: Agency for Toxic Substances and Disease Registry. 2009. facility (e.g., child or staff who is ill). Public health statement for formaldehyde. http://www.atsdr. Excretion – A process whereby the body rids itself of waste cdc.gov/phs/phs.asp?id=218&tid=39/. material, such as feces and urine. Free play – See Unstructured physical activity. Expulsion – Expulsion is the permanent removal of the child Friable asbestos – See Asbestos from the child care facility.

564 Glossary Functional outcomes – Health status measures that go flap that covers the windpipe), skin, lungs, blood, joints, and beyond traditional physiological assessments. By incorporat- coverings of the brain (meningitis). Hib should not be confused ing a multidimensional definition of health that encompasses with “the flu” which is a disease caused by a virus. Hib infec- physical, psychological and social aspects, functional out- tion is a vaccine preventable disease. come measures can capture the broader impact of disease Ref: Aronson, S. S., T. R. Shope, eds. 2009. Managing infectious and treatment on life from a child’s (or parent’s/guardian’s) diseases in child care and schools: A quick reference guide. 2nd own perspective. Such tools enable children and parents/ ed. Elk Grove Village, IL: American Academy of Pediatrics. guardians to offer input on their quality of life and their HBV – An abbreviation for hepatitis B virus. See also Hepatitis. capacity to function in normal social roles. Head Injury Criterion (HIC) – An empirical measure of impact Fungi (singular fungus) – Plantlike organisms, such as yeasts, severity based on published research describing the relation- molds, mildews, and mushrooms, which get their nutrition ship between the magnitude and duration of impact accelera- from other living organisms or from dead organic matter. tions and the risk of head trauma. Galactosemia – A condition in which the body is unable to Ref: ASTM International (ASTM). 2009. ASTM F1292-09: use (metabolize) the simple sugar galactose. Standard specification for impact attenuation of surfacing Ref: Medline Plus. 2009. Galactosemia. Medical Encyclopedia. materials within the use zone of playground equipment. http://www.nlm.nih.gov/medlineplus/ency/article/000366.htm. West Conshohocken, PA: ASTM. G-MAX – The measure of the maximum acceleration (shock) Health advocate – A staff person in an early care and educa- produced by an impact. tion setting responsible for policies and day-to-day issues Ref: ASTM International (ASTM). 2009. ASTM F1292-09: related to health, development, and safety of individual chil- Standard specification for impact attenuation of surfacing dren, children as a group, staff, and parents/guardians. The materials within the use zone of playground equipment. health advocate does not fill the same role as the child care West Conshohocken, PA: ASTM. health consultant. See also Child care health consultant. Gastric tube feeding – The administration of nourishment Health care professional – Someone who practices medicine through a tube that has been surgically inserted directly into with or without supervision, and who is licensed by an estab- the stomach. lished licensing body The most common types of health care Gastrointestinal (GI) tract – The human digestive tract that professionals include physicians, nurse practitioners, nurses, breaks down and absorbs food. Organs that make up the GI and physician assistants. tract) are the mouth, esophagus, stomach, small intestine, Ref: Donoghue, E. A., C. A. Kraft, eds. 2010. Managing chronic large intestine, rectum, and anus. health needs in child care and schools: A quick reference guide. Ref: National Digestive Diseases Information Clearinghouse. Elk Grove Village, IL: American Academy of Pediatrics. 2008. Your digestive system and how it works. http://digestive. Health consultant – See Child Care Health Consultant niddk.nih.gov/ddiseases/pubs/yrdd/. Health history – A compilation of health information about Gestational – Occurring during or related to pregnancy. an individual. See Standard 9.4.2.5 for list of information to Giardia intestinalis – A parasite that causes giardiasis, an be included in such a history. intestinal infection commonly referred to as “Giardia.” Health plan – See Care Plan Ref: Aronson, S. S., T. R. Shope, eds. 2009. Managing infectious Health supervision – Routine screening tests, immunizations, diseases in child care and schools: A quick reference guide. 2nd and chronic or acute illness monitoring. For children younger ed. Elk Grove Village, IL: American Academy of Pediatrics. than twenty-four months of age, health supervision includes Glomerulonephritis – A type of kidney disease in which the documentation and plotting of charts on standard sex-specific part of the kidneys that helps filter waste and fluids from the length, weight, weight for length, and head circumference and blood is damaged. assessing diet and activity. For children twenty-four months of Ref: Medline Plus. 2009. Glomerulonephritis. Medical age and older, sex-specific height and weight graphs should be Encyclopedia. http://www.nlm.nih.gov/medlineplus/ency/ plotted by the primary care provider in addition to body mass article/000484.htm. index (BMI). Gross motor skills – Large movements involving the arms, Hepatitis – Inflammation of the liver caused by viral infection. legs, feet, or the entire body (such as crawling, running, There are six types of infectious hepatitis: type A; type B; and jumping). nonA, nonB; type C; and type D. Ground-fault circuit-interrupter (GFCI) – A piece of equip- Herpes simplex virus – A viral organism that causes a recur- ment in an electrical line that offers protection against electro- rent disease which is marked by blister-like sores on mucous cution if the line comes into contact with water. membranes (such as the mouth, lips, or genitals) that weep Group A Streptococcus (GAS) – A bacterium commonly found clear fluid and slowly crust over. in the throat and on the skin that can cause a range of infec- Herpetic gingivostomatitis – Inflammation of the mouth and tions, from relatively mild sore throats “strep throat” and skin lips caused by the herpes simplex virus. infections (e.g., “scarlet fever”) to life-threatening disease. Hib – See Haemophilus influenzae type b Group size – The number of children assigned to a caregiver/ HIPPA – Health Insurance Portability and Accountability teacher or team of caregivers/teachers occupying an individual Act – Federal act that provides protections for personal health classroom or well defined space within a larger room. See also information held by covered entities and gives patients an Child:staff ratio. array of rights with respect to that information. Haemophilus influenzae type b (Hib) – A group of bacterial HIV – See Human Immunodeficiency Virus (HIV) infections that can infect ears, eyes, sinuses, epiglottis (i.e., the

565 Glossary HPV (human papillomaviruses) – Viruses that cause a number Infant – A child between the time of birth and the age of of skin and mucous membrane infections; the most common ambulation (usually the ages from birth through twelve infection is the skin wart months). Human Immunodeficiency Virus (HIV) – A virus that affects Infant walkers – Equipment consisting of a wheeled base sup- the body in a variety of ways. In the most severe infections, porting a rigid frame that holds a fabric seat with leg openings the virus progressively destroys the body’s immune system, and usually a plastic feeding/play tray. Also known as baby causing a condition called acquired immune deficiency syn- walkers. drome, or AIDS. Ref: Aronson, S. S., T. R. Shope, eds. 2009. Infectious disease – A disease caused by a microorganism Managing infectious diseases in child care and schools: (bacterium, virus, fungus, or parasite) that can be transmitted A quick reference guide. 2nd ed. Elk Grove Village, IL: from person to person via infected body fluids or respiratory American Academy of Pediatrics. spray, with or without an intermediary agent (such as a louse, Hypercholesterolemia – Having elevated cholesterol levels. mosquito) or environmental object (such as a table surface). High levels of cholesterol increase the risk for cardiovascular Many infectious diseases are reportable to the local health disease and stroke. authority. IEP – See Individualized Education Program Infested – Common usage of this term refers to parasites IFSP – See Individualized Family Service Plan (such as lice or scabies) living on the outside of the body. Immune globulin (Gamma globulin, immunoglobulin) – An Influenza (“flu”) – An acute viral infection of the respiratory antibody preparation made from human plasma. It provides tract. Symptoms usually include fever, chills, headache, muscle temporary protection against diseases such as hepatitis A. aches, dry cough, and sore throat. Influenza should not be Immunity – The body’s ability to fight a particular infection. confused with Haemophilus influenzae infection caused by For example, a child acquires immunity to diseases such as bacteria, or with “stomach flu,” which is usually an infection measles, mumps, rubella, and pertussis after natural infection caused by a different type of virus. or by immunization. Ingestion – The act of taking material (whether food or other Immunizations – Vaccines that are given to children and substances) into the body through the mouth. adults to help them develop protection (antibodies) against Injury, unintentional – Physical damage to a human being specific infections. Vaccines may contain an inactivated or resulting from an unintentional event (one not done by killed agent or a weakened live organism. design) involving a transfer of energy (physical, chemical, or Immunocompromised – The state of not having normal heat energy). body defenses (immune responses) against diseases caused Integrated pest management (IPM) – A common-sense by microorganisms. approach to eliminating the root causes of pest problems, Immunosuppression – Inhibition of the body’s natural providing safe and effective control of insects, weeds, rodents, immune response, used especially to describe the action of and other pests while minimizing risks to human health and drugs that allow the surgical transplantation of a foreign the environment. organ or tissue by inhibiting its biological rejection. Intradermal – Relating to areas between the layers of the skin Impervious – Adjective describing a smooth surface that does (as in intradermal injections). not become wet or retain particles. Isolation – The physical separation of a person who is ill from Impetigo – A common skin infection caused by streptococcal other persons in order to prevent or lessen contact between infection or staphylococcal bacteria. other persons and the body fluids of the person who is ill. Ref: Aronson, S. S., T. R. Shope, eds. 2009. Managing infectious Jaundice – Yellowish discoloration of the whites of the eyes, diseases in child care and schools: A quick reference guide. 2nd skin, and mucous membranes caused by deposition of bile ed. Elk Grove Village, IL: American Academy of Pediatrics. salts in these tissues. Incubation period – Time between exposure to an infectious Kinesiology – The study of the principles of mechanics and microorganism and beginning of symptoms. anatomy in relation to human movement. Individualized Education Program (IEP) – A written docu- Ref: Merriam-Webster. 2010. Kinesiology. Merriam-Webster ment, derived from Part B of IDEA 2004 (Individuals with Online. http://www.merriam-webster.com/dictionary/ Disabilities Education Improvement Act), that is designed kinesiology/. to meet a child’s individual educational program needs. The Laceration – A cut, which can be jagged or smooth and may main purposes for an IEP are to set reasonable learning goals be superficial or deep, large or small. and to state the services that the school district will provide Ref: American Academy of Pediatrics (AAP). 2005. Pediatric for a child with special educational needs. Every child who first aid for caregivers and teachers. Ed. S. S. Aronson. Boston: is qualified for special educational services provided by the Jones and Bartlett; Elk Grove Village, IL: AAP. http://www. school is required to have an IEP. pedfactsonline.com. Individualized Family Service Plan (IFSP) – A written docu- Large family child care home – See Family child care ment, derived from Part C of IDEA 2004 (Individuals with Lead – A highly toxic metal. Common sources of lead expo- Disabilities Education Improvement Act), that is formulated sure are lead-based paint in older homes, contaminated soil, in collaboration with the family to meet the needs of a child household dust, drinking water, lead crystal, and lead-glazed with a developmental disability or delay, to assist the family pottery. in its care for a child’s educational, therapeutic, and health Ref: National Institute of Environmental Health Sciences. needs, and to deal with the family’s needs to the extent to Lead. National Institutes of Health. http://www.niehs.nih.gov/ which the family wishes assistance. health/ topics/agents/lead/.

566 Glossary Lead agency – An individual state’s choice for the agency that Ref: Occupational Safety and Health Administration. Occu- will receive and allocate the federal and state funding for chil- pational safety and health standards: Hazard communication. dren with special educational needs. The federal funding is 29 CFR 1910.1200. http://www.osha.gov/pls/oshaweb/owadisp. allocated to individual states in accordance with the show_document?p_table=STANDARDS&p_id=10099/. Individuals with Disabilities Educational Act (IDEA). Lecithin – Any of several waxy lipids which are widely distrib- Measles (red measles, rubeola, hard measles, 8 to 10 day uted in animals and plants, and have emulsifying, wetting, measles) – A serious viral illness characterized by a red rash, and antioxidant properties. high fever, light-sensitive eyes, cough, and cold symptoms. Lethargy – Unusual sleepiness or low activity level. Medicaid – A program which provides medical assistance for Ref: Donoghue, E. A., C. A. Kraft, eds. 2010. Managing chronic individuals and families with low incomes and resources. The health needs in child care and schools: A quick reference guide. program became law in 1965 as a jointly funded cooperative Elk Grove Village, IL: American Academy of Pediatrics. venture between the Federal and State governments to assist Lice – Parasites that live on the surface of the human body states in the provision of adequate medical care to eligible (in head, body, or pubic hair). needy persons. Light emitting diode (LED) – Small light sources that become Medical home – Primary care that is accessible, continuous, illuminated by the movement of electrons through a semi- comprehensive, family centered, coordinated, compassionate, conductor material. and culturally effective. The child health care professional Ref: U.S. Environmental Protection Agency, U.S. Depart- works in partnership with the family and patient to ensure ment of Energy. LED light bulbs: Energy Star. http://www. that all the medical and non-medical needs of the patient energystar.gov/index.cfm?fuseaction=find_a_product. are met. showProductGroup&pgw_code=ILB/. Ref: Hagan, J. F., J. S. Shaw, P. M. Duncan, eds. 2008. Bright Listeriosis – Diseases caused by the Listeria bacterium. Can futures: Guidelines for health supervision of infants, children cause meningitis, blood infections, heart problems, and and adolescents. 3rd ed. Elk Grove Village, IL: American abscesses, and can cause a pregnant woman to miscarry. Academy of Pediatrics. Longitudinal study – A research study in which patients are Medications – Any substance that is intended to diagnose, followed and examined over a period of time. cure, treat, or prevent disease or is intended to affect the struc- Lyme disease – An infection caused by a type of bacteria ture or function of the body of humans or other animals. known as spirochetes, that is transmitted when particular Meningitis – A swelling or inflammation of the tissue cover- ticks attach to a person’s skin and feed on that person’s blood. ing the spinal cord and brain. Meningitis is usually caused by Ref: Aronson, S. S., T. R. Shope, eds. 2009. Managing infectious a bacterial or viral infection. diseases in child care and schools: A quick reference guide. 2nd Meningococcal disease – Pneumonia, arthritis, meningitis, ed. Elk Grove Village, IL: American Academy of Pediatrics. or blood infection caused by the bacterium Neisseria Lymphadenitis – An acute infection of one or more lymph meningitidis. nodes. Ref: Beers, M. H., R. S. Porter, T. V. Jones, J. L. Kaplan, Mercury – A naturally occurring metal which has several M. Berkwits, eds. 2006. The Merck manual of diagnosis and forms. Exposure to high levels of metallic, inorganic, or therapy. 18th ed. Whitehouse Station, NJ: Merck Research organic mercury can permanently damage the brain, Laboratories. kidneys, and developing fetus. Lymphoma – A general term for a group of cancers that origi- Ref: Agency for Toxic Substances and Disease Registry. 1999. nate in the lymph system. The two primary types of lymphoma Tox- FAQs for mercury. http://www.atsdr.cdc.gov/toxfaqs/ are Hodgkin lymphoma, which spreads in an orderly manner tf.asp?id=113 &tid=24/. from one group of lymph nodes to another; and non-Hodgkin Methemoglobinemia – Also known as blue baby syndrome, is lymphoma, which spreads through the lymphatic system in a blood disorder caused when nitrite interacts with the hemo- a non-orderly manner. Ref: Centers for Disease Control and globin in red blood cells and is characterized by the inability Prevention. 2009. Hematologic (blood) cancers: Lymphoma. of the blood to carry sufficient oxygen to the body’s cells and http://www.cdc.gov/cancer/ hematologic/lymphoma/. tissues. Although methemoglobinemia is rare among adults, Mandatory reporters – Individuals required by their state it may affect infants, when nitrate-contaminated well water laws to report concerns of child abuse and neglect. is used to prepare formula and other infant foods. Ref: Child Welfare Information Gateway. 2010. Mandatory Methicillin-resistant Staphylococcus aureus (MRSA) – A reporters of child abuse and neglect: Summary. http:// potentially dangerous type of staph bacteria that is resistant to www.childwelfare.gov/systemwide/laws_policies/statutes/ certain antibiotics and may cause skin and other infections. manda.pdf. Ref: Centers for Disease Control and Prevention. 2008. Mantoux intradermal skin test – A test to assess the likeli- National MRSA education initiative: Preventing MRSA skin hood of infection with tuberculosis. infections. http://www.cdc.gov/mrsa/. Material safety data sheet (MSDS) – Information regarding Methionine – A sulfur containing essential amino acid that is the proper procedures for handling, storing, and disposing important in many body functions. of chemical substances. Federal law dictates that employers Ref: PubChem Compound. 2004. Methionine – compound must provide information to their employees about hazardous summary. National Center for Biotechnology Information. materials and chemicals that employees may be exposed to in http://pubchem.ncbi.nlm.nih.gov/summary/summary. the workplace. The vehicle for that information is the MSDS. cgi?cid=6137/. MMR – Abbreviation for the vaccine against measles, mumps, and rubella.

567 Glossary Mold – Fungi that are found virtually everywhere, indoors Non-prescription medications – Drugs that are available and outdoors. Mold can cause or worsen certain illnesses without a prescription, also known as over-the-counter (e.g., some allergic and occupation-related diseases and (OTC) medications. infections in health care settings). Non-transient, non-community water supply – A non- Ref: Centers for Disease Control and Prevention. Mold. community water system in a location that serves the same http://www.cdc.gov/mold/. non-resident users daily. Schools, colleges, hospitals, and Molluscum contagiosum – A common skin disease that is factories with their own water supplies are examples. caused by a virus. Molluscum infection causes small white, Ref: Colorado Department of Public Health and Environment, pink, or flesh-colored bumps or growths with a dimple or Water Quality Control Division. 2008. Safe drinking water: pit in the center. A Colorado guide for non-transient non-community public Ref: Centers for Disease Control and Prevention. 2006. water systems that use surface water. http://www.cdphe.state. Molluscum (molluscum contagiosum). http://www.cdc.gov/ co.us/wq/DrinkingWater/ pdf/NTNCSurWtr_Guide.pdf. ncidod/dvrd/molluscum/overview.htm. Norovirus – Virus that causes an illness in humans called Morbidity – The incidence of a disease within a population. gastroenteritis. Noroviruses are very contagious. They usually Ref: Aronson, S. S., T. R. Shope, eds. 2009. Managing infectious are found in contaminated food or drinks, but they also can diseases in child care and schools: A quick reference guide. 2nd live on surfaces or be spread through contact with an infected ed. Elk Grove Village, IL: American Academy of Pediatrics. person. Motor skills – Coordinated muscle movements involved in Ref: National Institute of Allergy and Infectious Diseases. movement, object control, and postural control perceived 2007. Norovirus infection. http://www3.niaid.nih.gov/topics/ as occurring after a stage (or stages) involving birth reflexes, norovirus/. with the idea that fundamental motor skills must be mastered Nutritionist/Registered Dietitian – A professional with cur- before development of more sport-specific skills. rent registration with the Commission on Dietetic Registration Ref: Barnett, L. M., E. van Beurden, P. J. Morgan, L. O. of the American Dietetic Association or eligibility for regis- Brooks, J.R. Beard. 2009. Childhood motor skill proficiency tration with a Bachelor’s and Master’s degree in nutrition; a as a predictor of adolescent physical activity. J Adolescent Master’s degree from an approved program in public health Health 44:252-59. nutrition may be substituted for registration with the Com- MRSA – See Methicillin-resistant Staphylococcus aureus mission on Dietetic Registration. Current state licensure or Mucous membranes – Membranes that line body passages certification as a nutritionist or dietitian is acceptable. See and cavities which communicate directly or indirectly with also Appendix C. the exterior (as the alimentary, respiratory, and genitourinary Obesity – An excess percentage of body weight (Body Mass tracts), that functions in protection, support, nutrient absorp- Index equal or greater than 95%) due to fat that puts people tion, and secretion of mucus, enzymes, and salts. at risk for many health problems. In children older than two Ref: Merriam-Webster. 2009. Mucous membrane. Medline years of age, obesity is assessed by a measure called the Body Plus Medical Dictionary. http://www2.merriam-webster.com/ Mass Index (BMI). cgi-bin/mwmednlm?book=medical&va=mucous+membrane/. Ref: American Academy of Pediatrics. About childhood Mumps – A viral infection with symptoms of fever, headache, obesity. http://www.aap.org/obesity/about.html. and swelling and tenderness of the salivary glands, causing Occupational therapy – Treatment based on the utilization of the cheeks to swell. occupational activities of a typical child (such as play, feeding, Nasogastric tube feeding – The administration of nourish- toileting, and dressing). Child specific exercises are developed ment using a plastic tube that stretches from the nose to the in order to encourage a child with mental or physical disabili- stomach. ties to contribute to their own recovery and development. Necrotizing enterocolitis – A condition when the lining of Organisms – Living things. Often used as a general term for the intestinal wall dies and the tissue falls off. This disorder germs (such as bacteria, viruses, fungi, or parasites) that can usually develops in an infant that is already ill or premature, cause disease. and most often develops while the infant is still in the hospital. Otitis media – Inflammation or infection of the middle part of Ref: Medline Plus. 2009. Necrotizing enterocolitis. Medical the ear. Ear infections are commonly caused by Streptococcus Encyclopedia. http://www.nlm.nih.gov/medlineplus/ency/ pneumoniae or Haemophilus influenzae. article/ 001148.htm. Outbreak – A sudden rise in the incidence of a disease. Neisseria meningitidis (meningococcus) – A bacterium Ref: Merriam-Webster. 2010. Outbreak. Medline Plus Medical that can cause meningitis, blood infections, pneumonia, Dictionary. http://www.merriam-webster.com/medlineplus/ and arthritis. outbreak/. NOAA Weather Radio All Hazards (NWR) – A nationwide Outdoor learning environment – The physical outdoor space network of radio stations broadcasting continuous weather used during the planned program of daily activities. It encom- information directly from the nearest National Weather passes the objects (natural and manufactured) within the Service office. NWR broadcasts official Weather Service space, the specific play and learning settings, and the interac- warnings, watches, forecasts and other hazard information tions that occur between the caregivers/teachers and children. twenty-four hours a day, seven days a week. Over-the-counter medication (OTC) – Medicine that can be Ref: National Weather Service. 2008. NOAA weather bought without a prescription. radio now numbers 1000 transmitters! http://www.nws.noaa. Ref: Food and Drug Administration. 2010. Over-the-counter gov/nwr/. medicines. Medline Plus. http://www.nlm.nih.gov/ medlineplus/overthe countermedicines.html.

568 Glossary Overweight – Children and adolescents with a Body Mass Ref: National Report on Human Exposure to Environmental Index (BMI) equal to or over the 85th percentile for age but Chemicals. 2011. Fact sheet: Phthalates. Centers for Disease less than the 95th percentile for age are considered overweight. Control and Prevention. http://www.cdc.gov/exposurereport/ Ref: American Academy of Pediatrics. About childhood Phthalates_Fact Sheet.html. obesity. http://www.aap.org/obesity/about.html. Physical activity – Any bodily movement produced by the Oxygen saturation – A relative measure of the amount of contraction of skeletal muscle that increases energy expen- oxygen that is dissolved or carried in a given medium. diture above a basal level. Physical activity generally refers Paradichlorobenzene – A white crystalline compound to the subset of activity that enhances health. C6H4Cl2 made by chlorinating benzene and used chiefly Ref: National Center for Chronic Disease Prevention and as a moth repellent and deodorizer (also called PDB). Health Promotion. 2011. Physical activity for everyone: Ref: Merriam-Webster. 2011. Paradichlorobenzene. Medical Glossary of terms. Centers for Disease Control and Pre- Dictionary. http://www.merriam-webster.com/medical/ vention. http://www.cdc.gov/physicalactivity/everyone/ paradichloro benzene/. glossary/index.html. Parasite – An organism that lives on or in another living Age-appropriate physical activity – Physical movement that organism (such as ticks, lice, mites, etc.) is suitable for a specific age. Parent/Guardian – The child’s natural or adoptive mother Moderate physical activity – Levels that are at intensities or father, guardian, or other legally responsible person. faster than a slow walk, but still allow children to talk easily. Pasteurized – The partial sterilization of a food substance and It increases your heart rate and breathing rate. You may sweat, especially a liquid (as milk) at a temperature and for a period but you are still able to carry on a conversation; you can talk, of exposure that destroys objectionable organisms without but you probably can’t sing. major chemical alteration of the substance. Ref: Nemours Health and Prevention Services. 2009. Best Ref: Merriam-Webster. 2010. Pasteurization. Merriam- practices for physical activity: A guide to help children grow Webster Online. http://www.merriam-webster.com/ up healthy – For organizations serving children and youth. dictionary/pasteurization. Newark, DE: Nemours Health and Prevention Services. Pediatric first aid – The immediate care given to a suddenly http://www. nemours.org/filebox/service/preventive/ ill or injured child until a medical professional or a parent nhps/paguidelines.pdf. or legal guardian assumes responsibility for the medical Structured physical activity – Caregiver/teacher-led, develop- condition from becoming worse and does not take the mentally appropriate, and fun physical movement. Structured place of proper medical treatment. activity should include: a) Daily planned physical activity that Ref: American Academy of Pediatrics (AAP). 2005. Pediatric supports age-appropriate motor skill development (the activity first aid for caregivers and teachers. Ed. S. S. Aronson. Boston: should be engaging and involve all children with minimal or Jones and Bartlett; Elk Grove Village, IL: AAP. http://www. no waiting); and b) Daily, fun physical activity that is vigorous pedfactsonline.com. (gets children “breathless” or breathing deeper and faster than Pentachlorophenol – A manufactured chemical which is during typical activities) for short bouts of time. a restricted use pesticide and is used industrially as a wood Ref: Nemours Health and Prevention Services. 2009. Best preservative for utility poles, railroad ties, and wharf pilings. practices for physical activity: A guide to help children grow Exposure to high levels of pentachlorophenol can have up healthy – For organizations serving children and youth. negative effects on the body. Newark, DE: Nemours Health and Prevention Services. Ref: Agency for Toxic Substances and Disease Registry. 2001. http://www. nemours.org/filebox/service/preventive/ ToxFAQs for pentachlorophenol. http://www.atsdr.cdc.gov/ nhps/paguidelines.pdf. toxfaqs/tf.asp?id=401&tid=70/. Unstructured physical activity – Physical movement that is Perishable foods – Foods (such as fruit, vegetables, meat, child-led free play. Unstructured activity should include: a) milk and dairy, and eggs) that are liable to spoil or decay. Activities that respect and encourage children’s individual Ref: Merriam-Webster. 2010. Perishable. Merriam-Webster abilities and interests; and b) Caregiver/teacher engagement Online. http://www.merriam-webster.com/dictionary/ with children, support for extending play, and gentle prompts perishable/. and encouragement by caregivers/teachers, when appropriate, Pertussis – A highly contagious bacterial respiratory infection, to stay physically active. which begins with cold-like symptoms and cough and becomes Ref: Nemours Health and Prevention Services. 2009. Best progressively more severe, so that the person may experience practices for physical activity: A guide to help children grow vomiting, sweating, and exhaustion with the cough, also up healthy – For organizations serving children and youth. known as whooping cough. Newark, DE: Nemours Health and Prevention Services. Pesticides – A chemical used to kill pests, particularly insects. http://www.nemours.org/filebox/service/preventive/nhps/ Phenylketonuria (PKU) – A genetic disorder in which the body paguidelines.pdf. can’t process part of a protein called phenylalanine (Phe). Vigorous-intensity physical activity – Rhythmic, repetitive Ref: National Institute of Child Health and Human Develop- physical movement that uses large muscle groups, causing a ment. 2009. Phenylketonuria. Medline Plus. http://www.nlm. child to breathe rapidly and only enabling them to speak in nih.gov/medlineplus/phenylketonuria.html. short phrases. Typically children’s heart rates are substantially Phthalates – A group of chemicals used to make plastics more increased and they are likely to be sweating. flexible and harder to break, also known as plasticizers. They Ref: Nemours Health and Prevention Services. 2009. Best are used in products, such as vinyl, adhesives, detergents, oils, practices for physical activity: A guide to help children grow plastics, and personal-care products. up healthy – For organizations serving children and youth.

569 Glossary Newark, DE: Nemours Health and Prevention Services. Prescription medications – Medications that can only be http://www.nemours.org/filebox/service/preventive/nhps/ prescribed by a licensed practitioner (such as a physician paguidelines.pdf. or nurse practitioner). Physical therapy – The use of physical agents and methods Primary care provider – A person who by education, training, (such as massage, therapeutic exercises, hydrotherapy, electro- certification, or licensure is qualified to and is engaged in pro- therapy) to assist a child with physical or mental disabilities to viding health care. A primary care provider coordinates the optimize their individual physical development or to restore care of a child with the child’s specialist and therapists. their normal body function after illness or injury. Ref: Donoghue, E. A., C. A. Kraft, eds. 2010. Managing chronic Pica – A pattern of eating non-food materials (e.g., dirt or health needs in child care and schools: A quick reference guide. paper). Ref: Medline Plus. 2008. Pica. Medical Encyclopedia. Elk Grove Village, IL: American Academy of Pediatrics. http://www.nlm.nih.gov/medlineplus/ency/article/001538.htm. Professional development – A continuum of learning and Picaridin – An EPA registered synthetic ingredient formulated support opportunities designed to prepare individuals for for use in insect repellents. work with and on behalf of young children and their families, Ref: Centers for Disease Control and Prevention. 2010. Insect as well as opportunities that provide ongoing experiences to repellent use and safety. http://www.cdc.gov/ncidod/dvbid/ enhance this work. These opportunities lead to improvements westnile/qa/insect_repellent.htm. in the knowledge, skills, practices, and dispositions of early Picocuries – A measure of concentration of radiation per liter childhood professionals. Professional development programs of air. encompass both education and training programs: Education Plagiocephaly – Refers to a head that is abnormally shaped programs help learners to “…have a deep foundation of fac- from a variety of causes. tual knowledge, understand facts and ideas in the context of a Ref: Eunice Kennedy Shriver National Institute of Child conceptual framework, and organize knowledge in ways that Health and Human Development. 2007. Positional plagio- facilitate retrieval and application.” Education programs are cephaly. National Institutes of Health. http://www.nichd.nih. broad based: They include learning experiences specific to a gov/health/topics/positional_plagiocephaly.cfm. primary area of inquiry (e.g., child development, early child- Pneumonia – An acute or chronic disease marked by inflam- hood education, or related fields including elementary educa- mation of the lungs and caused by viruses, bacteria, or other tion and early childhood special education), as well as subjects microorganisms and sometimes by physical and chemical of general knowledge (e.g., mathematics, history, grammar). irritants. Education programs typically lead to an associate’s, baccalau- Poison Center – Service that provides poison expertise treat- reate, or graduate degree or other credit-based certification. ment advice by phone. All poison centers can be reached by These programs provide the foundations for a lifetime of pro- calling the same telephone number: 1-800-222-1222. Poison fessional practice, expanded upon through experience and centers are staffed by pharmacists, physicians, nurses, and ongoing professional development. Education programs also poison information providers who are toxicology specialists. may include continuing education programs that lead to the Ref: American Association of Poison Control Centers. award of continuing education units (CEUs), but not college About AAPCC. http://www.aapcc.org/dnn/About/tabid/ credits. Training programs are specific to an area of inquiry 74/Default.aspx. and set of skills related to an area of inquiry (e.g., a workshop Polybrominated diphenyl ether (PBDE) – Flame-retardant series on positive discipline for preschoolers). Completion of chemicals that are added to plastics and foam products to training participation can lead to assessment for award of the make them difficult to burn. Child Development Associate (CDA) Credential or another Ref: Agency for Toxic Substances and Disease Registry. 2004. type of credential, CEUs, clock hours, or certification. Tox- FAQs for Polybrominated diphenyl ethers (PBDEs). http:// Ref: National Research Council. 1999. How people learn: www.atsdr.cdc.gov/toxfaqs/tf.asp?id=900&tid=183/. Bridging research and practice, 12. Eds. M. S. Donovan, J. D. Polymer panels – A glass-like panel that is made of polymers Bransford, J. W. Pellegrino. Washington, DC: National and which serves to protect or add design elements to a living/ Academy Press. play area. Projectile – A fired, thrown, or otherwise propelled object. Pooling – A practice in larger child care settings where chil- Prone – Lying face-down. dren of various ages are brought together as they arrive at the Ref: Merriam-Webster. 2009. Prone. Medline Plus Medical beginning of the day or depart at the end of the day to consoli- Dictionary. http://www.merriam-webster.com/dictionary/ date the number of staff needed to meet child:staff ratios. prone/. Postural drainage – Body positioning resulting in the gradual Prosthetic devices – An artificial body replacement adapted flow of mucous secretions from the edges of both lungs into the to reproduce the form and, as much as possible, the function airway so secretions can be removed from the lungs by of the missing part. coughing. Protective barrier – Type of containment or deflector system Potable – Suitable for drinking. that surrounds and obstructs primarily vehicle passage into a Prenatal – Existing or occurring before birth (as in prenatal play area, such as bollards and posts. Barriers must pass impact medical care). tests for the highest speed limit allowed and posted on the Preschooler – A child from achievement of self-care routines street, road or parking lot adjacent to the outdoor play area. (such as toilet learning/training) and the age of entry into a Ref: ASTM International (ASTM). 2009. F2049-09b: Standard regular school; usually three to five years of age (thirty-six safety performance specification for fences/barriers for public, to fifty-nine months of age). commercial, and multi-family residential use outdoor play areas. West Conshohocken, PA: ASTM.

570 Glossary Pseudomonas aeruginosa – A type of organism that is Rifampin – An antibiotic often prescribed for those exposed commonly a contaminant of skin sores but that occasionally to an infection caused by Haemophilus influenzae type b (Hib) causes infection in other parts of the body and is usually or Neisseria meningitidis (meningococcus), or given to treat hospital-acquired. an infection caused by tuberculosis. Psychosocial – Involving aspects of social and psychological Ringworm – A fungal infection that may affect the body, behavior (as in a child’s psychosocial development). feet or scalp. Purulent – Containing pus, a thick white or yellow fluid. Ref: Aronson, S. S., T. R. Shope, eds. 2009. Managing infectious Purulent conjunctivitis – Also known as “Pink eye,” a white diseases in child care and schools: A quick reference guide. 2nd or yellow eye discharge, often with matted eyelids after sleep, ed. Elk Grove Village, IL: American Academy of Pediatrics. and including eye pain or redness of the eyelids or skin sur- Roseola – A viral infection causing rash in infants and rounding the eye. This type of conjunctivitis is more often children that primarily occurs between six and twenty-four caused by a bacterial infection, which may require antibiotic months of age. treatment. Ref: Aronson, S. S., T. R. Shope, eds. 2009. Managing infectious PVC (polyvinyl chloride) – Chemical, made up of many chains diseases in child care and schools: A quick reference guide. 2nd of vinyl chloride, used to make a variety of plastic products ed. Elk Grove Village, IL: American Academy of Pediatrics. including pipes, wire and cable coatings, and packaging mate- Rotavirus – A virus that causes diarrhea and vomiting. rials. PVC is made up. Vinyl chloride is a known carcinogen. Ref: Aronson, S. S., T. R. Shope, eds. 2009. Managing infectious Ref: Agency for Toxic Substances and Disease Registry. 2006. diseases in child care and schools: A quick reference guide. 2nd Public health statement for vinyl chloride. http://www.atsdr. ed. Elk Grove Village, IL: American Academy of Pediatrics. cdc.gov/phs/phs.asp?id=280&tid=51/. Rubella – A mild viral illness usually lasting three days, with Quality rating and improvement system (QRIS) – A systemic symptoms of red rash, low-grade fever, swollen glands, and approach to assess, improve, and communicate the level of sometimes achy joints also known as German measles, three- quality in early and school-age care and education programs. day measles, or light measles. Similar to rating systems for restaurants and hotels, QRIS Safety vacuum release system (SVRS) – A system or device award quality ratings to early and school-age care and educa- capable of providing vacuum release at a suction outlet (as in tion programs that meet a set of defined program standards. a swimming pool) caused by a high vacuum occurrence due Ref: National Child Care Information and Technical Assis- to a suction outlet blockage. SVRS devices must allow for the tance Center. About QRIS. http://nccic.acf.hhs.gov/ vacuum release with or without the suction outlet cover(s) qrisresourceguide/index.cfm?do=qrisabout#1/. in place, and shall operate in such a way as to not defeat or Radon – A radioactive gaseous element formed by the disinte- disengage other layers of protection installed to protect gration of radium that occurs naturally in the soil. Radon is against suction entrapment. considered to be a health hazard that may lead to lung cancer. Ref: North Carolina Department of Environment and Natural Reflux – An abnormal backward flow of stomach contents Resources. 2005. Top 20 frequently asked questions about into the esophagus. SVRS and anti-entrapment drain covers. http://www.deh.enr. Registration – Permission from a state that is required to oper- state.nc.us/ehs/ quality/svrs_faq05.doc. ate a child care facility. Some states use this term to describe Salmonella – A type of bacteria that causes food poisoning their regulatory process instead of the word licensing. (salmonellosis) with symptoms of vomiting, diarrhea, and Ref: National Child Care Information and Technical Assistance abdominal pain. Center, National Association for Regulatory Administration. Salmonella paratyphi – The bacterium responsible for 2010. The 2008 child care licensing study. http://naralicensing. paratyphoid fever. This Salmonella serotype has three forms: org/display common cfm?an=1&subarticlenbr=205. A, B, and C. Rescue breathing – The process of breathing air into the lungs Ref: Centers for Disease Control and Prevention. 2008. of a person who has stopped breathing. This process is also National typhoid and paratyphoid fever surveillance. http:// called artificial respiration. www.cdc.gov/nationalsurveillance/typhoid_surveillance.html. Respiratory syncytial virus (RSV) – A virus that causes colds, Salmonella typhi – The bacterium responsible for causing the bronchitis, and pneumonia. life-threatening illness typhoid fever. Respiratory tract – The nose, ears, sinuses, throat, and lungs. Salmonellosis – A diarrheal infection caused by Salmonella Return demonstration – An individual demonstrating what bacteria. (procedure, technique, etc.) they just learned. Sanitize – See Appendix J: Selecting an Appropriate Sanitizer Rheumatic fever – A severe infectious disease often occurring or Disinfectant. after a strep infection. Rheumatic fever is characterized by Scabies – An infestation of the skin by small insects called fever and painful inflammation of the joints and may result mites. Ref: Aronson, S. S., T. R. Shope, eds. 2009. Managing in permanent damage to the valves of the heart. infectious diseases in child care and schools: A quick reference Rhinorrhea – Excessive mucous secretion from the nose. guide. 2nd ed. Elk Grove Village, IL: American Academy Ref: Merriam-Webster. 2009. Rhinorrhea. Medline Plus of Pediatrics. Medical Dictionary. http://www2.merriam-webster.com/ Scarlet fever – A fine red rash that makes the skin feel like cgi-bin/mwmednlm?book=Medical&va=rhinorrhea. sandpaper caused by a streptococcal infection. Rhinovirus – A virus that causes the common cold. Ref: Aronson, S. S., T. R. Shope, eds. 2009. Managing infectious diseases in child care and schools: A quick reference guide. 2nd ed. Elk Grove Village, IL: American Academy of Pediatrics.

571 Glossary School-age child – For the purposes of early care and educa- Shelter-in-place – The process of staying where one is located tion settings, a child at the entry into regular school, including and taking shelter, rather than trying to evacuate. kindergarten through sixth grade. Ref: National Association of Child Care Resource and Referral School-age child care facility – A facility offering activities to Agencies, Save the Children. 2010. Protecting children in care school-age children before and after school, during vacations, during emergencies. http://www.naccrra.org/publications/ and non-school days set aside for such activities as caregivers’/ naccrra-publications/publications/8960503_Disaster Report- teachers’ in-service programs. SAVE_ MECH.pdf. Screen time – Time spent watching TV, videotapes, or DVDs; Shiga toxin-producing E. coli (STEC) – Bacterial intestinal playing video or computer games; and surfing the internet. tract infection that causes diarrhea. Ref: Guide to Community Preventive Services. 2010. Obesity Shigella – A type of bacterium that causes bacillary dysentery prevention: Behavioral interventions to reduce screen time. or shigellosis, a diarrheal infection. http://www.thecommunityguide.org/obesity/behavioral.html. Shigellosis – A diarrheal infection caused by the Shigella Screening – Examination of a population group or individual bacterium. to detect the existence of a particular disease (such as diabetes SIDS – See Sudden Infant Death Syndrome (SIDS) or tuberculosis). See also Developmental screening. Small family child care home – See Family child care Secondary infection – When a person is infected by an Special facility for children who are ill – See Facility for organism that had originated from the illness of another children who are mildly ill person. The first person infected has the primary infection, SSRI (selective serotonin reuptake inhibitors) – A type of and any persons infected from the originally infected person medication used to treat depression, anxiety disorders, is said to have contracted a secondary infection. and some personality disorders. Secretion – Wet material, such as saliva, that is produced by Ref: National Institute of Mental Health. 2010. What medica- a cell or a gland and that has a specific purpose in the body. tions are used to treat anxiety disorders? http://www.nimh. Sedentary activity – Non-moving activity like reading, nih.gov/health/publications/mental-health-medications/ playing a board game, or drawing. what-medications-are-used-to-treat-anxiety-disorders.shtml. Ref: Nemours Health and Prevention Services. 2010. Best Stackable cribs – Cribs that are built in a manner that there practices for physical activity: A guide to help children grow are two or three cribs above each other that do not touch the up healthy – For organizations serving children and youth. ground floor. Newark, DE: Nemours Health and Prevention Services. Staff – All personnel employed at the facility, including hhttp://www.nemours.org/content/dam/nemours/www/ directors, caregivers/teachers, and personnel who do not filebox/service/preventive/nhps/paguide2010. pdf. provide direct care to the children (such as cooks, drivers, Seizure – A sudden attack or convulsion due to involuntary, and housekeeping personnel). uncontrolled burst of electrical activity in the brain that can Standard precautions – Use of barriers to handle potential result in a wide variety of clinical manifestations, including exposure to blood, including blood-containing body fluids muscle twitches, staring, tongue biting, loss of consciousness, and tissue discharges, and to handle other potentially infec- and total body shaking. tious fluids and the process to clean and disinfect contami- Sensory table – A piece of equipment consisting of a liner nated surfaces. set inside of a frame; water and sand are popular fillers, but Standing orders – Orders written in advance by a health care almost anything can be used. provider that describe the procedure to be followed in defined Ref: Hunter, D. 2008. What happens when a child plays at circumstances. the sensory table? Young Children 63(6): 77-79. Staphylococcus – A common bacterium found on the skin Sepsis – An infection that involves the presence of pathogenic that may cause skin infections or boils. organisms or their toxins in the blood or body tissues. Streptococcal pharyngitis (strep throat) – A disease caused Serotype – A group of intimately related microorganisms by a Streptococcus bacterium. distinguished by a common set of antigens. For example, Ref: Aronson, S. S., T. R. Shope, eds. 2009. Managing infectious Salmonella has many serotypes including typhimurium diseases in child care and schools: A quick reference guide. 2nd and enteritidis. ed. Elk Grove Village, IL: American Academy of Pediatrics. Ref: Merriam-Webster. 2009. Serotype. Medline Plus Medical Streptococcus – A common bacterium that can cause sore Dictionary. http://www2.merriam-webster.com/cgi-bin/ throat, upper respiratory illnesses, pneumonia, skin rashes, mwmednlm?book=Medical&va=serotype/. skin infections, arthritis, heart disease (rheumatic fever), and Serum – The clear liquid that separates in the clotting kidney disease (glomerulonephritis). of blood. Structured physical activity – See Physical activity Sexual orientation – An emotional or affectional attraction Substitute staff – Caregivers/teachers hired for a temporary to another person. This includes heterosexuality (attraction to time frame (one day or for an extended period of time), who the opposite sex), homosexuality (attraction to the same sex), work under direct supervision of a trained, permanent and bisexuality (attraction to either sex). caregiver/teacher. Ref: American Psychological Association. Sexual orientation Suction – The removal of respiratory secretions or mucous and homosexuality. http://www.apa.org/helpcenter/ of a child to aid in breathing. sexual-orientation.aspx.

572 Glossary Sudden Infant Death Syndrome (SIDS) – The sudden death of Tricolosan – A chemical with antibacterial properties; an infant under one year of age, which remains unexplained used in consumer products such as detergents, soaps, skin after a thorough case investigation, including performance cleansers, deodorants, lotions, creams, toothpastes, and of a complete autopsy, examination of the death scene, and dishwashing liquids. review of the clinical history. Ref: Centers for Disease Control and Prevention. 2009. Ref: American Academy of Pediatrics, Task Force on Sudden Triclosan. http://www.cdc.gov/exposurereport/pdf/ Infant Death Syndrome. 2009. The changing concept of sudden Triclosan_FactSheet.pdf. infant death syndrome: Diagnostic coding shifts, controversies Tricyclic antidepressants – Any of a group of antidepressant regarding the sleeping environment, and new variables to drugs (as imipramine, amitriptyline, desipramine, and consider in reducing risk. Pediatrics 123:188. nortriptyline). Supine – Lying on the back or with the face upward. Ref: Merriam-Webster. 2009. Tricyclic antidepressant. Medline Ref: Merriam-Webster. 2009. Supine. Medline Plus Medical Plus Medical Dictionary. http://www.merriam-webster.com/ Dictionary. http://www2.merriam-webster.com/cgi-bin/ dictionary/tricyclic antidepressants/. mwmednlm?book=Medical&va=supine/. Tuberculosis (TB) – A disease caused by an infection with the Swaddling – The act of wrapping an infant tightly in a blanket. bacteria Mycobacterium tuberculosis that usually involves Ref: Healthy Children. 2009. Responding to your baby’s cries. the lungs but could affect other parts of the body. American Academy of Pediatrics. http://www.healthychildren. Tummy time – The time an infant spends on his stomach org/ English/ages-stages/baby/crying-colic/Pages/Responding- (tummy) throughout the day. Tummy time is only for when to-Your-Babys-Cries.aspx. the infant is awake, alert and being watched. Systemic – Pertaining to a whole body rather than to one Ref: Healthy Children. 2010. Back to sleep, tummy to of its parts. play. American Academy of Pediatrics. http://www. TB – See Tuberculosis healthychildren.org/English/ ages-stages/baby/sleep/ Tdap – Abbreviation for the immunization against tetanus, pages/Back-to-Sleep-Tummy-to-Play.aspx. diphtheria, and pertussis. Ulcerative colitis – A disease that causes inflammation and Thermal injury – Bodily injury due to burns. sores, called ulcers, in the lining of the rectum and colon. Thrush – A yeast infection predominately produced by the Ref: National Institute of Diabetes and Digestive and Kidney Candida albicans organisms causing mouth infections in Diseases. 2006. Ulcerative colitis. http://digestive.niddk.nih. young infants. gov/ddiseases/pubs/colitis/. Ref: Aronson, S. S., T. R. Shope, eds. 2009. Managing infectious Under-immunized – A person who has not received the diseases in child care and schools: A quick reference guide. 2nd recommended number or types of vaccines for his/her age ed. Elk Grove Village, IL: American Academy of Pediatrics. according to the current national and local immunization Toddler – A child between ambulation to accomplishment of schedules. self-care routines such as use of the toilet, usually thirteen Unitary surface material – A cushioned surface material through thirty-five months of age. (such as rubber mats or a combination of rubberlike materials Touch supervision – Within an arm’s reach or able to touch held in place by a binder) for placement under and around the child at all times. This concept has derived from the playground equipment that forms an uninterupted shock supervision of children during water play. absorbing surface. Ref: American Academy of Pediatrics. 2004. Policy statement: Universal precautions – See Standard precautions Swimming programs for infants and toddlers. Pediatrics Vacuum breaker – A device put on a pipe containing liquid 114:1126. (such as drinking water) to prevent the liquid from being Toxoplasmosis – A parasitic disease usually causing no sucked backward within the pipe. symptoms. When symptoms do occur, swollen glands, fatigue, Varicella-zoster – An illness with rash and fever caused by the malaise, muscle pain, fluctuating low fever, rash, headache, varicella-zoster virus, also known as chickenpox. and sore throat are reported most commonly. Toxoplasmosis Ref: Aronson, S. S., T. R. Shope, eds. 2009. Managing infectious can infect and damage an unborn child while producing mild diseases in child care and schools: A quick reference guide. 2nd or no symptoms in the mother. ed. Elk Grove Village, IL: American Academy of Pediatrics. Transmission – The passing of an infectious organism or Vector-borne diseases – A disease in which the pathogenic germ from person to person. microorganism is transmitted from an infected individual to Tremolite – A mineral that can occur in fibrous form another individual by an arthropod (e.g., insect) or other agent, (an asbestos). Ref: Agency for Toxic Substances and sometimes with other animals serving as intermediary hosts. Disease Registry. 2001. Toxicological profile for asbestos. Ref: Center for International Earth Science Information http://www.atsdr.cdc.gov/toxprofiles/ tp61-c10.pdf. Network. CIESIN thematic guides: Changes in the incidence Tributyltin oxide – A volatile organic compound, used as a of vector-borne diseases attributable to climate change. wood preservative. Columbia University. http:// www.ciesin.columbia.edu/ Ref: American Chemical Society. 2008. Tributyltin oxide. TG/HH/veclev2.html. http://portal.acs.org/portal/acs/corg/content?_nfpb=true&_ Vegan – Individual who does not eat meat, poultry, fish, eggs, pageLabel=PP_ARTICLEMAIN&node_id=841&content_ or dairy products; the individual only eats plant foods. id=WPCP_008064&use_sec=true&sec_url_var=region1& Ref: Healthy Children. 2010. Vegetarian diets for children. uuid=0e0ad 17e-1ead-4697-9c59-0d591d56bdd4/. American Academy of Pediatrics. http://www.healthychildren. org/English/ ages-stages/gradeschool/nutrition/pages/ Vegetartian-Diet-for-Children.aspx.

573 Glossary Vegetarian – An individual who does not eat meat, poultry, or Volatile organic compound (VOC) – Emitted gases from fish. Variations of vegetarians include: Lacto-ovo-vegetarians certain solids or liquids. VOCs include a variety of chemicals. who consume eggs, dairy products, and plant foods and Many types of household products contain VOCs, including lacto-vegetarians who eat dairy products and plant foods paints, paint strippers, adhesives, cleaners, pesticides, building but not eggs. materials, and office equipment. Ref: Healthy Children. 2010. Vegetarian diets for children. Ref: The National Women’s Health Information Center. American Academy of Pediatrics. http://www.healthychildren. 2009. The environment and women’s health: Frequently org/English/ages-stages/gradeschool/nutrition/pages/ asked questions. http://womenshealth.gov/faq/ Vegetartian-Diet-for-Children.aspx. environment-womens-health.cfm#hh. Ventilation – Method of controlling the environment with air Volunteer – An individual who is not paid and gives their flow. Ref: Occupational Safety and Health Administration. time to work at an early care and education program. Ventilation. U.S. Department of Labor. http://www.osha.gov/ See Standard 1.3.2.3 for qualifications. SLTC/ventilation/ index.html. Water play activities – Activities that involve the use of water Venlafaxine – A medication in a class of medications called such as swimming, wading, sprinklers, and water play tables. selective serotonin and norepinephrine reuptake inhibitors Ref: Milnes, S. Web-based learning units. Wonderful water. (SNRIs). Better Kid Care, Penn State University. http://betterkidcare. Ref: Medline Plus. 2009. Venlafaxine. Drugs and Supplements. psu.edu/angelunits/onehour/waterplay/waterlesson.html. http://www.nlm.nih.gov/medlineplus/druginfo/meds/ West Nile virus (WNV) – An infectious disease due to a virus a694020.html. spread by infected mosquitos. Viandas – Root vegetables common in some diets. Ref: Aronson, S. S., T. R. Shope, eds. 2009. Managing infectious Ref: Block, G., P. Wakimoto, C. Jensen, S. Mandel, R. R. diseases in child care and schools: A quick reference guide. 2nd Green. 2006. Validation of a food frequency questionnaire ed. Elk Grove Village, IL: American Academy of Pediatrics. for Hispanics. Preventing Chronic Disease 3(3): 1-10. http:// www.cdc.gov/pcd/ issues/2006/jul/pdf/05_0219.pdf. Vigorous-intensity physical activity – See Physical Activity Virus – A microscopic organism, smaller than a bacterium, that may cause disease. Viruses can grow or reproduce only in living cells.



575 Index A Allergies. See also Asthma exposure to animals, 128–129 Abbreviations, 553–555 food, 169, 170–172 Abdominal pain. See Pain peanut or tree nut, 171 Abrasions. See Cuts Abuse. See Child abuse and neglect Allergy and Anaphylaxis Emergency Plan (AAP), 169 Abusive head trauma. See Shaken baby syndrome/abusive head trauma Americans with Disabilities Act (ADA) Accessibility as it relates to ADA children with chronic health conditions and, 386 to exits, 221 for children with special health care needs and disabilities, 359, 366 to facilities, 212 goal of, 9 Accessibility to facility records, 410 licensing agency role in communicating importance of compliance with, 435 Accreditation of program, 410, 415, 426 on outdoor play areas, 283 Acronyms, 553–555 on play equipment and surfaces, 288 Activities. See also Developmental activities; Physical activities reasonable accommodations for persons with disabilities, 43 expressive, for preschoolers, 65 staff recruitment and, 9 participation of older children and staff in mealtime, 192 Americans with Disabilities Act Accessibility Guidelines for Buildings and school-age, 67 to support learning of infants and toddlers, 61–62 Facilities (ADAAG), 212, 220, 288 that are incompatible with eating, 190 Anaphylaxis, 168–172 ADA. See Americans with Disabilities Act (ADA) Animals (pets), 128–131 Adaptive equipment for children with special health care needs, 516–517 storage of, 260 allergies to, 128–129 Administration, 371–426 care for, 130–131 governance, 372 caregiver instruction on contact with, 128 human resource management, 405–407 exposure of immunocompromised children to, 128–129 policies, 372–404 humane care for, 130 records, 407–426 medical care for, 130 written delegation of authority in, 372 pregnant women’s exposure to cat feces, 129, 131 Admission agreement, contents of, between child care program and parents/ prohibited, 129–130 that have contact with children and adults, 128–129 guardians, 419–420 Annual staff competency evaluation, 47 Adults Antibiotics, use of, 332 judicious use, 353 animals that might have contact with, 128–129 Anti-scald aerators, 230 number of children fed simultaneously by one, 191 Areas used by children for wheeled vehicles, 223 supervision by, of children who are learning to feed themselves, 191–192 Arsenic, health effects related to, 288 Advocacy, 22, 84 Art and craft materials Advocates, qualifications and responsibilities for health, 17–19 proper use of, 247 AED. See Automated External Defibrillators (AED) ventilation when using, 226 Age, minimum, to enter child care, 7–9 Asbestos, preventing exposure to, 246–247 Age-appropriate solid foods Aspiration hazards, 304 feeding to infants, 184 Assistant teachers, qualifications for, 13–14 introduction to infants, 183–184 Asthma. See also Allergies Age requirements air pollution and, 100 assistant teachers and, 13 dust and dust mites and, 100 directors and, 11 tobacco smoke and residue and, 127 drivers and, 308 Attendance records lead teachers and, 13 children, 308, 309, 401–402, 407, 412, 467 teacher aides and, 13 maintenance of, for staff who care for children, 425 volunteers and, 13 Audits, reports of annual, monthly maintenance checks of play areas and Age-specific guidance for meals and snacks, 165 AIDS. See Human immunodeficiency virus (HIV) infection equipment, 404 Air, fresh, 224–225 Authorized persons to pick up child, 400–401 Airborne transmission of infections, 317 Autism, vaccines and, 319 Air filters, maintenance of, 227–228 Automated External Defibrillators (AED), child care facilities and, 26 Air pollution from idling vehicles, 309 B protection from, 100–101 respiratory effects on children, 212 Babies. See Infants sources of, 212 Baby wipes, 114 Air quality index (AQI), 100 Background screening, 9–10, 434, 441 defined, 100–101 levels of, 100–101 maintenance of record, 424 Alcohol process for substitutes, 34 beverages of, in family child care homes, 127 Back injuries, facilities arrangements to minimize, 257 child care facilities, use in, 127 Balloons, 305 policies prohibiting, 391–392 Ball pits, 295 Alcohol-based hand sanitizers, 118, 119 Balusters, 221, 223 Allergen triggering materials, removal of, from outdoor areas, 277 Barriers/guards for heating equipment and units, 229 Basements condition of, 217, 278 exits, 219 use of, 213–214

576 Breastfeeding. See also Human milk benefits of, 161 Index caregivers’/teachers’ encouragement of, 161 duration of, 8 Bathrooms. See also Bathtubs; Showers; Toilets encouragement and support of, 103, 549 floors, walls, and ceilings in, 256–257 importance of, to infant, 174 monitoring of, 69 preparing, feeding, and storing human milk, 176–177 supplies for, 276 reasons for choosing not to, 161 ventilation of, 227 Breast milk. See Human milk Bathtubs Building codes, 211, 213, 220–222, 226, 228, 235, 246, 262, 286 ratio and location of, 267 Buildings, inspection of, 211 safety of, 267–268 Bunk beds, 272 Burns Bedding cleaning individual, 126–127 from contact with space heaters, 228 concerning safety, 102 from hot liquids and foods, 192 laundering of, 268, 343 response to, 132 as personal item, 273 prohibiting sharing of, 147, 268–269, 272 C storage of, 273 CACFP. See Child and Adult Care Food Program (CACFP) Beds Caffeine intake, 166, 168 arrangement of, 269 Candles, inaccessibility to, 274 bunk, 272 Carbon monoxide, 228 cleaning of, 126–127, 268 Carbon monoxide detectors, 245–246 futons, 272 Cardiopulmonary resuscitation (CPR) safety of, 268–269 for toddlers, 268 child:staff ratio and skills, 4, 5 types, 268–272 for swimming, 27–28 training for staff, 26 Behavior for water play, 27–28 around swimming pool, 73 Caregivers/teachers. See also Staff modeling of healthy and safe, 86–87 ability of, with HIV infection to care for children, 348–349 prohibited, for caregivers/teachers, 78–79 access to in-service training, 77 self-stimulatory, 66 administration of medication, 13 sharing of information on, 84–85 alcohol use, 127 during transportation, 312 annual staff competency evaluation, 47 assessment and planning of nutrition by, 163–164 Below grade areas, use of, 213–214 assistant teachers, teacher aides, and volunteers, 13–14 Bike helmets, 547–548 avoiding thirdhand smoke exposure, 127, 391 Bike routes, 222, 307 awareness of television and computer exposure, 101 Bisphenol A (BPA), 176, 182, 189, 248 background screening and, 9–10 Biting, handling, 75–76 behavior around swimming pool, 73 Blood on bottle feeding, 181 care for children with food allergies, 170–172 exposure to, in diapers or pull-ups, 123–124 carrying out nutrition plan, 162 exposure to, in eyes or nose, 123 child abuse and neglect education, 32 exposure to, in human milk, 177 child car seat policy and, 401 exposure to, in oral hygiene, 109 child:staff ratio, group size, and minimum age, 3–9 exposure to, in skin openings, 123 communication between parents/guardians and, 170, 183 preventing exposure to, 123–125 concern about plagiocephaly, 104 Bloodborne infections, 344–349 consultants, 36–42 hepatitis B virus and, 344–346 continuing education, 33–34 hepatitis C virus and, 346–347 HIV and, 347–349 in centers and large family child care homes, 28 staff education on prevention of, 345–346 for small family child care home, 30–31 transmission of, 317 contribution of, to development of measurable objective for children with BMI. See Body mass index (BMI) special health care needs and disabilities, 363–364 Body awareness, 88 CPR, performance of, 13 Body fluids cuts and scrapes of, 122–123 cleaning up, 493 daily health check, 95 exposure to, 123–125 differentiated roles of, 12 prevention of exposure to, 123–125 digital media use, 70–71 training on occupational risk related to handling body fluids, 33 discipline measures, 73–75 Body mass index (BMI), information on, in routine health supervision, 96 drug use, 86, 127 Body mastery for three- to five-year-olds, 66 e-cigarette use, 86, 127 “Books Build Connections Toolkit” (AAP), 71 educational leave/compensation, 33–34 Bottle feeding emergency protocols of, 131–132, 247 cleaning and sanitizing equipment used for, 182 encouragement cow’s milk in, 180 of breastfeeding, 161 nipples not to use, 182 of physical activity by, 101 preparing, feeding, and storing infant formula, 178–179 of self-feeding by older infants and toddlers, 186 preparing bottles for, 179 enrollment information to, 373–376 soy-based formula and soy milk in, 179–180 establishing support services for parents/guardians, 83–84 techniques for, 181 warming bottles and infant foods, 182 Bottle propping, 181, 389, 560 Bottles, temperature in serving, 182 Brain development, 15, 88

exclusion of children and, 143–144 577 familiarity with facility policies, plans, and procedures, 47 family child care home qualifications, 19–21 Index feeding infants on cue by consistent, 175–176 first aid and CPR training, 26 safety education for, 88–89 food consumption take-home sheets, use of, 170 screen time, 70–71 gender and body awareness and, 88 sharing of pacifiers, 106 handling sleep positions and, 104 socialization during meals and, 190–191 complaints about, 48 staff improvement plan, 47–48 of intoxicated parents/guardians, 400, 401 stress for, 45–46 physical aggression, biting, and hitting, 75–76 substitutes, 34–36 head count of children during transportation, 6 supervision near body of water, 71–72 health education for, 88–89 support of, 448–449 health of, 42–46 HIV infection in ability to care for children, 348–349 for breastfeeding mothers, 161 human resource management and, 46–48 time-outs and, 74 immunity for reporting child abuse and neglect, 133 tobacco use, 86, 127 immunization of, 319–320 toilet learning/training, 63 recommended schedule, 476–481 training of, 448–449 inclusion/exclusion dismissal of children, 141 for influenza, 323 to administer medications, 154–155 information on poison control, 244 monitoring for hand hygiene, 120 informing of group A streptococcal (GAS) infections, 321 on preventing shaken baby syndrome/abusive head trauma, 133–134 instruction on contact with animals, 128 in safe sleep practices, 102–103 interactions with infants and toddlers, 60–61 transitioning within programs and indoor and outdoor learning/play introduction environments, 57–58 of age-appropriate solid foods to infants and, 183–184 on use of soy-based formula and soy milk, 179–180 of new foods, 170 verbal interaction, 59 lead teachers, 13 written reports on Individualized Family Service Plans (IFSPs), 365 licensing agency provision of written agreements for, 436 Care plan for children with special health care needs, 139–140, 500–505 mixed director/teacher role, 12 Carpeted areas, ventilation of recently installed, 226–227 modeling of healthy and safe behavior and health and safety education Carpets, cleaning and maintenance, 123–124, 232, 254–255 activities, 86–87 Carriage requirements, 258 monitoring children’s development/obtaining consent for screening, Car safety. See Child passenger safety 54–55 Car seat, limiting infant/toddler time in, 69–70 mutual responsibility of parents/guardians and, 80–81 Cat feces, pregnant women’s exposure to. See Animals (pets) need for health insurance, 405 Ceilings, 256–257 need for help with sound abatement, 232 height of, 216–217 nicotine withdrawal and, 46 Celiac disease, dietary modifications, 169 nonuse of tobacco and drug use, 127–128 Cell phone use, 70–71 nutrition Centers. See Child care centers as basic responsibility of, 161 Certificate, record of valid, 415 learning experiences for children and, 194–197 Certified Playground Safety Inspector, 283, 285, 287–288, 290, 293, 297, 404 provision of meals and snacks, 163 Changing tables observation of staff, 48 maintenance of, 267 occupational hazards and, 44–45, 458 requirements for, 266–267 oral health education and, 110–111 Charcoal grills, 228 oral hygiene activities and, 108–109 Chemical air fresheners, 227 orientation, 23–24 Chemical air sanitizers, 227 passenger load and, 314 Chemicals personal relationships in controlling odors, 249–250 for infants and toddlers, 59–60 in lawn care treatments, 243, 294 for three- to five-year-olds, 64 in pools, 302 “playful” behavior, 78 storage of, 88, 300 preparation of formula by, 179 in toys, 304 pre-service qualifications of, 12–21 ventilation of, 226–227, 242, 300 procedure for changing children’s soiled underwear/pull-ups and in water supply, 236 clothing, 115–117 Chemical toilets, 262 professional development/training, 21–33 Chickenpox. See Varicella-zoster (chickenpox) virus prohibited behaviors, 78–79 Child abuse and neglect protection of children, 372 background screening, 434 provision of information on ill children, 151–152 immunity for reporters of, 133 qualifications, 12–17 licensing agency provision of prevention materials, 435 for facilities that care for children who are ill, 149–150 licensing agency role in communicating importance of reporting for preschool-age children, 16 suspected, 434 for school-age children, 16–17 protective factors regarding, 498–499 recruitment and background screening, 9–10 recognizing and reporting suspected, 132–133, 494–497 replacement of toothbrushes, 109 registry for, 441 restriction from food preparation and handling, 200–201 risk factors, 32 signs and symptoms, 494–497 specialized training in, 32 training of licensing agency personnel about, 440

578 Index Child and Adult Care Food Program (CACFP) Child records, 418–424 age-specific guidance for meals and snacks, 165 attendance. See Attendance records meal and snack patterns, 166–167, 174 contents of, 418–424 nutrition learning experiences for children and, 195 admission agreement between child care program and parents/ nutrition training and, 29 guardians, 419–420 for school-age children, 186–187 child’s primary care provider’s assessment, 420–421 for toddlers and preschoolers, 184–185 facility health log for each child, 423 use of, 164 medication, 422–423 enrollment, 467 Child care health history, 422 agency collaboration to safeguard children in, 443 pre-admission enrollment information for each child, 418–419 child deaths in, 6 release of, 424 coordination of public and private resources to ensure families’ access symptoms, 467 to quality, 450 defined, 51 Children. See also Children who are ill; Infants; Preschool-age children; evening and nighttime, 390 School-age children; Toddlers foster care children transition to, 510–511 importance of immunization in, 318 access to kitchen, 198 inclusion for children with special health care needs and disabilities, 359–360 adult supervision of, who are learning to feed themselves, 191–192 minimum age for, 7–9 agency collaboration to safeguard, in child care, 443 protecting HIV-infected children and adults in, 347–348 animals that might have contact with, 128–129 sources of technical assistance to support quality of, 435–439 area used by, for wheeled vehicles, 223 use of fact sheets on common illnesses associated with, 447–448 assisting with hand hygiene, 120 authorized persons to pick up, 400–401 Child care areas behavior during transportation, 312 separating office space from, 214 caring for, who require medical procedures, 140–141 separation of operations from, 215 collection of data on illness or harm to, in facilities, 444 unrelated business in, 214 communication between school and, 67 content and development of plan for care of, who are ill, 380–381 Child care businesses, adherence to federal law, 9 contents of facility health log for each, 423 Child care centers. See also Family child care homes contents of primary care provider’s assessment, 420–421 documentation of exemptions and exclusion of, who lack immunizations, 383 adopting use of Standard Precautions, 123–125 health and safety education topics for, 85–86 Automated External Defibrillators (AED) and, 26 health history of, 422 contents of admission agreement between parents/guardians and, 419–420 influenza immunizations for, 323 credentialing of individual, 433–434 maintenance of attendance records for staff who care for, 425 defined, 211, 440 methods of supervision of, 68–69 development of organizations and networks, 449 monitoring development, 54–55 digital media use, 70–71 number of, fed simultaneously by one adult, 191 dishwashing in, 205 nutrition learning experiences of, 194–197 frequency of inspections for, 442 outdoor play for, 99–100 hand hygiene in, 118–121 parents’/guardians’ provision of information on health and behavior of, 84–85 handwashing sinks for diaper changing area in, 265 participation of older, in mealtime activities, 192 locations of, 211 pre-admission enrollment information for each, 418–419 need for immunization documentation, 317–318 procedure for changing soiled underwear/pull-ups and clothing, 115–117 preventing expulsions, suspensions, and other limitations in, 76–78 procedure for parent/guardian notification about exposure of, to infectious screen time, 70–71 diseases, 155–156 staff education for, 33 protection from air pollution, 100 transportation policy for, 403 ratios of toilets, urinals, and hand sinks to, 262–263 waste receptacles in, and in child care facility toilet rooms, 263 recognition of health problems in, 28–29 written daily activity plan and statement of principles, 51–52 release of record of, 424 written human resource management policies for, 405–406 separation of infants and toddlers from older, 62 Child Care Development Block Grants, 38, 434 space required per, 215–216 Child care food service manager, employment of, 162 unimmunized, 318–319 Child care health consultants, 36–39, 95 vulnerability of, to exposure of contaminated environmental media availability of, to facilitate, 436 materials, 212 in developing model policies, 373 Children who are ill. See also Facilities that care for children who are ill documentation of health consultation, 416–417 caring for, 147–152 for facilities that care for children who are ill, 150–151 collaborative development of child care requirements and guidelines for, 432 frequency of visits, 39–40 public-private collaboration on care of, 432–433 review of health policies, 392 space requirements for, 148, 272 staff training in conducting health check, 95 Children with special health care needs and disabilities, 357–367 staff training on growth assessment, 96 adaptive equipment for, 260, 516–517 Child care licensing advisory board, 431 Americans with Disabilities Act (1990) (ADA) for, 359, 366 Child deaths. See Death assessment of facilities, 366–367 Child development. See Developmental activities care plan for, 139–140, 500–505 Child exploitation, recognizing and reporting suspected, 132–133 child:staff ratio for, 3–4, 6 Child health assessment, 535 compensation for participation in multidisciplinary assessments for, 438–439 Child maltreatment. See Child abuse and neglect coordination and documentation, 365 Child passenger safety, 309–312 written reports on IFSPs/IEPs to caregivers/teachers, 365

579 Index developing service plan for, 361–365 routine schedule for, 125–126, 491–492 contracts and reimbursement, 364–365 schedule for exterior areas, 278 designation and role of staff person responsible for coordinating care of toys, 126 in child care facility, 362–363 Cleaning agents, inaccessibility of, 215 determination of eligibility for special services, 362 Clearance requirements of playground areas, 291–292 development of measurable objectives, 363–364 Climbing equipment, prohibited surfaces for placing, 292–293 formulation of action plan, 361 Closet door latches, 221 Closing facility, 34 dietary modifications for, 169 Clothing Emergency Information Form for, 527–528 appropriate for weather, 379 evacuation of, 219–220 for physical activity, 379 feeding plans and dietary modifications, 168–170 protective against sun exposure, 99 guiding principles for, 357 soiled, 112, 240, 266 inclusion of, in child care setting, 359–360 storage, 273 Individualized Education Program (IEP) for, 361–363, 364, 365 Coat hooks/cubicles, 273 Individualized Family Service Plan (IFSP) for, 358, 361–363, 365 Cold injury, preventing, 99 Individuals with Disabilities Education Act for, 357–359, 362, 364, 365, 367 Cold weather, outdoor play in, 99 need for diapering, 117 Collaborative development of child care requirements and guidelines for orthotic and prosthetic devices for, 260–261 periodic reevaluation, 365–366 children who are ill, 432 process prior to enrolling at facility, 360–361 Communicable diseases. See Infectious diseases qualifications of caregivers/teachers, 13 Communication resources for parents/guardians of, 438 Section 504 of the Rehabilitation Act (1973) for, 358, 359, 366, 367 between caregivers/teachers and parents/guardians, 183 special adaptive equipment for, 260 between child care and school, 67 specialized consultation for facilities serving, 42 disaster planning, training, and, 394–397 staff orientation for, 24–25 documentation of drop-off, pick-up, daily attendance of child, and standards for providers caring for, 367 parent/provider, 401–402 therapeutic and recreational equipment for, 260 licensing agency role in, importance of compliance with Americans toilet learning/training for, 62–63 with Disabilities Act, 435 Child restraint, age- and size-appropriate vehicle, 310 opportunities for, of health and safety education for parents/guardians, 90 Child:staff ratios parent/guardian conferences, 82–83 for children with special health care needs, 4 from specialists, 85 CPR skills and, 4, 5 successful feeding and, 170 developmentally appropriate, 68 verbal interaction in, 59 for facilities of written policies, 373 Community outreach for school-age children, 67 serving children with special health care needs and disabilities, 6 Community participation in development of licensing rules, 431 that care for children who are ill, 150 Community resource information, 417 first aid and, 4 Compensation for participation in multidisciplinary assessments for children for infants, 3–7, 13, 71, 131 for large family child care homes and centers, 4–6 with special health care or education needs, 438–439 for nap time, 3, 4 Complaints pediatric first aid and, 5 for small family child care homes, 3–4 handling, about caregivers/teachers, 48 supervision parent/guardian procedures, 84 for swimming and, 6–7, 71 procedure for receiving, 443–444 during transportation and, 6 Computer time. See Screen time for wading and, 6–7, 71 Conferences, parent/guardian, 82–83 for water play and, 6–7, 71 Confidentiality, written policy for facility records, 409–410 for toddlers, 3–7 Congenital toxoplasmosis, 131 Chlorine Conjunctivitis, 336–337 in pools, 302 Construction, during hours of operation, 252–253 washing dishes and, 206 Consultants Choking child care health, 36–40. See also Child care health consultants adult supervision of feeding and, 191 early childhood education, 41–42 foods that are hazards for, 192–193 early childhood mental health, 40–41 ChooseMyPlate.gov, 507–508 nutrition consultants, qualifications of, 459 Chromated copper arsenate (CCA) support for, to provide technical assistance to facilities, 436–437 testing wood fences and playground structures for, 286–288 Consumer Product Safety Improvement Act (CPSIA), 248 treatment of pressure-treated wood, 250–251 Continuing education Classroom Assessment Scoring System (CLASS), 42 for center staff, 28–30 Clean Air Act, checking of, 100–101 for directors in centers and large family child care homes, 28–30 Cleaning for licensing staff, 439 body fluids, cleaning up, 493 payment for, 34 of crib surfaces, 127 preventing infectious diseases and, 449 of humidifiers, 279 promotion of, 448 of individual bedding, 126–127 records of, 408, 425–426 nutrition and food service cleaning schedule, 515 for small family child care home caregivers/teachers, 30–31 of objects intended for mouth, 126 staff qualifications and, 13, 22, 47, 89 of pacifiers, 106 time off for, 33–34, 405–407 Contract services, requirements for compliance of, 412 Contracts for children with special health care needs and disabilities, 364–365 Cooling, 224–230

580 Index Cooperation, fostering, in three- to five-year-olds, 65 Diaper changing areas, 265 Coordinated child care health program model, 53–54 handwashing sinks for Copper, testing for levels of, in drinking water, 236–237 in centers, 265 Corporal punishment, prohibition of, 78–79 in homes, 265 Cough and sneeze use, location, and setup of, 266 etiquette, 122, 332 Diaper changing tables, 265 medications, 385 maintenance of, 266–267 Court records in background screening, 10, 434 requirements for, 266–267 Cow’s milk, feeding, 180 CPR. See Cardiopulmonary resuscitation (CPR) Diaper containers, labeling, cleaning, and disposal of, 241 Crawl spaces, size and anchoring of, 289 Diaper cream, 111, 113, 266, 385 Cribs, 270–271 Diaper dermatitis cleaning surfaces, 127 limiting infant/toddler time in, 69–70 diapering practices and, 111 sleep position in, 102 frequency and severity of, 112 stackable, 271 Diapers Crib toys, 304–305 checking for need to change, 112–113 Criminal history checks, 434. See also Background screening cloth, 111, 112 Criminal record files, 441 containment of soiled, 240 Cross-connections, 238 disposable, 111 Cross-contamination among children, 191 handling cloth, 111, 112 Cue feeding, 175–176 procedure for changing, 113–115 Cultural beliefs, dietary modifications based on, 169 types of, 111–112 Cups Diarrhea. See also Enteric (diarrheal) infections single service, 275–276 maintenance of records on incidents of, 336 sippy, 167, 181, 390 readmission of children in cases of, 143, 333 transition from bottle to, 176, 181 staff exclusion for diarrheal illness, 145, 332 Curriculum, diversity in, 58–59 temporary exclusion of children for, 142–143, 332–333 Cuts, body fluids and, 122–123 Dietary Guidelines for Americans, 162, 165 Cutting boards, 205 Dietary modifications, 168–170 Cytomegalovirus (CMV), 317, 349–350 Digital media use, 70–71 staff education and policies on, 349–350 Directors continuing education for, in centers and large family child care homes, 28 D general qualifications of, 11–12 mixed teacher role, 12 Daily attendance of child, documentation of, and parent/guardian qualifications of, of facilities that care for children who are ill, 148–149 communication, 401–402 Disability and Business Technical Assistance Centers (DBTAC), 43 Disasters Daily health checks planning, training, and communications, 394–397 conduct of, 95, 141, 398, 444 supply of food and water for, 204 documentation of, 95 Discipline measures, 73–75 Discipline policies, written, 377 Daily roster, use of, during evacuation drills, 400 Dishes, washing by hand, 206 Data, collection of, on illness or harm to children in facilities, 444 Dishwashing in small and large family child care homes, 205–206 Death. See also Sudden infant death syndrome (SIDS) Disinfecting appropriate disinfectants, selection of, 125–126 child, in child care, 6 routine schedule, 125–126, 491–492 documentation of parent/guardian notification of, 413–414 Dismissal of children, inclusion/exclusion, in management of illness, 141–146 plan for responding to, of child, 157–158 Disposable towels, used for cleaning, 276 Deck surfaces, 299 Diversity DEET, 137 in enrollment and curriculum, 58–59 Deficiencies, written plan/record to resolve, 415 technical assistance to facilities to address in community, 439 Definitions, 559–573 Documentation of daily health check, 95 Dehumidifiers, maintenance of, 230 Dog-assisted therapy programs, 129 Dental care emergencies, authorization, 550 Doors Dental health consultant, availability of, to facilitate, 437 ability to open toilet room, 261 Dermatitis, diaper, 111, 112 directional swing of indoor, 218–219 Developmental activities, 51–52 finger-pinch injuries in, 218 communication in native language other than English, 58 latches for closets, 221 coordinated child care health program model, 53–54 Drainage of paved surfaces, 223 diversity in enrollment and curriculum, 58–59 Drinking fountains, 239 health, nutrition, physical activity, and safety awareness, 52–53 Drivers, qualifications for, 308–309 helping families cope with separation, 56–57 Driving records in background screening, 10 monitoring children’s development/obtaining consent for screening, 54–55 Driving under the influence (DUI), 309 transitioning within programs and indoor and outdoor learning/play Drop-in facility, defined, 440 environments, 57–58 Droplet route, transmission of infection via, 317 verbal interaction, 59 Drop-off, 309–310 written daily activity plan and statement of principles, 51 documentation of, and parent/guardian communication, 401–402 Developmentally appropriate seating and utensils for meals, 188–189 points for, 222 Diabetes, dietary modifications and, 169 Diaper changing, gloves for, 116–117

581 Index Drownings Emergency/security policies, 393–402 circumstances surrounding, 7 on actions to be followed when no authorized person arrives to pick up defined, 27 child, 401 prevention of, 7, 28, 31, 71–72, 223, 267–268, 286, 294, 297, 298, 300, 302 authorized persons to pick up child, 400–401 use of CPR with, 27–28 daily roster during evacuation drills, 400 disaster planning, training, and communication, 394–397 Drug tests in background screening, 10 documentation of drop-off, pick-up, daily attendance of child, and Drug use parent/provider communication, 401–402 emergency and evacuation drills/exercises, 399–400 child care facilities, illegal drug use in, 127 review of written plan for urgent care, 394 policies, staff compliance with, 86 for seasonal and pandemic influenza, 397–399 Dry bulk foods, storage of, 204 sign-in/sign-out system, 400 DVD time. See Screen time written plan and training for handling urgent medical care or threatening incidents, 393–394 E Enclosures Early care and education programs on breastfeeding, 161 for outdoor play areas, 286–287 Early childhood education consultants, 41–42 requirements of, 258 availability of, to facilitate, 436–437 “Energy” beverages, 166 Early childhood mental health consultant (ECMHC), 40–41 English, communication in native language other than, 58 Enrollment availability of, to facilitate, 436, 437 Early childhood programs diversity in, 58–59 exchange of information upon, 376 licensing of, 536–543 information to parents/guardians and caregivers/teachers, 373–376 public regulation of, 536–543 record, 467 Early Head Start programs, 378 Enteric (diarrheal) infections. See also Diarrhea Eastern equine encephalitis, 242–243 control of, 332–334 Eating disease surveillance of, 335–336 activities that are incompatible with, 190 hepatitis A virus and, 332–335 hand hygiene before, 118 staff education and policies on, 334–335 staff modeling of healthy, 86–87 Enteroviruses, 337–338 utensils for, 189 Entrapment hazards of play equipment, 290–291 E-cigarettes Environmental audit of site location, 212–213 child care facilities, use in, 127 Environmental quality of outdoor and indoor, 224–253 policies, staff compliance with, 86 Epidemiological studies, 212 E coli, 143 Epinephrine, peanut and/or tree nut allergy and need for, 171 Education. See also Continuing education Equal Employment Opportunity Act (EEOA), staff recruitment and, 9 nutrition Equipment adaptive equipment for children with special health care needs, 516–517 for children, 194–196 cleaning and sanitizing, when used in bottle feeding, 182 for parents/guardians, 194–197 exercise, 259 for staff, 88 general, 253–260 oral health, 110–111 inspection and maintenance of heating and ventilation, 226 for parents/guardians, 196–197 installation of play, 289 Education for All Handicapped Children Act, 357 placement of, 255–256 Electrical cords, 192, 234, 256, 269 recreational, 260 Electrical devices, location of, near water, 234 selection of, for three- to five-year-olds, 64–65 Electrical fixtures, outlets maintenance and, 278 special adaptive, 260 Electrical outlets, safety covers and shock protection devices for, 233 storage for adaptive, 260 Electrical service, 233 surfaces of, 254–255 electrical cords, 234 therapeutic, 260 extension cords, 234 toilet learning/training, 263 ground fault circuit interrupters (GFCIs) for outlets near water, 233–234 Erythema infectiosum, attendance of children with, 326 location of electrical devices near water, 234 Etiquette, cough and sneeze, 122 safety covers and shock protection devices for, 233 Evacuation drills Electric fans, 227 record of, 416 Electric outlets, ground fault circuit interrupters (GFCIs) for, near water, 233–234 use of daily roster during, 400 Elevated play areas, 285 Evening child care, plans for, 390 Eligibility, determination of, for children with special health care needs and Exchange of information at transitions, 379 disabilities, 362 upon enrollment, 376 Emergency and evacuation drills/exercises policy, 399–400 Exclusion for illness Emergency exits, 219–220 of children, 141–144 conditions that do not require exclusion, 141–142 labeled, 221 criteria for exclusion, 142, 453–457 Emergency Information Form for Children With Special Needs, 527–528 in facilities for children who are ill, 152 Emergency lighting, 232 Signs and Symptoms Chart, 453–457 Emergency medical services (EMS) Exercise equipment, 259 authorization form, 550 call for, in anaphylaxis, 171 route to, 313 situations requiring, 506 Emergency procedures, 131–132 health protection in child care and, 131

582 floors, 256–257 high chair requirements, 257–258 Index orthotic and prosthetic devices, 260–261 placement of equipment and furnishings, 255–256 Exits product recall monitoring, 254 access to, 221 restrictive infant equipment requirements, 258–259 emergency, 219–220 safety of equipment, materials, and furnishings, 253–254 possibility of, from windows, 217–218 size of furniture, 254 special adaptive, 260 Expressive activities for preschoolers, 65 storage for adaptive, 260 Expulsions, preventing, 76–78 surfaces of equipment, furniture, toys, and play materials, 254–255 Extension cords, 234 therapeutic and recreational, 260 Exterior areas, cleaning schedule for, 278 walls, 256–257 Exterior surfaces, maintenance of, 277 governing body of, 371–372 inclusion and exclusion of children from, that serve children who are ill, 152 F inspection of, 211, 442–443 insurance coverage for, 407 Face-to-name count of children, transportation of children and, 6 integrated pest management, 241–242 Facilities insect breeding hazard, 242–243 laundry area accessibility of, 212 location of equipment and water temperature for laundering, 268 areas for school-age children, 217 service and equipment, 268 arrangements to minimize back injuries, 257 layout to reduce risk of child abuse and neglect, 135 assessment for children with special health care needs and disabilities, licensing, 440–444 366–367 alternative means of compliance, 442 basements and below grade areas, 213–214 procedure prior to issuing a license, 442 bathtubs and showers quality rating and improvement systems, 441 that care for children who are ill, 151 ratio and location of, 267 uniform categories and definitions, 440–441 safety of, 267–268 lighting buildings of wood frame construction, 214 emergency, 232 collection of data on illness or harm to children in, 444 fixtures including halogen lamps, 231 compliance with fire prevention code, 211 high intensity discharge lamps, 231–232 designating role of person responsible for coordinating care in child care, levels of illumination, 231 362–363 mercury lamps, 231–232 development of list of providers of services to, 438 multi-vapor lamps, 231–232 diaper changing areas, 265 maintenance handwashing sinks for cleaning of humidifiers, 279 cleaning schedule for exterior areas, 278 in centers, 265 electrical fixtures and outlets, 278 in homes, 265 of exterior surfaces, 277 maintenance of tables, 266–267 inaccessibility of hazardous equipment, 277 requirements for tables, 266–267 plumbing and gas, 278–279 use, location, and setup of, 266 removal of allergen triggering materials from outdoor areas, 277 electrical service, 233 removal of hazards from outdoor areas, 277 electrical cords, 234 storage area ventilation and, 278 extension cords, 234 structure, 278 ground fault circuit interrupters (GFCIs) for outlets near water, 233–234 monitoring of, 442–443 location of electrical devices near water, 234 multiple use of rooms, 215 safety covers and shock protection devices for, 233 noise, levels of, 232 exits notification of, about infectious disease or other problems by parents, 156 access to, 221 office space, 214 alternate, and emergency shelter, 219 on-site sewage systems, 239 closet door latches, 221 containment of garbage, 240 evacuation of children with special health care needs and children with containment of soiled diapers, 240 disabilities, 219–220 labeling, cleaning, and disposal of waste and diaper containers, 241 labeled emergency, 221 removal of garbage, 239 locks, 220 storage and disposal of infectious and toxic wastes, 241 path of egress, 220 openings exterior areas directional swing of indoor doors, 218–219 areas used by children for wheeled vehicles, 223 finger-pinch protection devices, 218 construction and maintenance of walkways, 223 possibility of exit from windows, 217–218 designated walkways, bike routes, and drop-off and pick-up points, 222 safety guards for glass windows/doors, 218 drainage of paved surfaces, 223 screens for ventilation, 218 guardrails and protective barriers, 223–224 weather-tightness and water-tightness, 217 location of satellite dishes, 224 walking surfaces, 223 fire warning systems, 234–235 portable fire extinguishers, 235 floor space beneath low ceiling heights, 216–217 general furnishings and equipment, 253–260 arrangements to minimize back injuries, 257 availability and use of telephone or wireless communication device, 259–260 carriage, stroller, gate, enclosure, and play yard requirements, 258 ceilings, 256–257 exercise, 259

583 Index plan for responding to death of child, 157–158 technical assistance to, to address diversity in community, 439 carbon monoxide detectors, 245–246 toilet and handwashing areas chemicals used to control odors, 249–250 construction and remodeling during hours of operation, 252–253 ability to open toilet room doors, 261 exposure to asbestos or other friable materials, 246–247 chemical toilets, 262 informing staff regarding presence of toxic substances, 244–245 cleaning and disinfection, 263 plastic containers and toys, 248–249 general requirements for, 261 prevention and management of toxic substances, 243–244 handwashing sinks, 264 prohibition of poisonous plants, 249 learning/training equipment, 263 proper use of art and craft materials, 247 location of toilets and privacy issues, 261 radon concentrations, 245 mop sinks, 264–265 shoes in infant play areas, 252 preventing entry to toilet rooms by infants and toddlers, 261–262 testing for lead, 251–252 prohibited uses of handwashing sinks, 264 treatment of chromated copper arsenate (CCA) pressure-treated ratios of toilets, urinals, and hand sinks to children, 262–263 wood, 250–251 waste receptacles in child care facility and in child care facility toilet use and storage of toxic substances, 243 rooms, 263 use of play dough and other manipulative art of sensory materials, toothbrushes and toothpaste in, 109–110 247–248 unrelated business in child care area, 214 use of poison center, 244 unscheduled access to rest areas, 107–108 water supply and plumbing, 235–239 process prior to enrolling at, for children with special health care needs cross-connections, 238 and disabilities, 360–361 drinking fountains, 239 program requirements for, that care for children who are ill, 149 emergency safe drinking water and bottled water, 237 in promoting active opportunities for physical activity, 97–98 handwashing sink using portable water supply, 238 provision of training to, by health agencies, 448–449 installation of pipes and plumbing fixtures, 238 quality of outdoor and indoor environment, 224–253 testing for lead and copper levels in drinking water, 236–237 testing of drinking water not from public system, 236 ventilation, heating, cooling, and hot water, 224–230 water handling and treatment equipment, 238 record of valid license, certificate, or registration of, 415 water supply, 235–236 records of water test results, 237 window size, 217 access to, 410 Facilities serving children with disabilities, specialized consultation for, 42 availability of records to licensing agency, 410 Facilities that care for children who are ill maintenance of, 407–408 child care health consultants for, 150–151 proper installation and maintenance of equipment of, 404 child:staff ratios for, 150 written policy on confidentiality of, 409–410 Facility health log, contents of, for each child, 423 requirements for, to report to health department, 447 Facility records/reports, 407–417 safe sleep policy at, 106–107 Fact sheets, use of, on common illnesses associated with child care, 447–448 safe sleep practices for, 102–105 Families scheduled rest periods and sleep arrangements, 106–107 coordination of public and private resources to ensure, access to quality separation of operations from child care areas, 215 child care, 450 sleep and rest areas helping cope with separation, 56–57 bunk beds, 272 information sharing on health of, 384–385 cribs, 270–271 meal service, benefits of meal service style, 190–191 equipment and supplies, 268–270 Family and Medical Leave Act (FMLA), parental leave and, 8 futons, 272 Family child care homes stackable cribs, 271 alcoholic beverages in, 127–128 space for children who are ill, injured, or need special therapies caregivers’/teachers’ qualifications, 19–21 for ill children, 272 child:staff ratios, 3 for therapy services, 272–273 continuing education for directors of, 28–30 space per child, 215–216 defined, 440 steps and stairs, 221–222 support networks for, 20–21 balusters, 221 Family Educational Rights and Privacy Act (FERPA), 41 guards at stairway access opening, 222 care plan for children with special health care needs, 139–140 handrails, 221–222 confidentiality of, 140–141 landings, 222 Fans, electric, 227 storage areas Feeding infants on cue by consistent caregivers/teachers, 175–176 coat hooks/cubicles, 273 Fever firearms, 274 defined, 152 of flammable materials, 274 temporary exclusion of children and, 141–142 inaccessibility to matches, candles, and lighters, 274 Film time. See Screen time of plastic bags, 274 Finger-pinch protection devices, 218 of play and teaching equipment and supplies, 273 Fire, response to, 132 for soiled and clean linens, 273–274 Firearms, 274 storage and labeling of personal articles, 273 policy prohibiting, 392 structurally sound, 213 Fire extinguishers supplies portable, 235 for bathrooms and handwashing sinks, 276 use of, 132 first aid and emergency, 274–275 Fireplaces, 229 microfiber cloths, rags, and disposable towels and mops used for inserts in, 229 cleaning, 276 single service cups, 275–276 support for consultants to provide technical assistance to facilities, 436–437

584 Food service. See Nutrition and food service Food service facilities, holding of food prepared at off-site, 207 Index Formula Fire prevention code, compliance with, 211 concentrated, 178 Fire protection devices, availability of reports on inspections of, 416 elements, 179 Fire warning systems, 234–235 powdered, 178–179 preparation, 178–179 portable fire extinguishers, 235 soy-based, 179–180 First aid storage, 178 Foster care children, helping, transition to child care, 510–511 child:staff ratio and, 4 Fountains, drinking, 239 emergency supplies and, 274–275 Friable materials, preventing exposure to, 246–247 topics covered in training, 26–27 Frostbite, 99 training for staff in, 26 Fruit, whole as more nutritious than juice, 168 Flammable materials, storage of, 274 Fruit juice, 168 Floors, 256–257 Funding, adequacy of staff and, for regulatory enforcement, 429 Flu. See Influenza Furnishings Fluoride toothpaste, 109 arrangements to minimize back injuries, 257 regular tooth brushing with, 108 availability and use of telephone or wireless communication device, 259–260 Fluoride varnish, reduction in decay rates and, 109 carriage, stroller, gate, enclosure, and play yard requirements, 258 Food allergies ceilings, 256–257 care for children with, 170–172 exercise, 259 dietary modifications and, 168–170 floors, 256–257 Food and nutrition service policies and plans, 389 general, 253–260 Food areas and equipment, cleaning, 204–205 high chair requirements, 257–258 Food avoidance, successful, 171 orthotic and prosthetic devices, 260–261 Foodborne illness. See also Infectious diseases placement of, 255–256 food brought from home and, 193–194 product recall monitoring, 254 outbreaks of, 388 requirements for safety of equipment, materials, and furnishing, 253–254 restriction of staff from food preparation and handling, 200–201 restrictive infant equipment requirements, 258–259 Food brought from home safety of equipment, materials, and furnishings, 253–254 nutritional quality of, 194 size of furniture, 254 selection and preparation of, 193–194 special adaptive, 260 Food poisoning, food brought from home and, 193–194 storage for adaptive, 260 Food preparation area, 198 surfaces of equipment, furniture, toys, and play materials, 254–255 Foods therapeutic and recreational, 260 avoidance of certain foods, 164–165 walls, 256–257 burns from hot liquids and, 192 Furniture, size of, 254 categories of, 164–166 Futons, 272 experience with familiar and new, 192 feeding age-appropriate solid, to infants, 184 G introduction of age-appropriate solid, to infants, 183–184 introduction of new, 170 Garbage maintaining safe temperatures, 198–199, 512 containment of, 240 nutritional quality of, when brought from home, 194 removal of, 239 prohibited uses of, 193 selection and preparation of, brought from home, 193–194 Gas grills, 228 storage of Gas heaters, 228 Gas maintenance, 278–279 chart, 513–514 Gas stoves, portable, 228 dry bulk foods, 204 Gastrointestinal (GI) tract disease, notification of parents/guardians, 156 foods not requiring refrigeration, 203–204 Gate requirements, 258 supply of, for disaster, 204 Gender awareness, 88 that are choking hazards, 192–193 Generators, 228 training of staff with responsibilities for handling, 31–32 Glass windows/doors, safety guards for, 218 Food safety Glossary, 559–573 ChooseMyPlate.gov, 507–508 Gloves/gloving, 460 cleaning food areas and equipment, 204–205 compliance with US Food and Drug Administration food sanitation body fluids exposure and, 122–123 standards, state and local rules, 200 for changing children’s soiled underwear/pull-ups and clothing, 115 cutting boards, 205 for diaper changing, 114 dishwashing hypoallergenic latex, 124 in centers, 205 preventing transmission of infectious diseases, 123–125 in small and large family child care homes, 205–206 G-max scale, 293 leftovers, 202–203 Governance, 371–372 precautions for safe food supply, 201–202 governing body of facility, 371–372 preparation for and storage of food in refrigerator, 203 written delegation of administrative authority, 372 staff restricted from food preparation and handling, 200–201 Ground fault circuit interrupters (GFCIs), 233 storage for outlets near water, 233–234 chart, 513–514 Group A streptococcal (GAS) infections of dry bulk foods, 204 exclusion for, 320–321 of foods not requiring refrigeration, 203–204 informing caregivers/teachers of, 321 supply of food and water for disasters, 204 during transport, 207 washing dishes by hand, 206 Food sensitivity, problems of, 169

Group size 585 defined, 4–5 floor space and, 216 Index recommended, and child:staff ratio for, 3 for small family child care homes, 3–4 Health education for caregivers/teachers, 88–89 Growth charts, basis for, 96 for parents/guardians, 90–91 Guardians. See Parents/guardians staff modeling of healthy and safe behavior and activities, 86–87 Guardrails topics for children, 85–86 for elevated play areas, 285 Health history, 422 protective barriers and, 223–224 Health information sharing, parents’/guardians’ provision of information on Guards at doors, 218 their child’s health and behavior, 84–85 for heaters, 229 Health insurance, caregivers/teachers need for, 405 splash, 198 Health Insurance Portability and Accountability Act (HIPAA) at stairway access openings, 222 at windows, 217 care plan for children with special health care needs, 140 confidentiality of, 140–141 H Health limitations of staff, 44 Health policies, 379–392 Haemophilus influenzae type b (Hib) child care health consultant’s review of, 392 immunization for, 321–322 content and development of plan for care of children and staff who are ill, informing parents/guardians of, 322 380–381 notification of parents/guardians, 156 documentation of exemptions and exclusion of children who lack staff exclusion and, 145 immunizations, 383 food and nutrition service, and plans, 389 Halogen lamps, light fixtures including, 231 identification of child’s medical home and parental consent for information Hand hygiene, 118–121 exchange, 383–384 infant feeding, 389–390 after applying insect repellent, 137 information sharing assisting children with, 120 hand sanitizers. See Hand sanitizers on family health, 384–385 handwashing procedure, 119–120 on therapies and treatments needed, 384 situations that require, 118–119 oral, 390 training and monitoring for, 120 plans for evening and nighttime child care, 390 upper respiratory infections, prevention of, 332 policies and practices that promote physical activity, 379–380 washing, 206 prohibiting Handrails, 221–222 firearms, 392 Hand sanitizers, 118, 119, 120–121 smoking, tobacco, alcohol, illegal drugs, and toxic substances, 391–392 alcohol-based, 118, 119 for reporting notifiable diseases to health department, 381 technique for using, 120 sanitation, and procedures, 387–388 Hand sinks, ratios of, to children, 262–263 on use of medications, 385–387 Handwashing procedure in child care centers, 119–120 written, for obtaining preventive health service information, 381–382 Handwashing sinks, 264 Health protection in child care for diaper changing areas in centers, 265 animals and, 128–131 for diaper changing areas in homes, 265 care for children who have been abused/neglected, 134–135 portable water supply for, 238 child abuse and neglect, 132–135 prohibited uses of, 264 for children who have been abused/neglected, 134–135 separate from food zones, 198 daily health check, 95 supplies for, 276 emergency procedures and, 313 Harm, collection of data on, or illness to children in facilities, 444 facility layout to reduce risk of child abuse and neglect, 135 Hazardous equipment, inaccessibility of, 277 fire extinguishers, 132 Hazards, removal of, from outdoor areas, 277 insect repellent and protection from vector-borne diseases, 136–138 Head count, caregivers/teachers, of children during transportation, 6 preventing and identifying shaken baby syndrome/abusive head trauma, Head-impact injuries, 292 133–134 Head injury criterion (HIC) scale, 293 to reduce risk of child abuse and neglect, 135 Head lice response to fire and burns, 132 attendance of children with, 341 routine health supervision and, 96 parent notification, 341 sun safety including sunscreen, 135–136 from sharing helmets, 306 tobacco and drug use, 127–128 staff exclusion and, 145 Heat-induced illness, preventing, 99 temporary exclusion of children with, 143, 341 Heating, 224–230 transmission of, 270, 306 Heating, ventilation, air conditioning (HVAC) Head Start Act, section 645A of, 378 inspection and maintenance, 226 Health, nutrition, physical activity, and safety awareness, 52–53 systems, 224–230 Health advocates, qualifications and responsibilities for, 17–19 Helmets, 306–307 Health agencies, provision of training to facilities by, 448–449 bike and multi-sport, 547–548 Health assessment, child, 535 Hepatitis A virus (HAV) infections Health care for animals, 130 control of, 332–334 Health department disease surveillance of, 335–336 requirements for facilities to report to, 447 staff education and policies on, 334–335 responsibilities and role of, 444–448 staff exclusion and, 145 written plans for role of, 446 temporary exclusion of children and, 143 written policy reporting notifiable diseases, 381

586 Index Hepatitis B virus (HBV) infections I disease recognition and control of, 344–345 handling injuries to carrier, 346 Idling vehicles, 309 observation and follow-up of child who is, 345 Illegal drugs, policies prohibiting, 391–392 risk of transmission in feeding human milk to another mother’s child, 178 Illness. See also Foodborne illness; Infectious diseases Hepatitis C virus (HCV) infections collaborative development of child care requirements for children with, 432 control measures with, 346–347 collection of data on, or harm to children in facilities, 444 risk of transmission in feeding human milk to another mother’s child, 178 content and development of plan for children and staff who have, 380–381 documentation of parent/guardian notification of, 413–414 Herpes simplex virus (HSV) records of, 412 disease recognition and control of, 350 reporting, 155–158 review and accessibility of reports on, 414 Herpes virus 6 and 7 (roseola), 351 use of fact sheets on common, associated with child care, 447–448 Herpes viruses, 349–352 Immunity for reporters of child abuse and neglect, 133 Immunizations cytomegalovirus (CMV), 349–350 autism and, 319 herpes simplex, 350 of caregivers/teachers, 319–320 herpes virus 6 and 7, 351 varicella-zoster (chickenpox), 351–352 recommended schedule, 476–481 High chair documentation, 317–318 limiting infant/toddler time in, 69–70 requirements for, 257–258 of exemptions and exclusion of children who lack, 383 washing, rinsing, and sanitizing trays, 189 against Haemophilus influenzae type b (Hib), 321–322 High intensity discharge lamps, 231–232 importance of, in child care, 318 Hip dysplasia, swaddling and, 105 against infectious diseases, 317–320 History, health, 422 against influenza, 323 Hitting, handling, 75–76 against measles, mumps, and rubella, 324, 340 HIV. See Human immunodeficiency virus (HIV) infection parent/guardian concerns over safety of, 318–319 Home room for school-age children, 5 PCV7, 329 Homes PCV13, 329 handwashing sinks for diaper changing areas in, 265 recommended schedule(s) nutritional quality of food when brought from, 194 selection and preparation of food brought from, 193–194 adults aged 19 years or older, 476–481 Hospitalizations from food allergy, 171 children and adolescents 18 years or younger, 468–475 Hot water, 224–230 against Streptococcus pneumoniae, 329 Hours of operation Impetigo, 338–339 construction and, 252–253 coverage/treatment of lesions, 142 remodeling during, 252–253 temporary exclusion of children and, 143 Humane care for animals, 130 Inborn errors of metabolism, dietary modifications and, 169 Human immunodeficiency virus (HIV) infection, 347–349 Inclusion, planning for, 359–360 attendance of children with, 347 Inclusion/exclusion dismissal of children, 141–145 feeding human milk to another mother’s child, risk of transmission in, 178 Individualized Education Programs (IEPs) staff education about preventing transmission of, 348 children with chronic health conditions and, 386 transmission of, 178, 349 for children with special health care needs and disabilities, 361–363, 364, 365 Human milk. See also Breastfeeding compensation for participation in multidisciplinary assessments for children as developmentally appropriate for infants, 161 with special health care or education needs and, 438 encouragement and support of feeding infants with, 103, 549 written reports on Individualized Family Service Plans (IFSPs), 365 feeding to another mother’s child, 177–178 Individualized Family Service Plans (IFSPs) iron-fortified infant formula as alternative to, 174 children with chronic health conditions and, 386 preparing, feeding, and storing, 176–177 for children with special health care needs and disabilities, 358, 361–363, 365 Human papillomaviruses (warts), 338 compensation for participation in multidisciplinary assessments for children Human resource management, 405–407 with special health care or education needs and, 438 benefits, 46–47 Individuals with Disabilities Education Act (IDEA) written for children with special health care needs and disabilities, 357–359, 362, 364, 365, 367 for centers and large family child care homes, 405–406 compensation for participation in multidisciplinary assessments for children for small family child care homes, 406–407 with special health care or education needs and, 438 Human temperatures, thermometers for taking, 146 Part B Section 619 of, 358–359 Humidifiers Part C of, 357–358, 377 cleaning of, 279 Indoor contaminants, building inspections for, 211 maintenance of, 230 Indoor learning/play environments, transitioning within programs, 57–58 Hygiene Indoor play areas checking for need to change diapers, 112–113 inspection of, 296 cough and sneeze etiquette, 122 size and requirements of, 284 diaper changing procedure, 113–115 Indoor temperature, 225–226 exposure to body fluids, 123–125 Infant equipment requirements, restrictive, 258–259 hand, 118–121 Infant feeding policy, 389–390 handling cloth diapers, 112 Infant foods, temperature in serving, 182–183 procedure for changing children’s soiled underwear/pull-ups and clothing, Infant formula 115–117 preparing, feeding, and storing, 178–179 type of diapers worn, 111–112 as supplement for breastfed infant, 161 Hyperthermia, 105, 312, 402 Infant play areas, shoes in, 252 Hypoallergenic latex gloves, 124 Hypothermia, 99, 312

Infants 587 brain development of, 15 caregivers/teachers, qualifications for, 14–15 Index child safety seats for, 310–311 child:staff ratio for, 3–4 procedure for parent/guardian notification about exposure of children to, encouraging self-feeding by older, 186 155–156 enrollment in child care settings, 7–8 requiring parent/guardian notification, 156 feeding age-appropriate solid foods to, 184 respiratory tract infections guardrails and protective barriers for, 223 housing of child care units for, 214 group A streptococcal infections, 320–321 human milk as developmentally appropriate for, 161 Haemophilus influenzae type b, 321–323 hunger cues, 175 influenza, 324 importance of low child:staff ratios for, 3 mumps, 324–325 interactions with caregivers/teachers, 60–61 Neisseria meningitides, 325–326 limiting time in crib, high chair, car seat, etc, 69–70 parvovirus B19, 326 nutrition for, 174–184 pertussis, 326–328 cleaning and sanitizing equipment used for bottle feeding, 182 respiratory syncytial virus, 328–329 feeding age-appropriate solid foods to, 184 Streptococcus pneumoniae, 329–330 feeding cow’s milk, 180 tuberculosis, 330–331 feeding human milk to another mother’s child, 177–178 unspecified, 331–332 feeding on cue by consistent caregivers/teachers, 175–176 sick leave in minimizing, 407 general plan for feeding, 174–175 skin and mucous membrane infections introduction of age-appropriate solid foods to, 183–184 conjunctivitis, 336–337 preparing, feeding, and storing formula, 178–179 enteroviruses, 337–338 preparing, feeding, and storing human milk, 176–177 human papillomaviruses, 338 techniques for bottle feeding, 181 impetigo, 338–339 use of soy-based formula and soy milk, 179–180 lymphadenitis, 339 warming bottles and foods, 182 measles, 340 outdoor play of, 97 molluscum contagiosum, 340–341 personal caregiver/teacher relationships for, 59–60 pediculosis capitis (head lice), 341 preventing entry to toilet rooms by, 261–262 scabies, 343 responsive feeding of, 175 Staphylococcus aureus skin infections including MRSA, 342–343 risk of sudden infant death syndrome (SIDS), 35, 36, 38 thrush, 344 safe sleep procedures for, 102 tinea capitis and tinea cruris, 342 separation of, from older children, 62 spread of, 317 space and activity to support learning of, 61–62 transmission of, 147–148 tummy time of, 97–98 written policy for reporting, to the health department, 381 Influenza, 324 Infectious diseases, 317–351. See also Foodborne illness control of, 323–324 bloodborne infections prevention education, 324 hepatitis B virus, 344–346 staff exclusion for, 145 hepatitis C virus, 346–347 written plan for seasonal and pandemic, 397–399 HIV, 347–349 Information daily health check and, 95 community resource, 417 enteric (diarrheal) infections and hepatitis A, 332–335 exchange of exposure of children to, 155–156 at transition, 379 gloves in preventing, 123–124 upon enrollment, 376 health check in reducing transmission of, 95 obtaining health check from parents/guardians, 95 herpes viruses parental consent for exchange of, 383–384 cytomegalovirus (CMV), 349–350 pre-admission enrollment, for each child, 418–419 herpes simplex, 350 sharing, on family health, 384–385 herpes virus 6 and 7, 351 sharing, on therapies and treatments needed, 384 varicella-zoster (chickenpox), 351–352 written policy for obtaining preventive health service, 381–382 immunizations against, 317–320 Ingestion of substances that do not provide nutrition, 172 of caregivers/teachers, 319–320, 476–481 Injuries documentation, 317–318 documentation of parent/guardian notification of, 413–414 unimmunized children, 318–319 head-impact, 292 interactions with state or local health departments, 353 records of, 412–413 judicious use of antibiotics, 353 report form(s) as major concern of parents/guardians and staff, 381 incident report form, 529 meaning of, 146 for indoor and outdoor injuries, 530 measures with hepatitis C virus (HCV) and control, 346–347 review and accessibility of reports on, 414 notification of facility about, or other problems by parents/guardians, 156 Insect breeding hazard, 242–243 outdoor play areas and, 100 Insect repellent, 136–138 for parent/guardian notification about exposure of children to, 155–156 in preventing transmission of infectious diseases, 123–124 prevention with sanitation policies, 387 of transmission by handwashing, 264

588 Lead common sources of, 172 Index effects of toxicity, 172 in paint, 172, 251–252, 277 Inspections in plastic, 248, 304 building, 211, 215 and poison center as a resource, 244 electrical, 233 in soil, 99, 212, 252 of equipment, 197 in tableware and feeding utensils, 189 of facility, 442 testing for, 251–252 fire safety, 211, 215 levels of, in drinking water, 236–237 of food, 200–201 test results for, 407, 411, 415 frequency, 442 of heating systems, 226 Lead teachers, qualifications of, 13 for lead, 212, 236, 251–252 Learning, space and activity to support in infants and toddlers, 61–62 playground safety, 287–288, 296, 403–404 Learning experiences for children, 194–197 of pools, 301 Learning/play environments, transitioning within programs and indoor and of records, 415 reports, 237, 415 outdoor, 57–58 sanitation,188, 239 Leftovers, 202–203 unannounced, 3 Lice. See Head lice of vehicles, 308, 309 Licenses/licensing water quality, 237 early childhood programs, 536–543 Installation of play equipment, 289 licensing agency procedures prior to issuing, 441 Insurance record of valid, 415 Licensing agency, 430–440 caregivers’/teachers’ need for health, 405 availability of records to, 410 facility coverage, 407 collaborative development of child care requirements and guidelines for vehicle, 407 children who are ill, 432 Integrated pest management, 241–242 community participation in development of rules, 431 insect breeding hazard, 242–243 licensing staff training, 439–440 Interferon-gamma release assay (IGRA) blood test, 330–331 operation permits, 430 Introduction of age-appropriate solid foods. See Age-appropriate solid foods procedures prior to issuing a license, 441 Introduction of new foods, 170, 184, 192, 194–195 provision of child abuse prevention materials, 435 Invasive infections, notification of parents/guardians, 156 public-private collaboration on care of children who are ill, 432–433 Iron-fortified infant formula as alternative to human milk, 174 rational basis of regulations, 430 role in communicating importance of compliance with Americans with J Disabilities Act, 435 role with staff credentials, child abuse prevention, and Americans with Juice. See Fruit juice Disabilities Act, 433–435 Juvenile record checks, 434 technical assistance from, 435–439 training of personnel, about child abuse, 440 K Licensing and community action, 429–450 caregiver/teacher support, 448–449 Kerosene heaters, 228 facility licensing, 440–444 Kitchen and equipment health department responsibilities and role, 444–448 licensing agency, 430–440 design of food service equipment, 197–198 regulatory policy, 429 food preparation area, 198 Licensing inspectors food preparation sinks, 198 education, experience and training of, 439–440 handwashing sink separate from food zones, 198 performance monitoring of, 439–440 maintaining safe food temperatures, 198–199 Licensing of facilities that care for children who are ill, 151 maintenance of food service surfaces and equipment, 198 Licensing rules, community participation in development of, 431 microwave ovens, 199–200 Licensing staff training, 439–440 ventilation over cooking surfaces, 199 Lighters, inaccessibility to, 274 Lighting, 231 L emergency, 232 fixtures including, 231 Lactose intolerance. See Soy-based formulas; Soy milk high intensity discharge lamps, 231–232 Landings, 222 levels of illumination, 231 Language development, fostering, in three- to five-year-olds, 65–66 mercury lamps, 231–232 Large family child care homes multi-vapor lamps, 231–232 natural, 230–231 child:staff ratio for, 4–6 Limiting time, in equipment (cribs, high chairs, etc), 69–70 continuing education for directors and caregivers/teachers in, 28 Linens, storage for soiled and clean, 273–274 defined, 440 Local health department dishwashing in, 205–206 interaction with, concerning infectious diseases, 353 food service staff at, 187 role of, 444–448 frequency of inspections for, 442 Lock down drills, record of, 416 locks in, 220 Locks, 220 transportation policy for, 403 Lost child, 393 written daily activity plan and statement of principles, 51–52 Lyme disease, 137 written human resource management policies for, 405–406 Lymphadenitis, 339 “Latchkey children,” 450 Latex, ongoing exposures to, 124 Latex gloves, hypoallergenic, 124 Laundry area location of equipment and water temperature for laundering, 268 service and equipment, 268 Laundry service and equipment, 268 Lawn care treatments, chemicals used in, 243

589 Index M Medical procedures, caring for children who require, 140–141 Medications Maintenance of air filters, 227–228 administration, 153–154 of changing tables, 267 administration packet, 522–526 cleaning of humidifiers, 279 labeling, storage, and disposal, 154 cleaning schedule for exterior areas, 278 non-prescription, over-the-counter (OTC), 153 of dehumidifiers, 230 parent/guardian notification on use of, 384 electrical fixtures and outlets, 278 policy on use of, 385–387 of exterior surfaces, 277 standing orders, 153 gas, 278–279 toxicity of, 243 of humidifiers, 230 training of caregivers/teachers to administer, 154–155 inaccessibility of hazardous equipment, 277 Medications record, 386 plumbing and gas, 278–279 contents of, 422–423 removal of allergen triggering materials from outdoor areas, 277 Meningococcal infections removal of hazards from outdoor areas, 277 informing public health authorities of, 326 storage area ventilation and, 278 recommended control measures for invasive, 325 structure, 278 staff exclusion and, 145 Mental health. See Consultants Management of illness Menus, written, 170 inclusion/exclusion due to illness, 141–146 Mercury lamps, 231–232 infectious disease outbreak control, 147 Methicillin-resistant Staphylococcus aureus (MRSA), 342–343 sharing of personal articles prohibited, 147 Microfiber cloths, used for cleaning, 276 staff exclusion for, 145 Microwave ovens, 199–200 thermometers for taking human temperatures, 146 Milk. See also Human milk allergy to, 163, 169, 171, 180 Manipulative art or sensory materials, use of, 247–248 cow’s, 180 Marijuana. See also Drug use dry, 201 flavored, 165, 185 edible marijuana, proper storage of, 243, 391 low-fat, 180, 202 Matches, inaccessibility to, 274 1%, 180, 202 Material Safety Data Sheet (MSDS). See Safety Data Sheets (SDSs) skim, 201 Maternal and Child Health programs, nutrition training and, 29 soy, 179–180 Mattresses, 127, 269 2%, 180, 202 McKinney-Vento Homeless Assistance Act, 383 whole, 180, 202 Meal and snack patterns, 166–167 Mini-blinds, 251–252 Minimum age to enter child care, 7–9 for infants, 389–390 Mixed age groups, 4, 28, 31, 62 for school-age children, 186–187 Mixed director/teacher role, 12 for toddlers and preschoolers, 184–185 Mobile phone use, 70–71 Meals, socialization during, 190–191 Modeling, opportunities for, of health and safety education for parents/guardians, Meal service, seating, and supervision, 188–193 activities that are incompatible with eating, 190 90 adult supervision of children who are learning to feed themselves, 191–192 Model work standards, development of, 405 developmentally appropriate seating and utensils for meals, 188–189 Molluscum contagiosum, 340–341 experience with familiar and new foods, 192 Mops for cleaning, 276 foods that are choking hazards, 192–193 Mop sinks, 264–265 hot liquids and foods, 192 Mosquito-borne viruses, 242–243 numbers of children fed simultaneously by one adult, 191 Motor vehicles. See Vehicles participation of older children and staff in mealtime activities, 192 Mouth prohibited uses of food, 193 socialization during meals, 190–191 cleaning and sanitizing objects intended for, 126 tableware and feeding utensils, 189 temporary exclusion of children and sores of, 143 Meals from outside vendors or central kitchens Movie time. See Screen time approved off-site food services, 206 Multidisciplinary assessment, compensation for participation in, for children food safety during transport, 207 holding of food prepared at off-site food service facilities, 207 with special health care or education needs, 438–439 Mealtime activities, participation of older children and staff in, 192 Multiple use of rooms, 215 Measles, 340 Multi-sport helmets, 547–548 immunization against, 324, 340 Multi-vapor lamps, 231–232 notification of parents/guardians, 156, 347 Mumps, 324–325 staff exclusion and, 145 temporary exclusion of children and, 143 temporary exclusion of children and, 143 Measles, mumps, and rubella (MMR) vaccine, 324, 340 MyPlate, 507–508 Measurable objectives, development of, for children with special health care N needs and disabilities, 363–364 Medical care Nap time area for, 107, 126, 268 authorization form, 550 child:staff ratio for, 3, 4 for children with special health care needs, 360–361 coordinating, 383–384 Nasal bulb syringes, use of, 123–125 for frostbite, 99 Nasal secretions, procedure for, 123–125 for hypothermia, 99 Native language, communication in, other than English, 58 written plan and training for handling urgent, or threatening incidents, Natural lighting, 230–231 393–394 Neisseria meningitides, 325–326 Medical home, identification of, 383–384 notification of parents/guardians, 156

590 meal service, seating, and supervision, 188–193 activities that are incompatible with eating, 190 Index adult supervision of children who are learning to feed themselves, 191–192 Nicotine withdrawal, caregivers’/teachers’ stress related to, 46 developmentally appropriate seating and utensils for meals, Nighttime child care, plans for, 390 188–189 Nipples, 176, 181, 182, 249 experience with familiar and new foods, 192 Noise foods that are choking hazards, 192–193 hot liquids and foods, 192 chronic noise pollution, 212 numbers of children fed simultaneously by one adult, 191 levels of, 232 participation of older children and staff in mealtime activities, 192 Nondiscriminatory policy, 376–377 prohibited uses of food, 193 Nurse, substitute, 34 socialization during meals, 190–191 Nutrition tableware and feeding utensils, 189 assessment and planning of, for individual children, 163–164 ChooseMyPlate.gov, 507–508 meals from outside vendors or central kitchens food handling staff, 31–32, 187–188 approved off-site food services, 206 for infants, 174–184 food safety during transport, 207 holding of food prepared at off-site food service facilities, 207 cleaning and sanitizing equipment used for bottle feeding, 172 feeding age-appropriate solid foods to, 184 need for written nutrition plan, 162–163 feeding cow’s milk, 180 staffing, 187–188 feeding human milk to another mother’s child, 177–178 feeding on cue by consistent caregivers/teachers, 175–176 food service staff by type of facility and food service, 187 general plan for feeding, 174–175 qualifications, 459 introduction of age-appropriate solid foods to, 183–184 use of nutritionist/registered dietitian, 187–188 preparing, feeding, and storing formula, 178–179 use of USDA CACFP guidelines, 164 soy-based formula and soy milk for, 179–180 vegetarian/vegan diets, 173 and storing human milk, 176–177 written menus and introduction of new foods, 170 techniques for bottle feeding, 181 Nutritionist/registered dietitian warming bottles and foods, 182 approval of dietary modifications, 169 need for written plan in, 162–163 availability of, to facilitate, 436 Nutrition and food service, 161–207 employment of, 162 approved off-site, 206 qualifications, 459 assessment and planning of nutrition for individual children, 163–164 use of, 187–188 availability of drinking water, 167 Nutrition service, records of, 417 care for children with food allergies, 170–172 categories of foods, 164–166 O cleaning schedule, 515 education for parents/guardians, 196–197 Obesity feeding plans and dietary modifications, 168–170 decreases in, 98 food brought from home dietary intake and, 163 nutritional quality of, 194 excessive media use and, 70 selection and preparation of, 193–194 prevention of, 22, 23, 36–37, 52, 85–89, 96–97, 161–162, 168, 175, 187, 193, food safety 196, 389, 567 cleaning food areas and equipment, 204–205 risk of, 174, 180, 181, 190, 193 compliance with US Food and Drug Administration food sanitation screening for, 420 standards, state and local rules, 200 cutting boards, 205 Observation of caregivers/teachers, 48 dishwashing in centers, 205 Occupational hazards, caregivers/teachers and, 44–45, 458 dishwashing in small and large family child care homes, 205–206 Occupational risk, training on, related to handling body fluids, 33 leftovers, 202–203 Occupational Safety and Health Administration (OSHA), 43 precautions for safe food supply, 201–202 Odors preparation for and storage of food in refrigerator, 203 staff restricted from food preparation and handling, 200–201 chemicals used to control, 249–250 storage of dry bulk foods, 204 ventilation to control, 227–228 storage of foods not requiring refrigeration, 203–204 Office space, separating from child care areas, 214 supply of food and water for disasters, 204 Oil heaters, 228 washing dishes by hand, 206 On-site inspections, statutory authorization of, 442 fruit juice, 168 On-site sewage systems, 239 ingestion of substances that do not provide nutrition, 172 containment of garbage, 240 kitchen and equipment containment of soiled diapers, 240 design of food service equipment, 197–198 labeling, cleaning, and disposal of waste and diaper containers, 241 food preparation area, 198 removal of garbage, 239 food preparation sinks, 198 storage and disposal of infectious and toxic wastes, 241 handwashing sink separate from food zones, 198 Open-door policy, 410, 411 maintaining safe food temperatures, 198–199 Operation permits, 430 maintenance of food service surfaces and equipment, 198 Oral health microwave ovens, 199–200 education for, 110–111 ventilation over cooking surfaces, 199 policy, 390 learning experiences for children, 194–197 routine hygiene activities, 108–109 meal and snack patterns, 166–167 toothbrushes and toothpaste, 109–110 Oral hygiene, caregivers/teachers in promoting, 181

591 Index Orientation mutual responsibility of staff and, 80–81 for care of children with special health care needs, 24–25 notification about infectious diseases or other problems, 156 initial, of all staff, 23–24 notification of use of insect repellent, 138 of substitutes, 35–36 notification on use of medication, 384 topics, 25 nutrition as basic responsibility of, 161 nutrition education for, 196–197 Orthotic devices, 260–261 nutrition learning experiences for children and, 194–197 Outdoor injuries, report form for, 530 obtaining health information from, 95 Outdoor play areas, 99–100 procedure for notification about exposure of children to infectious disease, 155–156 elevated, 285 provision of information on their child’s health and behavior, 84–85 enclosures for, 286–287 resources for, of children with special health care needs and disabilities, 438 inspection of, 296 seeking input, 83 location near bodies of water, 286 staff notification about varicella-zoster (chickenpox) virus and, 351 protection from air pollution, 100–101 support services for, 83–84 removal of hazards from, 277 unimmunized children and, 318–319 on rooftops, 284 visits of, 81–82 shading of, 286 Parvovirus B19 size and requirements of, 283 attendance of children with, 326 surfacing of, 289, 292–293 notification of parents/guardians, 156 transitioning within programs, 57–58 Passenger vans, 313–314 visibility of, 285 Path of egress, 220 Outdoor playground as exit, 219 Paved surface, drainage of, 223 Outlets maintenance, electrical fixtures and, 278 Payment for continuing education, 34 PCV7 vaccine, 329 P PCV13 vaccine, 329 Peanut allergy, need for epinephrine and, 171 Pacifiers Pediatric first aid, child:staff ratio and, 5 cleaning, 106 Pediculosis capitis (head lice), 341 as strangulation hazard, 138 Performance monitoring of licensing inspectors, 439–440 sudden infant death syndrome (SIDS) and, 104, 106 Personal articles, storage and labeling of, 273 use of, 102, 105 Pertussis, 326–328 exclusion for, 327–328 Pain notification of parents/guardians, 156 abdominal, 143, 152, 157 prophylactic treatment for, 327 from bite, 412 staff exclusion and, 145 bone, 342 temporary exclusion of children and, 143 chest, 337 Pest management, integrated, 241–242 eye, 141 Pets. See Animals (pets) first aid for, 27 Phthalates, 248 health check and, 95 Physical abuse. See Child abuse and neglect joint, 145, 342 Physical activities medication, 386 active opportunities for, 97–98 oral, 350 barriers to, 379 caregivers’/teachers’ encouragement of, 101 Paints digital media use and, 70 lead in, 172, 251–252, 277 how much is needed, 509 volatile organic compounds (VOCs), 252–253, 254 importance of, 70 policies and practices that promote, 379–380 Pandemic flu/influenza. See Influenza time spent on, 97 Paneled areas, ventilation of recently, 226–227 weight management and, 161 Parental leave, unpaid and paid, 8 Physical activity consultant, availability of, to facilitate, 437 Parents/guardians Physical aggression, handling, 75–76 Physical restraint, using, 79–80 availability of documents to, 410–412 Physical therapy caregiver/teacher handling of intoxicated, 401 equipment, 260 caregiver/teacher weaning of infants from, 106 space for, 272–273 communication between caregivers/teachers and, 170, 183 Pica, 172 complaint procedures for, 84 Pick-up, 309–310 concern about plagiocephaly, 104 Pick up child concerns over safety of vaccines, 318–319 authorized persons for, 400–401 conferences with, 82–83 documentation of, and parent/guardian communication, 401–402 consent for information exchange, 383–384 Pick-up points, 222 contents of admission agreement between child care program and, 419–420 Picky eater, 162 documentation of drop-off, pick-up, daily attendance of child, and Pillows, 268–269 communication, 401–402 Pink eye. See Conjunctivitis documentation of notification of injury, illness, or death in program, Pipes, installation of, 238 413–414 Plagiocephaly, concern about, 104 education plan of, 90–91 Planned program of daily activities, written description of, 51–52 enrollment information to, 373–376 health education for, 90–91 helping cope with separation, 56–57 infectious diseases that require notification, 156 informing, of Haemophilus influenzae type b (Hib) exposure, 322 licensing agency provision of written agreements for, 436 list of excludable and reportable conditions for, 157 monitoring children’s development/obtaining consent for screening, 54–55

592 play area, 403–404 review and communication of written, 373 Index sanitation, 387–388 transportation, 403 Plants written discipline, 377 poisonous. See Poisonous plants Polybrominated diphenyl ether (PBDE), 254 safe, 249 Polyvinyl chloride (PVC), 248–249 Pooling, 62 Plastic bags, storage of, 274 Pools. See Swimming pools Plastic containers, 248–249 Pool toys, 303 Plastic toys, 126, 248–249 Portable electric space heaters, 228–229 Play and teaching equipment, storage of, 273 Portable fire extinguishers, 235 Play area and playground surfacing Portable gas stoves, 228 Portable wading pools, 303 inspection of, 296–297 Portable water supply, handwashing sink using, 238 prohibited surfaces for placing climbing equipment, 292–293 Pre-admission enrollment information for each child, 418–419 shock-absorbing materials, 520–521 Pregnant women, exposure to cat feces, 129, 131 Play areas/playgrounds Preschool-age children America’s Playgrounds Safety Report Card, 532–534 body mastery for, 66 clearance requirements of, 291–292 caregivers’/teachers’ qualifications for serving, 16 elevated, 285 expressive activities for, 65 enclosures for outdoor, 286–287 fostering cooperation of, 65 inspection of, 296–297 fostering language development of, 65–66 location of, near bodies of water, 286 guardrails and protective barriers for, 223 policies on, 403–404 housing of child care units for, 214 nutrition for records of proper installation and maintenance of facility equipment, 404 meal and snack patterns for, 184–185 reports of annual audits/monthly maintenance checks of equipment, serving size for, 185–186 404 outdoor play of, 97 use and maintenance, 403–404 personal caregiver/teacher relationships for, 64 reports of annual audits/monthly maintenance checks of, 404 selection of equipment for, 64–65 rooftops as, 284 short structured activities for, 97 shading of, 286 supervision for, 3 shoes in infant, 252 toilet facilities for, 69 size and location of, 283 toilet height for, 262 size and requirements of indoor, 284 Pre-service qualifications soil in, 212 caregivers/teachers, 12–21 visibility of, 285 director’s, 11–12 water, 297–303 mixed director/teachers, 12 Play dough, use of, 247–248 Pre-service training, 21–23 Play equipment Prevention and management of toxic substances, 243–244 Americans with Disabilities Act requirements for, 288 carbon monoxide detectors, 228, 245–246 arrangement of, 291 chemicals used to control odors, 249–250 ball pits, 295 construction and remodeling during hours of operation, 252–253 connecting and linking devices, 289 exposure to asbestos or other friable materials, 246–247 crawl spaces in, 289 informing staff regarding presence of toxic substances, 244–245 design of, 288–289 plastic containers and toys, 248–249 enclosure of moving parts on, 290 prohibition of poisonous plants, 249 entrapment hazards of, 290–291 proper use of art and craft materials, 247 installation of, 289 radon concentrations, 245 location of moving, 291 shoes in infant play areas, 252 material defects and edges on, 290 testing for lead, 251–252 requirements for, 287–288 treatment of chromated copper arsenate (CCA) pressure-treated wood, sandboxes, 293 250–251 sensory table materials, 294–295 use and storage of toxic substances, 243 trampolines, 295 use of play dough and other manipulative art of sensory materials, 247–248 use zone for fixed, 291 use of poison center, 244 water play tables, 293–294 Prevention of obesity. See Obesity Play materials, surfaces of, 254–255 Preventive health services Play yard requirements, 258 provision of routine, 96 Plumbing recommendations for, 482–483 installation of fixtures, 238 written policy for obtaining information, 381–382 maintenance of, 278–279 Privacy. See also Health Insurance Portability and Accountability Act (HIPAA) Poison center, use of, 244 toilet location and, 261 Poisonous plants, 518–519 Private residence, use of, as child care facility, 211 prohibition of, 249 Product recall monitoring, 254 Policies, 372–404 Professional development/training, pre-service training, 21–23 content of, 372–373 Program consultant, availability of, to facilitate, 436 enrollment information to parents/guardians and caregivers/teachers, Prohibited animals, 129–130 373–376 Prohibited surfaces for placing climbing equipment, 292–293 exchange of information upon enrollment, 376 food and nutrition service, 389 health, 379–392 infant feeding, 389–390 nondiscriminatory, 376–377 oral health, 390

593 Index Projectile toys, 305 Regulatory enforcement, state statute support of, 429 Prophylactic treatment for pertussis, 327 Regulatory policy Propping bottle. See Bottle propping Prosthetic devices, 260–261 adequacy of staff and funding for enforcement, 429 Public health authorities, informing regulation of all out-of-home child care, 429 state statute support of enforcement, 429 of hepatitis B virus cases, 346 Rehabilitation Act (1973), Section 504 of, accessibility of facilities and, 212 of invasive Haemophilus influenzae type b (Hib) cases, 322–323 Reimbursement for children with special health care needs and disabilities, of invasive Streptococcus pneumoniae, 329–330 of meningococcal infections, 326 364–365 of pertussis cases, 326–327 Relationships, developing, for school-age children, 67 Public policy issues and resource development, 450 Religious beliefs, dietary modifications based on, 169 Public-private collaboration on children who are ill, 432–433 Remodeling, during hours of operation, 252–253 Pull-ups, changing soiled, 115–117 Reports, facility, 407–417 Punishment. See Corporal punishment Resource and referral agencies, development of, 450 Respiratory illness, staff exclusion and, 145 Q Respiratory syncytial virus (RSV), 328–329 Quality, sources of technical assistance to support, of child care, 435–439 attendance of children with, 328 Quality improvement, management principles of, 371 Respiratory tract infections (RTIs) Quality rating and improvement system (QRIS), 441 attendance of children with, 331–332 R group A streptococcal infections, 320–321 Haemophilus influenzae type b (Hib), 321–323 Radon concentrations, 245 influenza, 324 Rags, used for cleaning, 276 mumps, 324–325 Raisins, 193 Neisseria meningitides, 325–326 Rash parvovirus B19, 326 pertussis, 326–328 staff exclusion and, 145 respiratory syncytial virus, 328–329 temporary exclusion of children and, 143 Streptococcus pneumoniae, 329–330 Rational basis of regulations, 430 tuberculosis, 330–331 Ratios. See Child:staff ratios unspecified, 331–332 Reasonableness as legal standard, 364 Rest areas, unscheduled access to, 107–108 Recalls. See Product recall monitoring Rest periods, scheduled, 106–107 Recipes, provision of, in nutrition education for parents/guardians, 196 Retaining wall in creating elevated play areas, 285 Records, 407–426. See also Staff records Rifampin treatment of children exposed to child with Haemophilus influenzae access to facility, 410 attendance. See Attendance records type b (Hib) disease, 322 availability of Ringworm, attendance of children with, 342 Rooftops as play areas, 284 documents to parents/guardians, 410–412 Roseola, 351 on inspections of fire protection devices, 416 Routine health supervision, 96 to licensing agency, 410 Rubella child, 418–424 community resource information, 417 staff exclusion and, 145 documentation of child care health consultation/training visits, 416–417 temporary exclusion of children and, 143 documentation of parent/guardian notification of injury, illness, and death in program, 413–414 S enrollment, 467 evacuation and shelter-in-place drill, 416 Safe sleep practices. See Sleep facility, 407–417 Safety facility records/reports, 407–417 of illness, 412 education topics for staff, 88–89 of injury, 412–413 strangulation hazards, 138–139 maintenance and display of inspection, 415 sun, 135–136 maintenance of, on incidents of diarrhea, 336 Safety covers medication, 386, 422–423 for electrical outlets, 233 of nutrition service, 417 for swimming pools, 298 requirements for compliance of contract services, 412 Safety Data Sheets (SDSs), 227, 243, 250 review and accessibility of injury and illness, 414 Safety guards for glass windows/doors, 218 staff, 424–426 Safety straps for diaper changing table, 113–115 symptoms, 467 Salmonella. See Animals (pets); Exclusion for illness; Food safety training, 425–426 Salmonellosis, 202, 336 of valid license, certificate, or registration of facility, 415 Sand written plan/record to resolve deficiencies, 415 as a surfacing material, 293 written policy of facility confidentiality, 409–410 type used in sandboxes, 293 Recreational equipment, 260 Sandboxes, 293 References, checking in background screening, 10 Sanitation Refrigeration, storage of foods not requiring, 203–204 appropriate disinfectants/sanitizers, selection of, 484–490 Refrigerator, preparation for and storage of food in, 203 of objects intended for mouth, 126 Registration of facility, record of valid, 415 policies and procedures, 387–388 Regulations, rational basis of, 430 routine/routine schedule, 125–126, 491–492 Regulatory agency, provision of caregivers/teachers and consumer training and toys, 126 Satellite dish, location of, 224 support services, 448–449

594 Index Scabies, 343 Single service cups, 275–276 attendance of children with, 343 Sippy cups. See Cups staff exclusion and, 145 Site location, environmental audit of, 212–213 temporary exclusion of children with, 143, 343 Skin and mucous membrane infections, 336–337 treatment of, 143 conjunctivitis, 336–337 School, communication between child and, 67 enteroviruses, 337–338 School-age activities human papillomaviruses, 338 impetigo, 338–339 space for, 67 lymphadenitis, 339 supervised, 66 measles, 340 School-age child care facility, 440 molluscum contagiosum, 340–341 School-age children notification of parents/guardians, 156 areas for, 217 pediculosis capitis (head lice), 341 bike routes for, 307 scabies, 343 caregivers’/teachers’ qualifications for serving, 16–17 staff exclusion and, 145–146 community outreach for, 67 Staphylococcus aureus skin infections including MRSA, 342–343 developing relationships, 67 thrush, 344 fostering collaboration to establish programs for, 449–450 tinea capitis and tinea cruris, 342 guardrails and protective barriers for, 223 Sleep, 102–105 home room for, 5 developmentally not nutritionally determined, 183 housing of child care units for, 214 facility arrangements for, 106–107 limiting screen time for, 101 healthy sleep habits, 52, 85, 106–107 meal and snack patterns for, 186–187 pacifier use and, 105–106 planning activities for, 67 safe practices and SIDS/suffocation risk reduction, 102 in small family child care homes, 3 supervision during, 3 supervision of, 68–69 swaddling and, 105 use of toilet facilities of, 69 Sleep and rest areas Scrapes, body fluids and, 122–123 bunk beds, 272 Screening, obtaining consent for, 54–55 cribs, 270–271 Screens for ventilation openings, 218 equipment and supplies, 268–270 Screen time, 70–71 futons, 272 caregivers’/teachers’ awareness of, 101 stackable cribs, 271 school-age children, limiting for, 101 Sleeping equipment and supplies, 268–270 Section 504 of the Rehabilitation Act for children with special health care needs Small family child care homes child:staff ratio for, 3–4 and disabilities, 359, 366, 367 continuing education for caregivers/teachers of, 30–31 Self-feeding, encouraging, in older infants and toddlers, 186 defined, 440 Self-stimulatory behaviors, ignoring, 66 dishwashing in, 205–206 Sensors or remote monitors for swimming pools, 298 food service staff at, 187 Sensory table materials, 294–295 frequency of inspections for, 442 Separation, helping families cope with, 56–57 locks in, 220 Separation of operations from child care areas, 215 mixed use of rooms, 215 Service plan, developing, for children with special health care needs and school-age children in, 3 transportation policy for, 403 disabilities, 361–365 written daily activity plan and statement of principles, 51–52 Services, planning for child’s transition to new, 377–378 written human resource management policies for, 406–407 Sewage systems, on-site, 239 Smoke alarms, 234–235 Sex offender registries, 433, 434, 441 Smoke detection systems, 234–235 Smoking, policies prohibiting, 391–392 in background screening, 10 Sneezing etiquette, 122. See also Cough and sneeze Sexual abuse. See Child abuse and neglect Social interactions, importance of, 70 Shading of play areas, 286 Socialization during meals, 190–191 Shaken baby syndrome/abusive head trauma Social policies, efforts to strengthen, 8 Social Security Act, social policies and, 8 preventing and identifying, 133–134 Social Security trace in background screening, 10 prevention of, 19–20 Soil in play areas, 212 Shelter-in-place, 397 Solid foods, introduction of age-appropriate, 183–184 Shelter-in-place drills Sound abatement, caregivers’/teachers’ need for help with, 232 evacuation and records of, 416 Soy-based formulas, use of, 179–180 records of, 416 Soy milk, use of, 179–180 Shigella. See Exclusion for illness Space Shingles, staff exclusion and, 145 for children with special health care needs, 272–273 Shock protection devices for electrical outlets, 233 per child, 215–216 Shoes in infant play areas, 252 for play areas per child, 283 Showers for school-age activity, 67 ratio and location of, 267 to support learning of infants and toddlers, 61–62 safety of, 267–268 Space for children who are ill, injured, or need special therapies Sick leave, 46–47 space for ill children, 272 in minimizing infectious diseases, 407 space for therapy services, 272–273 SIDS. See Sudden infant death syndrome (SIDS) Sign-in/sign-out system, 400 Signs and symptoms child abuse and neglect, 494–497 exclusion of child with, 453–457 symptom record, 467

Space heaters, portable electric, 228–229 595 Special adaptive equipment, 260 Special health care needs, recognition of health problems in, 28–29 Index Specialists, communication from, 85 Special Supplemental Nutrition Programs for Women, Infants, and Storage areas Children (WIC) coat hooks/cubicles, 273 firearms, 274 nutrition training and, 29 of flammable materials, 274 soy-based formula and soy milk, 180 inaccessibility to matches, candles, and lighters, 274 Sports beverages, 166 maintenance and ventilation, 278 Square footage. See Space of plastic bags, 274 Stackable cribs, 271 of play and teaching equipment and supplies, 273 Staff. See also Caregivers/teachers for soiled and clean linens, 273–274 adequacy of, and funding for regulatory enforcement, 429 storage and labeling of personal articles, 273 competence and training of transportation, 307–308 content and development of plan for care of, who are ill, 380–381 Storage for adaptive equipment, 260 designating role of person responsible for coordinating care in child care Stoves, wood/corn pellet, 229 facility, 362–363 Strangulation hazards, 138–139 education of Strep throat, staff exclusion and, 145 Streptococcal pharyngitis, temporary exclusion of children and, 143 policies on cytomegalovirus (CMV) and, 349–350 Streptococcus pneumoniae, 329–330 preventing transmission of HIV infection, 348 on prevention of bloodborne diseases, 345–346 informing public health authorities of invasive, 329–330 exclusion for illness, 145–146 Stress for caregivers/teachers, 45–46 food service, by type of facility and food service, 187 Strings on children’s clothing as strangulation hazard, 138–139 health appraisals of, 441 Stroller requirements, 258 health limitations of, 44 Structurally sound facility, 213 health of Structure maintenance, 278 assessment, 461–466 Substances, ingestion of, not providing nutrition, 172 daily check, 44 Substitutes pre-employment and ongoing adult health appraisals, including immunization, 42–44 age of, 34 informing, regarding presence of toxic substances, 244–245 employment of, 34–35 in-person interviews, 10 illness of, 44 maintenance of attendance records for, who care for children, 425 orientation of, 35–36 notification of parents/guardians about varicella-zoster (chickenpox) Sudden infant death syndrome (SIDS) virus, 351 accusation of child abuse and neglect and, 157–158 nutritionist/registered dietitian as member of, 187–188 in child care, 19–20 participation in mealtime activities, 192 deaths in child care facilities attributable to, 103 recruitment of, 9 pacifier use and, 104, 106 reference checks, 10. See also Background screening reducing risk of, 102, 103, 104 restriction from food preparation and handling, 200–201 risk of, 21, 22, 35, 36, 38, 105 screening resources, 10 Suffocation, 102–105 Staff:child ratios. See Child:staff ratios Sunny weather, outdoor play in, 99 Staff records, 424–426 Sun safety, 135–136 maintenance and content of, 424–425 Sunscreen, 135–136, 137 maintenance of attendance, who care for children, 425 Supervision training, 425–426 methods of, 68–69 Stairway access openings, guards at, 222 near bodies of water, 71–72 Standard Precautions for preschoolers, 3 adopting use of, 123–125 for school-age activity, 66 bodily fluids, preventing exposure to, 123–125 during sleep, 3 policies for use of, 387–388, 393 for swimming, wading, and water play, 6–7 toothbrushing and, 109 for toddlers, 3 training in, 17 touch, 7 Standing orders guidance, 153 Supervision during transportation, child:staff ratio and, 6 Staphylococcus aureus skin infections including MRSA, 342–343 Supplies State child abuse registries in background screening, 10 for bathrooms and handwashing sinks, 276 State early childhood advisory council, 431–432 first aid and emergency, 274–275 State health department microfiber cloths, rags, and disposable towels and mops used for cleaning, interaction with, concerning infectious diseases, 353 276 role of, 444–448 single service cups, 275–276 State law, whistle-blower protection under, 444 Support networks for, family child care, 20–21 State statute support of regulatory enforcement, 429 Support services for parents/guardians, 83–84 Stationary activity centers, 258 Suspensions, 76–78 Statutory authorization of on-site inspections, 442 Swaddling, 105 Steps and stairs, 221–222 Swimming St. Louis encephalitis, 242–243 CPR training for, 27–28 supervision for, 6–7

596 guardrails and protective barriers for, 223 housing of child care units for, 214 Index importance of low child:staff ratios for, 3 interactions with caregivers/teachers, 60–61 Swimming pools limiting time in crib, high chair, car seat, etc, 69–70 accessibility to aboveground, 298 nutrition for behavior around, 73 deck surface, 299 encouraging self-feeding by older, 186 drain covers, 299 meal and snack patterns for, 184–185 electrical safety for areas, 301 serving size for, 185–186 equipment, 300 outdoor play of, 97 hot tubs, spas, and saunas in areas around, 302 personal caregiver/teacher relationships for, 59–60 maintenance, 301 preventing entry to toilet rooms by, 261–262 safety covers for, 298 sensory table materials and, 294 safety rules, 299 separation of, from older children, 62 supervision of pool pump, 300 short structured activities for, 97 water quality of, 302 space and activity to support learning of, 61–62 water temperature, 301 supervision for, 3 swimming pools risk for, 71–72 Swings, clearance space for, 292, 544–546 toilet height for, 262 Syrup of Ipecac, 275 toilet learning/training, 62–63 Toilet and handwashing areas T ability to open toilet room doors, 261 chemical toilets, 262 Tablet computer time. See Screen time cleaning and disinfection, 263 Tableware and feeding utensils, 189 general requirements for, 261 Tamper-resistant electrical outlets, 233 handwashing sinks, 264 Teacher aides learning/training equipment, 263 location of toilets and privacy issues, 261 assistant teachers and, 13–14 mop sinks, 264–265 qualifications for, 13–14 preventing entry to toilet rooms by infants and toddlers, 261–262 Technical assistance prohibited uses of handwashing sinks, 264 to facilities to address diversity in community, 439 ratios of toilets, urinals, and hand sinks to children, 262–263 from licensing agency, 435–439 waste receptacles in child care facility and in child care facility toilet Telephone, availability and use of, 70–71, 259–260 rooms, 263 Television exposure/time. See Screen time Toilet learning/training equipment, 263 Temperature Toilet rooms of bottles and infant foods, 182 ability to open door of, 261 of foods, 198–199, 512 preventing entry to, by infants and toddlers, 261–262 human, 95, 99, 141–142 Toilets indoor, 225–226 chemical, 262 interior of vehicles, 312 cleaning and disinfecting, 263 for laundering, 268 location of, 261 of swimming pool water, 301 ratios of, to children, 262–263 thermometers for taking human, 146 use of, 69 wind chill, 99 Toilet training, changing children’s soiled underwear/pull-ups and clothing Temporary Assistance for Needy Families (TANF), 38 Termination of child attending facility. See Expulsions and, 115–117 Therapeutic equipment, 260 Tongue thrust, dietary modifications and, 169 Therapy services, space for, 272–273 Tooth brushing, 108 Thermometers Toothpaste, 108, 109 for taking human temperatures, 146 Touch supervision, 7 type and placement of room, 228 Towels Threatening incidents, written plan and training for handling urgent medical for cleaning, 276 care or, 393–394 for handwashing, 119 Three- to five-year-olds. See Preschool-age children storage as personal article, 273 Thrush (candidiasis), 344 Toxic substances Ticks informing staff regarding presence of, 244–245 poisonous plants. See Poisonous plants protecting children from, 136–138 policies prohibiting, 391–392 removal of, 137 prevention and management of, 243–244 Tinea capitis and tinea cruris (ringworm), 342 Title V, 38 carbon monoxide detectors, 245–246 Tobacco chemicals used to control odors, 249–250 child care facilities, use in, 127 construction and remodeling during hours of operation, 252–253 drug use and, 86, 127–128 exposure to asbestos or other friable materials, 246–247 policies prohibiting, 391–392 informing staff regarding presence of toxic substances, 244–245 staff compliance with policies regarding, 86 plastic containers and toys, 248–249 Toddlers prohibition of poisonous plants, 249 caregivers’/teachers’ qualifications for serving, 12–16 proper use of art and craft materials, 247 child:staff ratio for, 3–4 radon concentrations, 245 cleaning of individual bedding for, 126–127 shoes in infant play areas, 252 encouraging self-feeding by older, 186

testing for lead, 251–252 597 treatment of chromated copper arsenate (CCA) pressure-treated wood, 250–251 Index use and storage of toxic substances, 243 use of play dough and other manipulative art of sensory materials, Tummy time for infants, 97–98 247–248 TV time. See Screen time use of poison center, 244 Twenty-four–hour care. See Evening child care; Nighttime child care use and storage of, 243–244 Toxoplasmosis, 293 U congenital, 131 Toys Underwear, changing soiled, 115–117 cleaning and sanitizing, 126 Uniform categories and definitions, 440–441 crib, 304–305 Unimmunized children, 318–319 inaccessibility of, or objects to children under three years of age, 303–304 Universal precautions. See Standard Precautions projectile, 305 Unrelated business in child care area, 214 riding, with wheels and wheeled equipment, 305–306 Unscheduled access, to rest areas, 107–108 sleep policy regarding, 102 Unspecified respiratory tract infection, 331–332 surfaces of, 254–255 Training attendance of children with, 331–332 of caregivers/teachers, 448–449 Urgent care, review of written plan for, 394 on administering medications, 154–155 Urinals, ratios of, to children, 262–263 on care of children with special health care needs, 24–25 Use zone for fixed play equipment, 291 on emergency/disaster planning and response, 394–397 Utensils, tableware and feeding, 189 on first aid and CPR, 26 on food handling, 31–32 V on health topics, 88–89 pre-service, 21–23 Vaccines. See Immunizations on safe sleep practices, 102–103 Varicella-zoster (chickenpox) virus, 351–352 documentation of child care training visits, 416–417 of licensing personnel about child abuse, 440 exclusion of children with, 351–352 licensing staff, 439–440 notification record of, 425–426 Training time and professional development leave, 33–34 of parents/guardians, 156, 351 Transition plan, format for, 378 of staff, 351 Transitions, 377–379 staff exclusion and, 145 exchange of information at, 379 temporary exclusion of children and, 143 format for, 378 Vector-borne diseases, protection from, 136–138 planning for child’s, to new services, 377–378 Vegetarian/vegan diets, 173 Transportation Vehicles child behavior during, 312 idling vehicles, 309 distractions while driving, 312–313 interior temperature of, 312 food safety during, 207 passenger vans, 313–314 interior temperature of vehicles, 312 Ventilation, 224–230 passenger vans, 313–314 to control odors, 227 policies, 403 over cooking surfaces, 100 for centers, 402 of recently carpeted or paneled areas, 226–227 for large family child care homes, 402 screens for openings, 218 for small family child care homes, 402 storage area and, 278 qualifications for drivers, 308–309 when using art materials, 226 route to emergency medical services, 313 Verbal interaction, 59 Transportation safety Video time. See Screen time child passenger safety, 310–311 Visibility of outdoor play area, 285 drop-off and pick-up, 309–310 Visits, parents/guardians, 81–82 Transportation staff, competence and training of, 307–308 Volatile organic compounds (VOCs), 252–253 Trash. See Garbage Voluntary records, maintenance and content of, 424–425 Trauma, abusive head, preventing and identifying, 133–134 Volunteers Tree nut allergy, need for epinephrine and, 171 age of, 34 Tremolite, 293 assistant teachers and, 13–14 Tube feeding, 140, 169 illness of, 44 Tuberculin skin test (TST), 330–331 qualifications for, 13–14 Tuberculosis, 330–331 Vomiting attendance of children with latent infection or active disease, 331 staff exclusion and, 145 measures for detection, control, and reporting of, 330–331 temporary exclusion of children and, 143 notification of parents/guardians, 156 staff exclusion and, 145 W temporary exclusion of children and, 143 Wading, supervision for, 6–7 Wading pools, portable, 303 Walking surfaces, 223 Walkways construction and maintenance of, 223 designated, 222 Walls, 256–257 Warm weather, outdoor play in, 99 Waste containers, labeling, cleaning, and disposal of, 241 Waste receptacles in child care facility and in child care facility toilet rooms, 263 Wastes, storage and disposal of infectious and toxic, 241

598 Water test results, 237 Water-tightness of opening, 217 Index Weather-tightness of opening, 217 Weight management, physical activity and, 161 Water Western equine encephalitis, 242–243 access to safety around bodies of, 297–298 West Nile virus, 242–243 availability of drinking, 167 Wheeled vehicles, areas used by children for, 223 bodies of, location of play areas near, 286 Wheels and wheeled equipment, riding toys with, 305–306 bottled, 237 Whistle-blower protection, under state law, 444 in containers, 303 Whooping cough, 319, 320, 326–328. See also Pertussis emergency safe drinking, 237 Wind chill advisory, 99 handling and treatment equipment, 238 Wind chill temperature, 99 handwashing sink using portable supply, 238 Windows heating devices and temperature allowed, 229–230 location of electrical devices near, 234 covering cords as strangulation hazard, 138 location of play areas near bodies of, 286 possibility of exit from, 217–218 supervision near bodies of, 71–72 Wireless communication device, availability and use of, 259–260 supply of, for disaster, 204 Wood/corn pellet stoves, 229 testing for lead and copper levels in drinking, 236–237 Wood frame construction, buildings of, 214 testing of drinking, not from public system, 236 Written daily activity plan and statement of principles, 51 Written discipline policies, 377 Water play Written plan and training for handling urgent medical care or threatening CPR training for, 27–28 supervision for, 6–7 incidents, 393–394 Water play areas Z access to and safety around bodies of water, 297–298 hot tubs, spas, and saunas, 302 Zika virus, 137 portable wading pools, 303 Zoning, 415 Water play tables, 293–294 Water-related injuries, circumstances surrounding, 7 Water supply, 235–236 Water temperature for laundering, location of laundry equipment and, 268

Caring for Our Children National Health and Safety Performance Standards Guidelines for Early Care and Education Programs, 4th Edition A Joint Collaborative Project of American Academy of Pediatrics American Public Health Association National Resource Center for Health and Safety in Child Care and Early Education Every day millions of children attend early care and These national standards represent the best evidence, education programs. It is critical that they have the expertise, and experience in the country on quality opportunity to grow and learn in healthy and safe health and safety practices and policies that should environments with caring and professional be followed in today’s early care and education caregivers/teachers. settings. The American Academy of Pediatrics, the American Substantially revised and updated, the fourth edition Public Health Association, and the National Resource features 10 chapters of more than 650 standards and Center for Health and Safety in Child Care and Early dozens of appendixes with valuable supplemental Education are pleased to release the fourth edition of information, forms, and tools. Caring for Our Children: National Health and Safety Performance Standards; Guidelines for Early Care Key Features and Education Programs. ä More than 100 updated standards Topics Include ä Updated appendixes, including Signs and ä Staffing Symptoms Chart, recommended immunization ä Program Activities for Healthy Development schedules, and “Recommendations for Preventive ä Health Promotion and Protection Pediatric Health Care” ä Nutrition and Food Service ä Facilities, Supplies, Equipment, and Environmental Health ä Many revisions and updates in environmental health, ä Play Areas/Playgrounds and Transportation infectious diseases, and nutrition ä Infectious Diseases ä Children with Special Health Care Needs and Disabilities ä Administration ä Licensing and Community Action And more…