promoting a healthy environment for children coursework

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Promoting a healthy environment for children coursework charles lamb essayist pen name

Promoting a healthy environment for children coursework

Sunscreen is needed on cloudy days and in the winter at high altitudes. Sun reflects off water, snow, sand, and concrete. UVA protection is designated by a star rating system, with four stars the highest allowed in an over-the-counter product. Sunscreen should be applied thirty minutes before going outdoors as it needs time to absorb into the skin.

If the children will be out for more than one hour, sunscreen will need to be reapplied every two hours as it can wear off. If children are playing in water, reapplication will be needed more frequently. Children should also be protected from the sun by using shade and sun protective clothing. Exposure to UV light is highest near the equator, at high altitudes, during midday 10 AM to 4 PM , and where light is reflected off water or snow 5.

Sunscreen needs to be applied every two hours because it wears off after swimming, sweating, or just from absorbing into the skin 1. There is a theoretical concern that daily sunscreen use will lower vitamin D levels. UV radiation from sun exposure causes the important first step in converting vitamin D in the skin into a usable form for the body. Current medical research on this topic is not definitive, but there does not appear to be a link between daily normal sunscreen use and lower vitamin D levels 7.

This is probably because the vitamin D conversion can still occur with sunscreen use at lower levels of UV exposure, before the skin becomes pink or tan. However, vitamin D levels can be influenced significantly by amount of sun exposure, time of the day, amount of protective clothing, skin color and geographic location 8. These factors make it difficult to apply a safe sunscreen policy for all settings. A health consultant may assist the program develop a local sunscreen policy that may differ from above if there is a significant public health concern regarding low vitamin D levels.

Most insects do not carry human disease and most insect bites only cause mild irritation. Insect repellents may be used with children older than 2 months in child care where there are specific disease outbreaks and alerts. It does not require written permission from a primary care provider.

Most product labels for registrations containing DEET recommend consultation with a physician if applying to a child less than six months of age. Do not use products that combine insect repellent and sunscreen. This is because sunscreen may need to be re-applied more often and in larger amounts than repellent.

Sunscreens may increase absorption of DEET through the skin. Other Types of Insect Repellents Picaridin and IR are other products registered at the Environmental Protection Agency EPA identified as providing repellent activity sufficient to help people avoid the bites of disease carrying mosquitoes 4. Para-menthane-diol PMD or pil of lemon eucalyptus products, according to their product labels, should NOT be used on children under three years of age 4,5.

General Guidelines for Use of Insect Repellents with Children As noted above, insect repellents may be applied to children older than two months. When applying insect repellent on a child, use just enough to cover exposed skin. Do not apply under clothing. Avoid applying to areas around the eyes and mouth.

Do not use over cuts or irritated skin. Do not use near food. After returning indoors, wash treated skin immediately with soap and water. If the child gets a rash or other skin reaction from an insect repellent, stop using the repellent, wash the repellent off with mild soap and water, and call a local poison center for further guidance 4. Remove leaf litter and clear tall grasses and brush around homes and buildings and at the edges of lawns; b.

Place wood chips or gravel between lawns and wooded areas to restrict tick migration to recreational areas; c. Mow the lawn and clear brush and leaf litter frequently; d. Keep playground equipment, decks, and patios away from yard edges and trees; e. Ensure that children wear light colored clothing, long sleeves and pants, tuck pants into socks; and f. Conduct tick checks of children when returning indoors 7. How to Remove a Tick 8 : It is important to remove the tick as soon as possible.

Use the following steps: a. If possible, clean the area with an antiseptic solution or soap and water. Take care not to scrub the tick too hard. Just clean the skin around it; b. Use blunt, fine tipped tweezers or gloved fingers to grasp the tick as close to the skin as possible; c. Pull slowly and steadily upwards to allow the tick to release; d.

Wash the area around the bite with soap; f. Following the removal of the tick, wash your hands, the tweezers, and the area thoroughly with soap and warm water. Take care not to do the following: a. Do not use sharp tweezers. Do not use a twisting or jerking motion to remove the tick. Do not handle the tick with bare hands. Do not try to make the tick let go by holding a hot match or cigarette close to it. Do not try to smother the tick by covering it with petroleum jelly or nail polish.

Any child who meets these criteria should have a Routine and Emergent Care Plan completed by their primary care provider in their medical home. In addition to the information specified in Standard 9. A template for a Care Plan for children with special health care needs is provided in Appendix O.

The Care Plan should be updated after every hospitalization or significant change in health status of the child. The child care health consultant should be involved to assure adequate information, training, and monitoring is available for child care staff. Child care health consultants are very helpful in assisting in implementing Care Plans and in providing or finding training resources. For additional information on care plans and approaches for the most prevalent chronic diseases in child care see the following resources:.

Digital thermometers should be used with infants and young children when there is a concern for fever. Tympanic ear thermometers may be used with children four months and older. Glass or mercury thermometers should not be used. Mercury containing thermometers and any waste created from the cleanup of a broken thermometer should be disposed of at a household hazardous waste collection facility.

Oral under the tongue temperatures can be used for children over age four. Types of Thermometers for Child Care. Mercury thermometers can break and result in mercury toxicity that can lead to neurologic injury. To prevent mercury toxicity, the American Academy of Pediatrics AAP encourages the removal of mercury thermometers from homes. This includes all child care settings as well 1. Although not a hazard, temporal thermometers are not as accurate as digital thermometers 2.

Safety and child abuse concerns may arise when using rectal thermometers. Many state or local agencies operate facilities that collect used mercury thermometers. Typically, the service is free. For more information on household hazardous waste collections in your area, call your State environmental protection agency or your local health department.

Any prescription medication should be dated and kept in the original container. The container should be labeled by a pharmacist with:. All medications, refrigerated or unrefrigerated, should:. Medication should not be used beyond the date of expiration. In the event medication cannot be returned to the parent or guardian, it should be disposed of according to the recommendations of the US Food and Drug Administration FDA 1.

Documentation should be kept with the child care facility of all disposed medications. The current guidelines are as follows:. Proper disposal of medications is important to help ensure a healthy environment for children in our communities. There is growing evidence that throwing out or flushing medications into our sewer systems may have harmful effects on the environment Content in this standard was modified on August 23, and November 10, All children should be monitored to prevent them from eating substances that do not provide nutrition often referred to as pica 1,2.

Question: I cannot find any information in the new CFOC as to how long a bottle of breast milk can be kept after it is fed to an infant. It states that a bottle of formula should be discarded after one hour. I would think that it should be the same, since saliva is introduced into the bottle regardless of its contents, but I want to make sure. Can you offer some guidance? Both re-sources state that breast milk should be discarded after it is fed to an infant. Expressed human milk should be transported and stored in clean and sanitary bottles with nipples that fit tightly or in equivalent clean and sanitary sealed containers to prevent spilling during transport to home or to the facility.

Only cleaned and sanitized bottles, or their equivalent, and nipples should be used in feeding. Frozen human milk may be transported and stored in single-use plastic bags and placed in a freezer with a separate door or a stand-alone freezer, and not in a compartment within a refrigerator.

This is especially important when a frozen bottle is thawed in running tap water. There may be several bottles for different children being thawed and warmed at the same time in the same place. Human milk should be thawed in the refrigerator if frozen. If there is insufficient time to thaw the milk in the refrigerator before serving, it may be thawed in a container of warm water, gently swirling the bottle periodically to evenly distribute the temperature in the milk and mix the fat, which may have separated.

Frozen milk should never be thawed in a microwave oven because uneven hot spots in the milk may cause burns in the child and excessive heat may destroy beneficial components of the milk. Although human milk does not need to be warmed, some children prefer their milk warmed to body temperature, around When warming human milk, it is important to keep the container sealed while warming to prevent contamination. Human milk can be warmed. Human milk should never be warmed directly on the stove or in the microwave.

It should feel warm, not hot. Avoid bottles made of plastics containing bisphenol A BPA or phthalates, sometimes labeled with recycling code 3, 6, or 7. Human milk cannot be served if it does not meet the requirements for sanitary and safe milk. Although human milk is a body fluid, it is not necessary to wear gloves when feeding or handling human milk.

Some infants around 6 months to 1 year of age may be developmentally ready to feed themselves and may want to drink from a cup. There are many different factors that can affect how long human milk can be stored in various locations, such as storage temperature, temperature fluctuations, and cleanliness while expressing and handling human milk.

These factors make it difficult to recommend exact times for storing human milk in various locations, but the Human Milk Storage Guidelines table can be helpful. By following this standard, early care and education staff is able, when necessary, to prepare human milk and feed a child safely, thereby reducing the risk of inaccuracy or feeding the child unsanitary or incorrect human milk.

The formula should be of the same brand that is served at home and should be of ready-to-feed strength or liquid concentrate to be diluted using cold water from a source approved by the health department. Powdered infant formula, though it is the least expensive formula, requires special handling in mixing because it cannot be sterilized. Before opening the can, hands should be washed.

The can and plastic lid should be thoroughly rinsed and dried. Also, a scoop can be contaminated with a potential allergen from another type of formula. Iron-fortified formula should be refrigerated until immediately before feeding. For bottles containing formula, any contents remaining after a feeding should be discarded.

Any prepared formula must be discarded within one hour after serving to an infant. Some infants will require specialized formula because of allergy, inability to digest certain formulas, or need for extra calories. The appropriate formula should always be available and should be fed as directed. For those infants getting supplemental calories, the formula may be prepared in a different way from the directions on the container.

Formula should not be used beyond the stated shelf life period 3. The bottles must be sanitary, properly prepared and stored, and must be the same brand in the early care and education program and at home. Avoid bottles made of plastics containing bisphenol A BPA or phthalates sometimes labeled with 3, 6, or 7. Use glass bottles with a silicone sleeve a silicone bottle jacket to prevent breakage or those made with safer plastics such as polypropylene or polyethylene labeled BPA-free or plastics with a recycling code of 1, 2, 4, or 5.

Question: I have concerns about the standards recommending glass and ceramic containers due to concerns about using plastic. I had a center that had a glass bottle drop and shatter in their infant room. Answer: BPA-free plastic bottles, those labeled 1, 2, 4, or 5, can be used to avoid the use of glass.

For those child care and early education facilities that choose to use glass bottles, a relatively new option is to use a bottle sleeve with the glass bottle to reduce the risk of shattered glass. Efficacy on this product is still being proven. Overall, glass is safer than plastic with BPA. Bottles and infant foods do not have to be warmed; they can be served cold from the refrigerator. Bottles should not be left in a pot of water to warm for more than 5 minutes.

Infant foods should be stirred carefully to distribute the heat evenly. Bottles used for infant feeding should be made of the following substances 3 :. Bisphenol A BPA -free plastic; plastic labeled 1, 2, 4, or 5, or. Bottles of human milk or infant formula that are warmed at room temperature or in warm water for an inappropriate period provide an ideal medium for bacteria to grow.

Infants have received burns from hot water dripping from an infant bottle that was removed from a crock-pot or by pulling the crock-pot down on themselves by means of a dangling cord. Caution should be exercised to avoid raising the water temperature above a safe level for warming infant formula or infant food. Food safety for moms to be: once baby arrives. Updated November 8, Pediatric oral burns: a ten-year review of patient characteristics, etiologies and treatment outcomes.

Int J Pediatr Otorhinolaryngol. Environmental Working Group. Guide to baby-safe bottles and formula. Updated October, Tableware and feeding utensils should meet the following requirements:. Food should not be put directly on the table surface for two reasons. First, even washed and sanitized tables are more likely to be contaminated than disposable plates or washed and sanitized dishes. Second, eating from plates reduces contamination of the table surface when children put down their partially eaten food while they are eating.

Although highchair trays can be considered tables, they function as plates for seated children. The tray should be washed and sanitized before and after use 4. The use of disposable items eliminates the spread of contamination and disease and fosters safety and injury prevention. Single-service items are usually porous and should not be washed and reused. Items intended for reuse must be capable of being washed, rinsed, and sanitized. Medium-weight plastic should be chosen because lighter-weight plastic utensils are more likely to have sharp edges and break off small pieces easily.

Older children can cut their mouth tissues in the same way. Foam can break into pieces that can become choking hazards for young children. Imported dishware may be improperly fired and may release toxic levels of lead into food. There is no safe level of lead in dishware. If there is a question about whether tableware is safe and sanitary, consult the regulatory health authority or local health department.

In centers using commercial cooking equipment to prepare meals, ventilation should be equipped with an exhaust system in compliance with the applicable building, mechanical, and fire codes. These codes may vary slightly with each locale, and centers are responsible to ensure their facilities meet the requirements of these codes All gas ranges in centers should be mechanically vented and fumes filtered prior to discharge to the outside.

All vents and filters should be maintained free of grease build-up and food spatters, and in good repair. An exhaust system must collect fumes and grease-laden vapors properly at their source. Proper construction of the exhaust system duct-work assures that grease and other build-up can be easily accessed and cleaned.

If the odor of gas is present when the pilot lights are on, turn off gas and immediately call a qualified gas technician, commercial gas provider, or local gas, electric or utility provider. Never use an open flame to locate a gas leak. Microwave ovens should be inaccessible to all children, with the exception of school-age children under close adult supervision. Any microwave oven in use in a child care facility should be manufactured after October and should be in good condition.

While the microwave is being used, it should not be left unattended. Question: I am hoping to get some clarification on the amount of bleach to use when washing dishes in a three compartment sink. While the standard says: If the facility does not use a dishwasher, reusable food service equipment and eating utensils should be first scraped to remove any leftover food, washed thoroughly in hot water containing a detergent solution, rinsed, and then sanitized by one of the following methods: a.

The sanitized items should be air-dried; Can you clarify which measurement needs to be used in the three compartment sink method? Answer: The sanitizing solution referenced in Standard 4. If the facility does not use a dishwasher, reusable food service equipment and eating utensils should be first scraped to remove any leftover food, washed thoroughly in hot water containing a detergent solution, rinsed, and then sanitized by one of the following methods:.

Often, sponges are used in private homes when washing dishes. The structure of natural and artificial sponges provides an environment in which microorganisms thrive. This may contribute to the microbial load in the wash water. Nevertheless, the rinsing and sanitizing process should eliminate any pathogens contributed by a sponge.

When possible, a cloth that can be laundered should be used instead of a sponge. The concentration of bleach used for sanitizing dishes is much more diluted than the concentration recommended for disinfecting surfaces elsewhere in the facility. After washing and rinsing the dishes, the amount of infectious material on the dishes should be small enough so that the two minutes of immersion in the bleach solution or treatment with an EPA-registered sanitizer combined with air-drying will reduce the number of microorganisms to safe levels.

Air-drying of surfaces that have been sanitized using bleach leaves no residue, since chlorine evaporates when the solution dries. However, other sanitizers may need to be rinsed off to remove retained chemical from surfaces. Before an early care and education ECE space is made accessible to children, a qualified inspector should ensure compliance with applicable building and fire codes for all newly constructed, renovated, remodeled, or altered buildings.

ECE programs should follow all applicable local and state requirements. Inspections of facilities are used to help make sure that the space is safe for occupants. Building and fire code inspections help ensure compliance with critical structural and fire safety concerns. Inspections are especially important for older buildings or spaces that were not previously used for child care and that might contain materials that, when present or disturbed, can be hazardous for children.

When facilities are inspected prior to beginning operations and before and after renovation or construction activities, the risks of exposure to potential environmental hazards are lessened. For example, floor tiles with asbestos would need to be properly handled during renovations to avoid releasing asbestos into the space. In addition, past use of the site may have left remaining environmental health hazards, such as chemicals in soil or groundwater, which could still be present.

Thus, in addition to fire and building code inspections, assessing the facility for the presence of environmental hazards is important to identify potential contaminants that need to be addressed before children are exposed. State and local health agencies may provide information about a range of environmental health hazards, assess facilities, and help answer questions about concerns that are identified in a facility assessment.

US Environmental Protection Agency. Information for owners and managers of buildings that contain asbestos. Renovation and demolition requirements. Updated December 19, Accessed March 9, Agency for Toxic Substances and Disease Registry. Reviewed October 30, Public Health Rep. Question: Has the recommendation for minimum distance between a playground site and hazards, such as electrical transformers and high voltage power lines changed since the CFOC, 2 nd Ed.

Answer: Yes, specific distances are no longer recommended as distances may differ according to local municipalities and states. Please consult your local ordinance for appropriate information. An assessment of the environment at an early care and education site location should be conducted before children receive care at the site.

This includes assessment of the site prior to occupying an existing building, before renovating or constructing a building, and after a natural disaster. The assessment of the environment should evaluate safety hazards; potential environmental exposures from air, water, drinking water, and soil contamination; and noise.

The assessment should include consideration of. Guidance for environmental assessments is available. Consider consulting with environmental health professionals, such as the state or county health department. State environmental agencies can also be important resources, particularly with regard to assessment, sampling, and mitigation. Keep on file any documentation of the site assessment, sampling, and remediation actions taken.

A range of potential environmental exposures may exist. These include air pollution from nearby industries, businesses, or busy roadways; noise from an airport; drinking water contaminants; and contaminants in the soil such as arsenic, lead, or pesticides from past site use. C ontamination in the soil or groundwater may enter indoor air spaces through a process known as vapor intrusion. For example, a smelter may affect a larger area than a dry cleaner.

Children can be exposed to harmful substances contained in the indoor and outdoor air they breathe and water they drink. Additionally, children can be exposed to harmful substances in soil or dust when they play on the ground. Children have higher exposures to some harmful substances than adults due to their unique behavior, such as crawling and hand-to-mouth activity. They also eat, drink, and breathe more than adults do relative to their body size.

In addition, children are much more vulnerable to harm from exposures to contaminated materials than adults because their bodies and organ systems are still developing. Disruption of this development could result in permanent damage with lifelong health and developmental consequences. Methods to identify risks include reviewing the property history and understanding what the site was used for in the past, reviewing maps and records to determine what activities and contaminants may be nearby, visiting the site to look for indications of hazards and potential environmental exposures, reviewing environmental investigation and remediation reports previously prepared for the site, and consulting federal or state environmental agency staff about the regulatory status of the site.

Awareness of site-related environmental health risks and actions to mitigate or avoid those risks can reduce exposure to hazards that adversely affect health and development. Options to reduce risk may include reducing migration of hazardous substances to non-harmful levels or choosing a different location for the early care and education facility. Another example is an early care and education facility proposed to be built on former agricultural land that has soil contamination from past pesticide use.

To mitigate the potential exposure to chemicals in the soil, the contaminated soil could be removed, covered with pavement or artificial turf, or made inaccessible to children. State or local environmental health programs may be able to help answer questions about identified concerns. In addition, guidance and tools have been created to assist in conducting assessments. The Agency for Toxic Substances and Disease Registry Choose Safe Places for Early Care and Education program has guidance to help ensure that environmental exposures are considered for early care and education facilities where children spend time.

Eco-Healthy Child Care. Safe siting of child care facilities. Accessed August 21, Choose safe places for early care and education. Reviewed March 6, School Siting Guidelines. Pediatric Environmental Health. Environmental Law Institute. Published May Every exterior wall, roof, and foundation should be structurally sound, weathertight, and watertight, in compliance with applicable building codes.

Every interior floor, wall, staircase, and ceiling should be structurally sound and finished in compliance with applicable building codes. The structural soundness of an early care and education program is important for preventing injuries and providing protection from weather and natural disasters. A weathertight and watertight building not only helps preserve the building elements but is also important for maintaining indoor temperatures in acceptable ranges, limiting the entry of pests, and preventing water intrusion that can lead to excessive dampness and mold contamination.

Early care and education programs sometimes use older buildings or buildings originally designed for other purposes. Whole Building Design Guide. National Institute of Building Sciences. Updated September 28, Occupant Safety and Health. Updated January 13, Reviewed December 4, Finished basements or areas that are partially below grade may be used for children who independently ambulate and who are two years of age or older, if the space is in compliance with applicable building and fire codes.

Environmental health factors may be reviewed with county or city public health departments. Child care areas should not be used for any business or purpose unrelated to providing child care when children are present in these areas. If unrelated business is conducted in child care areas when the child care facility is not in operation, activities associated with such business should not leave any residue in the air or on the surfaces, or leave behind materials or equipment, that could be harmful to children.

Rooms or spaces that are used for the following activities or operations should be separated from the child care areas and the egress route should not pass through such spaces:. Areas that have combustibles should be protected by fire-resistant barriers. The egress route and the fire-resistant separation should be approved by the appropriate regulatory agencies responsible for building and fire inspections.

In small and large family child care homes, a fire-resistant separation should not be required where the food preparation kitchen contains only a domestic cooking range and the preparation of food does not result in smoke or grease-laden vapors escaping into indoor areas. Where separation is provided between the egress route and the hazardous area, it should be safe to use such route, but egress should not require passage through the hazardous area.

Cleaning agents must be inaccessible to children out of reach and behind locked doors. Food preparation surfaces must be separate from diaper changing areas including sinks for handwashing. Children must be restricted from access to the stove when cooking surfaces are hot. Each window, exterior door, and basement or cellar hatchway should be weather-tight and water-tight when closed. As much fresh outdoor air as possible should be provided in rooms occupied by children.

Screened windows should be opened whenever weather and the outdoor air quality permits or when children are out of the room 1. When windows are not kept open, rooms should be ventilated, as specified in Standards 5. The rate depends on the activities that normally occur in that room. Indoor air should be kept as free from unnecessary chemicals as possible, including those emitted from air fresheners and other fragrances, cleaning products containing chemicals, aerosol sprays, and some furnishings.

The health and well-being of both the staff and the children can be greatly affected by indoor air quality. The air people breathe inside a building is contaminated with micorbes shared among occupants, chemicals emitted from common consumer products and furnishings, and migration of polluted outdoor air into the facility. Sometimes the indoor air is more polluted than the outdoor air. Air quality significantly impacts people's health.

The health impacts from exposure to air pollution indoor and outdoor can include: decreased lung function, asthma, bronchitis, emphysema, learning and behavioral disabilities, and even some types of cancer. Children are particularly vulnerable to air pollution because their organ systems respiratory, central nervous system, etc. Indoor air pollution is often greater than outdoor levels of air pollution due to a general lack of adequate air filtration and ventilation, and lingering and build up of air contaminants emitted from certain long-term furnishings 2.

The presence of dirt, moisture, and warmth encourages the growth of mold and other contaminants, which can trigger allergic reactions and asthma 3. Children who spend long hours breathing contaminated or polluted indoor air are more likely to develop respiratory problems, allergies, and asthma 2,4,5. Although insultation of a building is important in reducing heating or cooling costs, it is unwise to try to seal the building completely.

Air circulation is essential to clear infectious disease agents, odors, and toxic substances in the air. Levels of carbon dioxide are an indicator of the quality of ventilation. Air circulation can be adjusted by a properly installed and adjusted heating, ventilation, air conditioning, and cooling HVAC system as well as by using fans and open windows.

Qualified engineers can ensure heating, ventilation, air conditioning HVAC systems are functioning properly and that applicable standards are being met. Indoor air quality is important to all children and early care and education staff. All rooms that children use should be heated and cooled to maintain the required temperatures and humidity. The system should be operated in accordance with operating instructions and be certified that it meets the local building code by a representative of the agency that administers the building code.

Documentation of these inspections and certification of safety should be kept on file in the facility. Areas where arts and crafts activities are conducted should be well-ventilated. Materials that create toxic fumes or gases such as spray adhesives and paints should not be used when children are present.

Doors and windows should be opened in areas that have been recently carpeted or paneled using adhesives until the odors are no longer present. Window fans, room air conditioners, or other means to exhaust emission to the outdoors should be used.

Odors in toilets, bathrooms, diaper changing areas, and other inhabited areas of the facility should be controlled by ventilation and appropriate cleaning and disinfecting. Toilets and bathrooms, janitorial closets, and rooms with utility sinks or where wet mops and chemicals are stored should be mechanically ventilated to the outdoors with local exhaust mechanical ventilation to control and remove odors in accordance with local building codes.

Air fresheners or sanitizers both manmade and natural should not be used. Unvented gas or oil heaters and portable open-flame kerosene space heaters should be prohibited. Gas cooking appliances, including portable gas stoves, should not be used for heating purposes. Charcoal grills should not be used for space heating or any other indoor purposes. Many burns have been caused by contact with space heaters and other hot surfaces such as charcoal and gas grills 1.

If charcoal grills are used outside, adequate staff ratios must be maintained and the person operating the grill should not be counted in the ratio. The front opening should be equipped with a secure and stable protective safety screen. The facility should clean the chimney as necessary to prevent excessive build-up of burn residues or smoke products in the chimney.

Heating equipment is the second leading cause of ignition of fatal house fires 1. This equipment can become very hot when in use, potentially causing significant burns. If humidifiers or dehumidifiers are used to maintain humidity, as specified in Standard 5.

Natural lighting should be provided in rooms where children work and play for more than two hours at a time. The following guidelines should be used for levels of illumination:. Natural lighting is the most desirable lighting of all. Natural lighting provided by sky lights exposes children to variations in light during the day that is less perceptually stimulating than eye-level windows, but is still preferable to artificial lighting.

A study on school performance shows that elementary school children seem to learn better in classrooms with substantial daylight and the opportunity for natural ventilation 4. Lighting levels should be reduced during nap times to promote resting or napping behavior in children. During napping and rest periods, some degree of illumination must be allowed to ensure that staff can continue to observe children.

While decreased illumination for sleeping and napping areas is a reasonable standard when all the children are resting, this standard must not prevent support of individualized sleep schedules that are essential for infants and may be required by other children from time to time.

Contact the lighting or home service department of the local electric utility company to have foot-candles measured. High intensity discharge lamps, multi-vapor, and mercury lamps should not be used for lighting the interior of buildings unless provided with special bulbs that self-extinguish if the outer glass envelope is broken. These measures include noncombustible acoustical ceiling, rugs, wall covering, partitions, or draperies, or a combination thereof.

Although noise sources may be located outside the child care facility, sometimes the noise source is related to the design of the child care spaces within the facility. While carpets can help reduce the level of noise, they can absorb moisture and serve as a place for microorganisms to grow. Area rugs should be considered instead of carpet because they can be taken up and washed often. Area rugs should be secured with a non-slip mat or other method to prevent tripping hazards.

For further assistance on finding an acoustical engineer, contact the Acoustical Society of America. In centers with new installations, a smoke detection system such as hard-wired system detectors with battery back-up system and control panel or monitored wireless battery operated detectors that automatically signal an alarm through a central control panel when the battery is low or when the detector is triggered by a hazardous condition should be installed with placement of the smoke detectors in the following areas:.

In large and small family child care homes, smoke alarms that receive their operating power from the building electrical system or are of the wireless signal-monitored-alarm system type should be installed. Battery-operated smoke alarms should be permitted provided that the facility demonstrates to the fire inspector that testing, maintenance, and battery replacement programs ensure reliability of power to the smoke alarms and signaling of a monitored alarm when the battery is low and that retrofitting the facility to connect the smoke alarms to the electrical system would be costly and difficult to achieve.

Facilities with smoke alarms that operate using power from the building electrical system should keep a supply of batteries and battery-operated detectors for use during power outages. The water should be sufficient in quantity and pressure to supply water for cooking, cleaning, drinking, toilets, personal hygiene, water play, and outside uses. Water supplied by a well or other private source should meet all applicable health and safety federal, state, tribal, and local public health standards and should be approved by the local regulatory health authority.

Well water should be tested annually for pH acidity levels to determine whether the water is corrosive and for bacteria, parasites, viruses, and chemical content including, but not limited to, arsenic, radon, methyl tert-butyl ether, lead, nitrates, heavy metals, or other runoff chemicals or according to local regulatory health authority. A water supply that is safe and free from harmful substances and microorganisms and does not spread disease is essential to the health of children enrolled in early care and education programs.

Potential well water contaminants and their impacts. Updated August 8, Accessed May 18, Testing wells to safeguard your water. Drinking water from nonpublic sources includes private or household wells or rainwater collection systems ie, cisterns. Testing of private water supplies should be completed by a state-certified laboratory. Most testing laboratories or services supply their own sample containers. Samples for bacteriologic testing must be collected in sterile containers and under sterile conditions.

Laboratories may sometimes send a trained technician to collect the sample. For more information, contact the local health authority or view the US Environmental Protection Agency list of state certification programs.

After a disaster such as a flood, earthquake, or chemical spill, drinking water systems can become contaminated. Routine or new testing should be done to ensure safe drinking water. Public water systems are responsible for complying with all regulations, including monitoring, reporting, and performing treatment techniques. Environmental Protection Agency and state regulations do not apply to privately owned drinking water systems.

Individual owners and operators of the water system are responsible for ensuring the water is safe. Unsafe water supplies may cause acute illness, such as diarrhea from microorganisms, or other health problems that are harder to identify and have long-lasting health effects.

Chemicals can contaminate nonpublic water supplies from a variety of sources, and water quality testing is often the only way to identify the contamination. Some contamination can come from naturally occurring contaminants, such as arsenic, in groundwater. Other chemicals, such as pesticides, can enter drinking water systems from past or adjacent site use.

Regular testing is valuable because it establishes a record of water quality. A water supply that is safe and free of harmful substances and microorganisms and does not spread disease is essential to the health of children enrolled in early care and education programs.

Contamination of nonpublic drinking water supplies may occur after disasters, and additional or repeat testing of water may be necessary to ensure drinking water quality. State and local health officials may be helpful in determining if water testing is needed after a disaster.

Certification of laboratories for drinking water. Contact information for certification programs and certified laboratories for drinking water. Updated March 26, Drinking water. Private water systems. Reviewed January 17, Drinking water, including water in drinking fountains, should be tested and evaluated in accordance with the assistance of the local health authority or state drinking water program to determine whether lead and copper levels are safe.

It is especially important to test and have safe water at child care facilities because of the amount of time children spend in these facilities. Cold water is less likely to leach lead from the plumbing. Contact your local health department or state drinking water program for information on how to collect samples and for advice on frequency of testing. See also the EPA references below. All water test results should be in written form and kept with other required reports and documents in one central location in the facility, ready for immediate viewing by consumers and regulatory personnel.

Early care and education programs should maintain photocopies of all water-testing results if the business is required to submit reports to the regulatory authority. Children should have constant access to fresh, potable water if the regular approved supply of drinking water is temporarily interrupted. Do not use water that is suspected to be contaminated to wash dishes or toys, brush teeth, wash and prepare food, wash hands, make ice, or make baby formula. Emergency safe drinking water should be supplied during interruption of the regular approved water supply.

Safe water for drinking, cooking, and personal hygiene includes bottled, boiled, or treated water. Do not attempt to drink water that is believed to have been contaminated with fuel or toxic chemicals; boiling and other disinfectants will not work to purify it.

If bottled water is not available, boiling water is the best way to purify drinking supplies and kill disease-carrying bacteria, viruses, and parasites. If boiling water is not an option, use unscented household chlorine bleach, iodine, or chlorine dioxide tablets. Keep in mind that while such methods are effective at killing harmful bacteria and viruses, only chlorine dioxide tablets and boiling will kill disease-carrying parasites.

To purify water using unscented household chlorine bleach, add one-eighth teaspoon for every gallon of clear water and one-fourth teaspoon for every gallon of cloudy water. Stir the water and let it sit for 3 0 minutes before using it. Use bottled water if instructed. Bottled water can be used by early care and education programs, provided that the bottles are kept in the proper environment, and should be stored in a pantry or similar environment free from excessive heat or sunlight for 1 to 2 years.

For this reason, bottlers may voluntarily put expiration dates on their labels. Early care and education programs should keep bottled water away from chemicals and cleaning agents. Commercial bottled water containers should not be used for any purpose other than to hold drinking water. All drinking water containers must be thoroughly washed and sanitized prior to being refilled with drinking water. Flooding, earthquakes, landslides, other natural disasters, or emergencies can affect the safety of drinking water, making it unsafe to consume.

In addition, depending on the geographic location of the program, a written plan, prepared in advance, is important in disaster planning and maintaining the safety and health of children in care. Natural disasters and severe weather. Keep food and water safe after a disaster or emergency. Reviewed February 20, American Public Health Association. Keeping food and water safe in an emergency.

Fact sheet: how to make your water safe to drink. Updated January 3, Making water safe in an emergency. Reviewed February 24, Drink safe water. NSF International. Five facts you should know about bottled water. Published December 19, Newly installed water handling, treatment, filtering, or softening equipment should meet applicable National Sanitation Foundation NSF standards and should be approved by the local regulatory health authority.

The facility should have no cross-connections that could permit contamination of the potable water supply:. Vacuum breakers may be installed as part of the plumbing fixture or are available to attach to the end of a faucet of hose bib.

A sewage system should be provided and inspected in accordance with state and local regulations. Whenever a public sewer is available, the facility should be connected to it. Where public sewers are not available, an on-site sewage system or other method approved by the local public health department should be installed. Raw or treated wastes should not be discharged on the surface of the ground.

The wastewater or septic system drainage field should not be located within the outdoor play area of a child care program, unless the drainage field has been designed by a sanitation engineer with the presence of an outdoor play area in mind and meets the approval of the local health authority. The weight of children or the combined weight of children and playground equipment may cause the drainage field to become compacted, resulting in failure of the system.

Some structures are anchored in concrete, which adds weight. The legs of some equipment, such as swing sets, can puncture the surface of drainage fields. In areas where frequent rains are coupled with high water tables, poor drainage, and flooding, the surface of drainage fields often becomes contaminated with untreated sewage. Staff should consult with the local public health department regarding sewage storage and disposal. Garbage should be kept in containers approved by the regulatory health authority.

Such containers should be constructed of durable metal or other types of material, designed and used so wild and domesticated animals and pests do not have access to the contents, and so they do not leak or absorb liquids. Waste containers should be kept covered with tight-fitting lids or covers when stored. The facility should have a sufficient number of waste and diaper containers to hold all of the garbage and diapers that accumulate between periods of removal from the premises.

Plastic garbage bag liners should be used in such containers. Exterior garbage containers should be stored on an easily cleanable surface. Garbage areas should be free of litter and waste that is not contained. Children should not be allowed access to garbage, waste, and refuse storage areas. If a compactor is used, the surface should be graded to a suitable drain, as approved by the regulatory health authority.

Infectious and toxic wastes should be stored separately from other wastes, and should be disposed of in a manner approved by the regulatory health authority. Facilities should adopt an integrated pest management program IPM to ensure long-term, environmentally sound pest suppression through a range of practices including pest exclusion, sanitation and clutter control, and elimination of conditions that are conducive to pest infestations. IPM is a simple, common-sense approach to pest management that eliminates the root causes of pest problems, providing safe and effective control of insects, weeds, rodents, and other pests while minimizing risks to human health and the environment 2,4.

Pest Prevention: Facilities should prevent pest infestations by ensuring sanitary conditions. This can be done by eliminating pest breeding areas, filling in cracks and crevices; holes in walls, floors, ceilings and water leads; repairing water damage; and removing clutter and rubbish on the premises 5.

Pest Monitoring: Facilities should establish a program for regular pest population monitoring and should keep records of pest sightings and sightings of indicators of the presence of pests e. Pesticide Use: If physical intervention fails to prevent pest infestations, facility managers should ensure that targeted, rather than broadcast applications of pesticides are made, beginning with the products that pose least exposure hazard first, and always using a pesticide applicator who has the licenses or certifications required by state and local laws.

Facility managers should follow all instructions on pesticide product labels and should not apply any pesticide in a manner inconsistent with label instructions. Safety Data Sheets SDS are available from the product manufacturer or a licensed exterminator and should be on file at the facility Facilities should ensure that pesticides are never applied when children are present and that re-entry periods are adhered to.

Facilities should avoid the use of sprays and other volatilizing pesticide formulations. Pesticides should be applied in a manner that prevents skin contact and any other exposure to children or staff members and minimizes odors in occupied areas. Care should be taken to ensure that pesticide applications do not result in pesticide residues accumulating on tables, toys, and items mouthed or handled by children, or on soft surfaces such as carpets, upholstered furniture, or stuffed animals with which children may come in direct contact 3.

Following the use of pesticides, herbicides, fungicides, or other potentially toxic chemicals, the treated area should be ventilated for the period recommended on the product label. A member of the child care staff should directly observe the application to be sure that toxic chemicals are not applied on surfaces with which children or staff may come in contact.

Warning Signs: Child care facilities must post warning signs at each area where pesticides will be applied. These signs must be posted forty-eight hours before and seventy-two hours after applications and should be sufficient to restrict uninformed access to treated areas.

Record Keeping: Child care facilities should keep records of pesticide use at the facility and make the records available to anyone who asks. Record retention requirements vary by state, but federal law requires records to be kept for two years 7. It is a good idea to retain records for a minimum of three years. Pesticide Storage: Pesticides should be stored in their original containers and in a locked room or cabinet accessible only to authorized staff.

No restricted-use pesticides should be stored or used on the premises except by properly licensed persons. Importantly, the researchers found that the teachers in the treatment group spent less than half of their class time on activities from the curriculum. In addition, while these teachers generally implemented the activities, how they interacted with children e. For example, Second Step is a violence prevention curriculum aimed at a wider range of children from ages 4 to Through short 20—minute lessons, classroom management support, and parent training, the program has been found to reduce aggressive behaviors NASEM, b , p.

Across the above interventions, one key ingredient for success appears to be curricula that are intentionally designed to promote targeted skills and strong training and professional development McClelland et al. In addition, when they are effective, they appear to have compensatory effects for those children who live or learn in more challenging or adverse environments.

As described earlier, SEL can encompass a range of skills. Effective curricula or interventions are explicit about which specific skills are targeted and have intentionally designed activities or program components that target those skills. In their meta-analysis of 31 studies that focused on externalizing behaviors, Schindler et al. Durlak et al. Beyond the design of the intervention or curriculum, the support provided to early childhood educators who implement SEL programs also appears to matter.

In their study of Head Start programs, Morris et al. Raver and Gilliam et al. However, Schindler et al. In a qualitative analysis of six statewide or local early childhood mental health consultation programs, Duran et al.

In addition, interventions at the classroom or teacher level are more likely to be effective if they are supported by the leadership and broader culture of the school or ECE program. Effective educators are more able to demonstrate their competencies if they work under supportive leadership and policies IOM and NRC, Finally, it is unclear how critical it is for SEL interventions—whether through a curriculum or consultation—to include a parent education or engagement component.

Many programs do so to ensure that the strategies implemented in the classroom are reinforced at home Duran et al. NASEM, b , p. Unfortunately, the evaluation was not able to disaggregate the impact of the parent engagement component. Other research had ambiguous findings. In one small, quasi-experimental study of the Incredible Years program, Williford and Shelton found that parents in the intervention group were more likely to report the use of effective parenting skills, but they did not observe a significantly lower or different level of disruptive behavior when compared with those in the control group.

The two groups also did not differ in their experience of stress. The researchers posited that more robust and targeted interventions may be needed for families, as opposed to relying on a supplement to a classroom-based or teacher-focused intervention.

In their qualitative review, Duran et al. Perhaps a better approach to strengthening social-emotional development through ECE is to consider the comprehensive array of cross-sector strategies that meet the needs of children and families. The evidence described above suggests that early childhood educators are more effective at promoting social-emotional development when they have access to effective training and consultation and evidence-based curricula.

But even with those supports, ECE programs and educators may lack the capacity to fully provide what children and families need, especially recipients who have experienced trauma, chronic stress, or adverse experiences. ECE programs and teachers may need to partner with other community agencies that provide services, such as screening, referrals, and enrollment in programs outside the ECE sector e. By coordinating services at school by colocating or other mechanisms , community schools try to address service fragmentation and encourage more communication and collaboration among providers and educators Biag and Castrechini, There is mixed evidence relating FSCSs with student outcomes.

These mixed findings are likely due to the variation in FSCSs and their communities Sanders, , thus indicating a need for more effectiveness studies. Unfortunately, many of the evaluations on FSCSs to date have focused on academic outcomes, which calls for an intentional focus on health and social-emotional outcomes.

See Box for an example of a promising model that was designed to close the achievement gap by providing wraparound services for families. SDP is implemented in 1, schools across the world. Studies of SDP schools show significant student gains in achievement, attendance, behavior, and overall adjustment Lunenburg, It is theorized that the SDP model effect manifests through improvement in school climate, indicated by improved relationships among staff and students, collaboration among staff, and central focus on students Lunenburg, Quasi-experimental design studies have shown that students in SDP schools in comparison to students in matched non-SDP schools showed significant gains in achievement, behavior, and overall school adjustment Haynes.

Studies have emphasized the importance of implementation of key components of the SDP to find evidence of effectiveness Cook et al. The 21st CCLC program provides students in high-poverty communities across the nation with the opportunity to participate in academic enrichment and youth development programs designed to enhance their well-being ED, Programs provide the following activities: academic enrichment learning programs; tutoring; supplemental educational services; homework help; mentoring; recreational activities; career or job training for youth; drug and violence prevention, counseling, and character education programs; expanded library service hours; community service or service-learning programs; and activities that promote youth leadership ED, Studies of 21st CLCC have been mixed, with limited significant findings associated with gains in achievement scores and some gains in parental involvement in school and student commitment to work Durlak and Weissberg, In their review of after-school programs beyond the 21st CLCC, Durlak and Weissberg found four evidence-based practices that formed the acronym SAFE: S step-by-step training approach, A emphasis on active forms of learning through practicing new skills, F focused specific time and attention on skill development, and E explicitness in defining the skills being promoted.

Students who participated in SAFE programs had more positive social behaviors effect size of 0. Thus, there is a need to examine and incorporate these evidence-based approaches in all aspects of learning during the school day or extended day. Suspensions and expulsions in ECE or K—12 settings are often used as a deterrent for misbehavior, which could be due to many factors, including learning disabilities and social-emotional needs in response to trauma, chronic stress, and adverse experiences.

The U. More than 1 out of 5 American Indian or Alaska Native 22 percent , Native Hawaiian or other Pacific Islander 23 percent , black 23 percent , and multiracial 25 percent boys with disabilities served by the IDEA received one or more out-of-school suspensions, compared to 1 out of 10 white 10 percent boys with disabilities served by the IDEA. Black students are 2. Turning to children in general education, more than preschoolers are suspended or expelled daily Malik, Estimates show that as many as 8, 3- and 4-year-old children may be expelled from or pushed out of their state-funded preschool or pre-K classrooms annually—a rate nearly three times that of students in kindergarten through 12th grade.

In child care centers, expulsion rates are 13 times what they are in kindergarten through 12th grade. These rates are particularly pernicious for black children, who are suspended and expelled at much higher rates than their peers. Black preschoolers are 3. Black children represent only 19 percent of preschool enrollment but are 47 percent of children receiving one or more out-of-school suspensions; in comparison, white children are 41 percent of preschool enrollment but 28 percent of children receiving one or more out-of-school suspensions Boyd et al.

Various scholars, and more recently, Gilliam et al. In a meta-analytic study using 53 studies examining the link between suspension and student outcomes, Noltemeyer et al. Effect sizes ranged from 0. There was an effect size of 0. Noltemeyer et al. These practices are. In response to suspension and expulsion, there have been two general approaches for training professionals—trauma-informed care TIC and implicit bias training see the section on supports for the ECE professional for an overview of both approaches to help address suspension and expulsion issues.

Research suggests that children who are bilingual tend to have better self-regulation skills than their monolingual peers Castro et al. They have enhanced ability to control their attention and greater EF skills, such as planning, working memory, and cognitive flexibility. Another crucial pathway through which ECE leads to health equity is the family and home environment see Chapter 4 for the importance of family cohesion and support. As indicated in the pathway by Hahn et al.

Specifically, it found that parental knowledge of child development is positively associated with parent behaviors. The pathway linking ECE to health equity through supporting responsive parenting and a quality home environment is generally supported by many programs, including the three foundational early childhood programs, each of which included a significant family engagement component—the HighScope PPP, focused on 3- and 4-year olds, the Carolina ABC Study, focused on children birth to age 3, and the Chicago Child-Parent Centers CPCs see Box While these studies are quite old, focused on particular populations i.

Other early childhood programs, including home visiting programs that serve mothers prenatally and last until the children are 3 years old and family engagement programs for preschool- and school-age children, provide additional support for the links between ECE and healthy equity through parenting. The focus on family engagement has been bolstered by the recent federal funds for parent and family community engagement centers U.

These parent-focused programs have several different structures. For example, some include parent supports and parent self-sufficiency support as well as intensive classroom-based services for children that are multipronged. Others offer services that are primarily classroom-based with either some parenting education services or some parent self-sufficiency services NASEM, a. In their examination of the impact of Head Start on child outcomes through parenting, Puma et al. With respect to Early Head Start, there was some evidence that programs that were mixed delivery center and home had favorable and consistent impact on parenting outcomes, including sensitive parenting and language-rich environments.

The Kids in Transition to School KITS Program is a short-term, targeted, evidence-based intervention aimed at increasing early literacy, social skills, and self-regulatory skills among children who are at high risk for school difficulties. This program provides a session readiness group for children that promotes social-emotional skills and early literacy as well as a session parent workshop focused on promoting parent involvement in early literacy and the use of positive parenting practices.

In a pilot efficacy trial with 39 families, Pears and colleagues found that children in families who received the KITS intervention demonstrated early literacy and social skill improvements as compared with their peers who did not receive the intervention Pears et al. In randomized controlled studies, foster children who received the intervention exhibited improvements in social competence, self-regulation skills, and early literacy skills.

Pears et al. Many of these programs have not resulted in significant positive outcomes, at least based on older versions of the models NASEM, a. The new iterations of two-generation models focus. Parenting knowledge, attitudes, and practices may be improved, but the improvement comes indirectly through higher parental job skills and education and reduced household stress rather than explicit programming directed at parenting skills.

NASEM, a , p. There are also other family-focused interventions for school-age children. In addition to reduced behavior problems among children in the treatment group, parents displayed more effective parenting practices than in the control group. Parents in the treatment group reported using more effective disciplinary practices and receiving higher scores on tests of knowledge of effective behavior management strategies; in addition, higher-quality parenting was observed for parent—child interactions by the research team Brotman et al.

The program includes parent—teacher conferences, monthly family socialization, and teacher home visits with parents using structured interactions. The goal is to actively engage parents in learning and behavior goal setting and decision making. Knoche et al. Sheridan et al. However, caution is warranted because these are not national studies and, in many instances, are localized and researcher controlled, unlike the Head Start and Early Head Start studies. Home visiting which targets families with pregnant women and children from birth through age 5—though most attend until children are 3 years old has been found to increase parental knowledge and practices and reduce parental stress and depression while also supporting child health and reducing maltreatment.

Regarding positive parent practices, the review shows that. Nor is there a strong pattern of effects on parenting practices across evaluation studies and home visiting models. None of the home visiting models were linked to reductions in juvenile delinquency, family violence, and crime. Healthy Families America, however, had one or more favorable impacts in each of the eight domains, and Nurse-Family Partnership had favorable impacts in seven domains, followed by Early Head Start—Home Visiting with favorable impacts in five domains.

What Works Clearinghouse. Find What Works. While it is challenging to disentangle family engagement and support from ECE classroom practices, there is indication that supporting family functioning and processes and providing resources and strategies will likely lead to better outcomes for parents themselves and their children, resulting in health equity.

With new approaches to family engagement and support, such as the Two Gen 2. The salutary effects that ECE can have on the physical, mental, and social-emotional health of children—whether through the inclusion of comprehensive services, evidence-based curriculum, high-quality professional development and supports, or effective family engagement—can be disrupted if the ECE professionals themselves are not trained or supported to implement best practices or navigate systems of services for children and families outside the ECE sector.

Since the release of the National Academies report Transforming the Workforce for Children Birth Through Age 8: A Unifying Foundation IOM and NRC, , there has been increased interest from funders, policy makers, and advocates in overhauling the professional preparation and ongoing supports for early childhood educators so that these experiences—and the policies and funding that shape them—better reflect the science of early development. Department of Health and Human Services.

Home Visiting Evidence of Effectiveness. The report found that, in most cases, these statements need to be updated to follow recent developments in science and research. Incorporating these issues into efforts to improve policies, systems, and programs that prepare and support early childhood educators is critical to maximizing the potential of ECE programs to improve health outcomes and equity. For example, teachers, especially those who work with students who experience trauma, can be more effective if they receive more training and education on mental health issues and skills to access relevant services from that sector Hydon et al.

Whether or not children are suspended or expelled, many are exposed to traumatic experiences, including abuse and neglect, family and media violence, community or school violence, loss of a parent, parents dealing with substance abuse, and mental or other health challenges. In turn, children who experience trauma can exhibit behaviors in ECE programs and schools that may indicate social-emotional challenges. Box describes a trauma-informed service system for children and families.

TIC can be provided in multiple settings by trained, committed professionals who understand the principles of a TIC system, including. For example, Zakszeski et al. Zakszeski et al. The limitation of the studies in this review was that most occurred with subpopulations of children rather than across the student population. See Box for an example of a promising model that employs a cognitive behavioral intervention to address trauma in schools.

It has been suggested that implicit bias is one reason for the disproportionality of suspension and expulsion rates for black children and children with special needs. That is, educators may see the normative behaviors of black children in particular as dangerous and aggressive, even when there is no evidence of misbehavior Gilliam et al.

Implicit bias training may be a potential strategy to counter these unconscious biases. Evidence is emerging on the impact of implicit bias training, mostly from the public health and nursing sectors. See Box for more information on the importance of cultural competence and sensitivity in ECE. Scholars caution about the focus on cultural competence without antiracist training. A literature review by Allen indicates that cultural competence training could be strengthened by antiracist training to adequately ensure that professionals are able to.

This promotes cultural stereotyping with the risk of discrimination and it fails to account for individual and family differences within cultural groups. Allen, , p. However, there is an absence of a validated antiracist training and intervention. Other options to address unconscious bias are mindfulness training and prejudice habit breaking.

While Burgess et al. It should also be noted that in order to maximize mindfulness, it is imperative for individuals to recognize their own implicit bias, any privilege that comes with their social status, and unintentional microaggressions i. Thus, when people who are opposed to prejudice believe they have acted with bias, they will seek out information to help them break this habit of prejudice or bias.

That training includes 1 stereotype replacement recognizing stereotypic responses within oneself and society , 2 counter-stereotypic imaging imagining examples of outgroup members who counter popularly held stereotypes , 3 individuating viewing others according to their personal rather than stereotypic characteristics , 4 perspective taking adopting the perspective of a member of the stigmatized group , and 5 contact increasing exposure to outgroup members.

In an RCT, Devine et al. This study was conducted with introductory graduate students. There is a need for more rigorous examination of this training approach with educational professionals and those caring for and teaching young children. In addition, even the most competent early childhood educators will not be effective if they are not physically, mentally, and social-emotionally healthy.

Educators who have strong social-emotional awareness and skills are more likely to develop close, constructive relationships with children, implement SEL programs effectively, and be more able to create a positive classroom climate.

Conversely, educators who are stressed, depressed, or have low social-emotional skills are more likely to be less sensitive and warm toward children and have more conflictual relationships with them. Since children who live in high-stress communities or with adverse conditions benefit the most from warm, enriching interactions with adults, it is critically important for them to be in ECE programs in which the educators are social-emotionally healthy and strong Becker et al.

Indeed, McClelland et al. Unfortunately, it has been well documented that compared to other fields, the ECE workforce experiences a high level of stress and depression; one reason is the stress of low compensation and benefits see IOM and NRC, Most of them 53 percent participate in at least one of four public support or health care programs for low-income individuals, compared to 21 percent of the U.

There is also emerging evidence Borntrager et al. Which supports or interventions can help educators manage or mitigate their general social-emotional health and their experience of stress, depression, or STS? Studies of public school teachers by Borntrager et al. In addition, stable classroom assignments were related to lower stress, as was unsurprisingly higher pay. In another analysis, Roberts et al.

Interestingly, Madill et al. There is emerging evidence that professional support that is targeted to improve the mental and social-emotional well-being of educators could be helpful. In their small, qualitative study, Caringi et al. In one study based on a survey of 1, Head Start teachers, those who were more mindful had closer relationships with children and less conflict with them, partly because mindfulness is also associated with fewer depressive symptoms.

A mindful disposition may help teachers view challenging interactions with more equanimity. Alternatively, mindful teachers may have fewer challenging interactions. Their attention and focus may help them to be proactive in their guidance of young children, structuring the classroom for successful interactions and diffusing potentially difficult situations before they begin.

Teachers who are more mindful may be better able. Mindful teachers may be aware of situations that may elicit challenging behavior, and take action to engage in reappraisal to regulate their emotional response. Becker et al. CARE provides 30 hours of training in group-based settings and individual sessions with trainers. RCTs with elementary teachers showed improvements in their mindfulness and emotional regulation.

Below, the committee provides conclusions and recommendations, based on the information reviewed in this chapter, to ensure adequate resources for ECE programs and educators, support and improve competencies for the ECE workforce, and improve access to ECE for eligible children. The goal of these recommendations is to advance the ECE system to promote health equity during the early childhood period to set the course for good health and well-being into adulthood.

ECE programs, including systems that support and ensure standards for high quality e. That can. Furthermore, current funding levels for child care, pre-K, and Head Start generally are not based on systematic estimates of the cost of quality, including those elements that promote better health outcomes.

It is also critical to consider the cost of funding programs to ensure that they reach all eligible children. Until that has been remedied, our nation will not maximize the potential of ECE programs to promote the health and school readiness of young children, especially those who tend to fall on the wrong side of the health equity equation e.

For ECE to be part of a system that ensures children are healthy and ready for school and life, these programs need. However, there is a need for systems and supports to strengthen their competencies and skills, as well as stability, in supporting health-promoting and health equity practices. Children who experience comprehensive high-quality ECE early in life and for multiple years are likely to show stronger cognitive, academic, and social-emotional outcomes over time. Unfortunately, many children who could benefit the most from ECE are less likely, for various reasons, to.

To ensure health promotion and health equity in the early years, there is a need to ensure that these programs are available to and affordable for families as early as possible and as long as possible. The strategic plan should be modeled after and build on the relevant performance standards of Early Head Start and Head Start, which emphasize mixed settings, the whole child, family and community engagement, transition between home and school, and continuous quality improvement. It should also strengthen the program components discussed in.

Critical components include a comprehensive social-emotional strategy that encompasses both the classroom curriculum, teacher training, and support and program or school leadership, culture, and climate levels and educators who have the competencies described in Recommendation The plan should identify strategies to bolster capacity and resources of new and existing programs to implement these more ambitious standards, including by incentivizing collaboration among Head Start, pre-K, and child care programs.

Implementation of this plan will likely require funding from Congress. Heeding the findings from the Head Start Impact Study that program implementation and workforce challenges vary widely from site to site, which leads to variable outcomes Phillips et al. This study will help to identify factors that supported or hindered expansion and access at the federal, state, and local levels, as well as the impact of this effort for children, families, and communities.

State policy makers e. State pre-K programs are highly variable, and some will be better positioned to serve as a platform for promoting health equity than others. Health promotion including social-emotional health and family engagement are already important goals of the program that can be strengthened based on evidence from this report. The ECE system is a critical setting to provide young children with a strong foundation for skill building and positive learning, as well as shaping social-emotional, cognitive, and physical health.

This chapter delves into the evidence on ECE programs and childhood outcomes with respect to the many different service settings e. In addition, the committee highlights salient issues and populations related to health equity throughout the chapter, such as early intervention for children with developmental disabilities, DLLs, and implicit bias training for educators.

Based on its review of the evidence and committee expertise, the committee applies the evidence to provide recommendations in the areas of allocating adequate resources to support ECE programs and educators, supporting and training the workforce, and improving access to quality ECE for eligible children.

By targeting these key areas that are instrumental to an effective and equitable system, the committee identifies a comprehensive approach to leveraging and enhancing the current ECE system to promote health equity. The following chapter integrates the crosscutting themes from the report and applies them to inform a systems approach to promote equitable prenatal and childhood development.

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THINGS FALL APART THESIS TOPICS

It states many policies and procedures to keep each child intellectually, socially, emotionally and physically safe from all hazards. It is the role of the practitioner to write these policies and ensure they are put into practise by safeguarding each and every child. My fourth piece of evidence is a risk assessment taken from my setting when we were conducting a school trip to the local village, every member of staff on the trip would read and sign the document to accept legal responsibility.

The United Nation Convention on the Rights of the Child means that I must legally provide clean water, nutritious food and a safe environment for the children in my setting, to do this I must carry out many risk assessments of the environment to ensure the setting is safe for every child to attend. During school trips, indoor and outdoor play, practitioners must always conduct risk assessments to ensure that the environment with be as safe as possible for every child.

Practitioners must take steps to keeping children safe e. There are many risk assessments carried out to manage every risk to provide a healthy environment to challenge each child. Safety procedures are carried out regularly such as first aid and fire drills and there should always be the correct staff to children ratio.

Ensure safety without stopping reasonable risk-taking. My final piece of evidence is an accident report taken from my setting. At my setting, there are many policies and procedures that must be followed by all staff members if a child has an accident. Every time a child has an injury the Date, Time, Place of accident, Circumstances, Nature and Treatment must be recorded and then the Supervisor, Manager, Witnesses and parents must all sign the log to prove that they have all been notified.

The accident must then be given a number and that number must be placed on a diagram to show where the child has hurt themselves, it is the role of the practitioner to fill out all these forms and record each accident. After every accident the manager must be informed about all the details and then must sign the accident log to prove that they have been informed.

As a practitioner it is my role to promote this healthy lifestyle by following legislation and acting as a role model, by eating and providing a variety of healthy food and snacks with the children so they can choose which ones they prefer as every child is different and would have a different opinion. As a practitioner I must follow initiatives such as the 5-a-day scheme which states that a child should have at least 5 fruits or vegetables a day to keep healthy.

As a practitioner it is my role to ensure that I encourage children to clean their teeth and go to the dentist and doctors regularly and to produce hygiene routines such as hand washing or teeth brushing before or after lunch, this will become a habit to children and they will continue to do this throughout their life. It is the role of practitioners to never discriminate against a child because of their disability, race, gender or beliefs; they must be treated fairly and given equal opportunities to succeed.

This is the bases on anti-discriminatory practise and focus of many laws today. E8] Every child is different and has different likes and dislikes and cultural background, this personal information can be used to help plan specific activities to keep a emotionally and intellectually healthy, for example a child who likes trains can count toy trains to develop their maths skills as every child is unique and will have different interests and will need different activities planned to help them develop.

Workers must follow many health and safety procedures to never put staff members or children at risk; they must constantly behave as professionals to safe-guard every child in a setting. For example it is the role of the practitioner to always carry a first aid kit when taking children off the premises, as children made need medication or medical assistance while they are out.

If a child is showing signs of sickness or illness then a practitioner must follow strict policies and procedures to protect the welfare of the child. C so emergency calpol had to be administrated and her mother was called and informed, the setting then isolated the child so the infection could not spread, following their procedure for prevention of infection.

C then the parents would immediately have to come and collect the child and take them to the doctors. The parents of the child, supervisor present and the manager of the setting then had to sign the log. According to Bruce T and Meggitt C Practitioners, including students, should not discuss or otherwise share this information — for example, when chatting in the staffroom or with friends at the weekend.

According to Bruce T and Meggitt C For example, when I carried out my dairy tasks and observations in my setting I had to sign a statement of confidentiality to ensure that I respected my settings policies of confidentiality and instead of naming the setting and the children I used names such as Child A and Adult B to refer to each child.

Although I could improve my practise by keeping all my observation about the children in a safer location such as a lockable file cabinet instead of my current plastic folder. About the author. This sample is completed by Emma with Health Care as a major. She is a student at Emory University, Atlanta. The administrative authority should review, and collaborate with the CCHC in implementing recommended changes in policies and practices. Consider alternatives to CCHC onsite consultation and schedule other methods for delivering services:.

Centers for Disease Control and Prevention. Center for Health Care Strategies. Some professionals may not have the full range of knowledge and expertise to serve as a child care health consultant but can provide valuable, specialized expertise.

For example, a sanitarian may provide consultation on hygiene and infectious disease control and a Certified Playground Safety Inspector would be able to provide consultation about gross motor play hazards. Credentialing is an umbrella term referring to the various means employed to designate that individuals or organizations have met or exceeded established standards. These may include accreditation of programs or organizations and certification, registration, or licensure of individuals.

Accreditation refers to a legitimate state or national organization verifying that an educational program or organization meets standards. Certification is the process by which a non-governmental agency or association grants recognition to an individual who has met predetermined qualifications specified by the agency or association. Certification is applied for by individuals on a voluntary basis and represents a professional status when achieved. Typical qualifications include 1 graduation from an accredited or approved program and 2 acceptable performance on a qualifying examination.

CCHCs who are not employees of health, education, family service or child care agencies may be self-employed. Compensating them for their services via fee-for-service, an hourly rate, or a retainer fosters access and accountability. Listed below is a sample of the policies and procedures child care health consultants should review and approve:. Written personnel policies of centers and large family child care homes should address the major occupational health hazards for workers in child care settings.

These coordinated health programs should consist of health and safety education, physical activity and education, health services and child care health consultation, nutrition services, mental health services, healthy and safe indoor and outdoor learning environment, health and safety promotion for the staff, and family and community involvement.

The guidelines consist of the following eight interactive components:. Health Education: A planned, sequential, curriculum that addresses the physical, mental, emotional, and social dimensions of health. The curriculum is designed to motivate and assist children in maintaining and improving their health, preventing disease and injury, and reducing health-related risk behaviors 1,2.

Physical Activity and Education: A planned, sequential curriculum that provides learning experiences in a variety of activity areas such as basic movement skills, physical fitness, rhythms and dance, games, sports, tumbling, outdoor learning and gymnastics. Health Services and Child Care Health Consultants: Services provided for child care settings to assess, protect, and promote health.

These services are designed to ensure access or referral to primary health care services or both, foster appropriate use of primary health care services, prevent and control communicable disease and other health problems, provide emergency care for illness or injury, promote and provide optimum sanitary conditions for a safe child care facility and child care environment, and provide educational opportunities for promoting and maintaining individual, family, and community health.

Qualified professionals such as child care health consultants may provide these services 1,2,4,5. Nutrition Services: Access to a variety of nutritious and appealing meals that accommodate the health and nutrition needs of all children. School nutrition programs reflect the U.

Dietary Guidelines for Americans and other criteria to achieve nutrition integrity. The school nutrition services offer children a learning laboratory for nutrition and health education and serve as a resource for linkages with nutrition-related community services 1,2. These services include individual and group assessments, interventions, and referrals. Organizational assessment and consultation skills of mental health professionals contribute not only to the health of students but also to the health of the staff and child care environment 1,2.

Healthy Child Care Environment: The physical and aesthetic surroundings and the psychosocial climate and culture of the child care setting. Factors that influence the physical environment include the building and the area surrounding it, natural spaces for outdoor learning, any biological or chemical agents that are detrimental to health, indoor and outdoor air quality, and physical conditions such as temperature, noise, and lighting.

The psychological environment includes the physical, emotional, and social conditions that affect the well-being of children and staff 1,2. This personal commitment often transfers into greater commitment to the health of children and creates positive role modeling.

Health promotion activities have improved productivity, decreased absenteeism, and reduced health insurance costs 1,2. Health and safety education for staff should include physical, oral, mental, emotional, nutritional, physical activity, and social health of children. In addition to the health and safety topics for children in Standard 2. Written material, at a minimum, should address the most important health and safety issues for all age groups served, should be in a language understood by families, and may include the topics listed in Standard 2.

Children should play outdoors when the conditions do not pose any concerns health and safety such as a significant risk of frostbite or heat-related illness. Please reference Standard 3. Play areas should be fully enclosed and away from heavy traffic areas.

In addition, outdoor play for infants may include riding in a carriage or stroller. Infants should be offered opportunities for gross motor play outdoors. Outdoor play is not only an opportunity for learning in a different environment; it also provides many health benefits. Outdoor play allows for physical activity that supports maintenance of a healthy weight 3 and better nighttime sleep 4.

Short exposure of the skin to sunlight promotes the production of vitamin D that growing children require. Open spaces in outdoor areas, even those located on screened rooftops in urban play spaces, encourage children to develop gross motor skills and fine motor play in ways that are difficult to duplicate indoors. Nevertheless, some weather conditions make outdoor play hazardous. Children need protection from adverse weather and its effects. Heat-induced illness and cold injury are preventable.

Weather alert services are beneficial to child care centers because they send out weather warnings, watches, and hurricane information. Alerts are sent to subscribers in the warned areas via text messages and e-mail. It is best practice to use these services but do not rely solely on this system. Weather radio or local news affiliates should also be monitored for weather warnings and advisories. Heat and humidity can pose a significant risk of heat-related illnesses, as defined by the NWS 5.

Children have a greater surface area to body mass ratio than adults. Therefore, children do not adapt to extremes of temperature as effectively as adults when exposed to a high climatic heat stress or to cold. Children produce more metabolic heat per mass unit than adults when walking or running. They also have a lower sweating capacity and cannot dissipate body heat by evaporation as effectively 6.

Wind chill conditions can pose a risk of frostbite. Frostbite is an injury to the body caused by freezing body tissue. The most susceptible parts of the body are the extremities such as fingers, toes, earlobes, and the tip of the nose. Symptoms include a loss of feeling in the extremity and a white or pale appearance.

Medical attention is needed immediately for frostbite. If warm water is not available, wrap gently in warm blankets 7. Hypothermia is a medical emergency that occurs when the body loses heat faster than it can produce heat, causing a dangerously low body temperature. An infant with hypothermia may have bright red, cold skin and very low energy.

Call or your local emergency number if a child has these symptoms. Both hypothermia and frostbite can be prevented by properly dressing a child. Dressing in several layers will trap air between layers and provide better insulation than a single thick layer of clothing. Generally, infectious disease organisms are less concentrated in outdoor air than indoor air.

The thought is often expressed that children are more likely to become sick if exposed to cold air; however, upper respiratory infections and flu are caused by viruses, and not exposure to cold air. These viruses spread easily during the winter when children are kept indoors in close proximity. Additional Resources. Wind chill safety. Accessed January 11 , Accessed January 11, Acta Paediatr. KidsHealth from Nemours.

Heat illness. Reviewed February American Academy of Pediatrics. Extreme temperatures: heat and cold. Int J Obes Lond. Winter safety tips from the American Academy of Pediatrics. Published January Extreme temperature exposure. Updated November 21, Supervising adults should check the air quality index AQI each day and use the information to determine whether it is safe for children to play outdoors.

The AQI is divided into six categories; each category corresponds to a different level of health concern. The six levels of health concern and what they mean are:. Question: Is the recommendation for an Environmental Protection Agency EPA -registered disinfectant different from the previous cleaning and sanitizing definitions?

For some surfaces sanitizing is enough to be healthy and safe, and for some surfaces cleaning is adequate. Question: What is the rationale for requiring hand washing before diaper changing? Answer: The diaper changing process may require many interactions with the child before the process, for example evaluating whether the diaper contains stool. Because of the potential for contamination of hands during this process, hand hygiene should be performed before collection of diaper supplies and further handling of the child to avoid contaminating the remaining diaper supplies.

However, activities in child care do not occur in isolation. If hand hygiene has been done for another reason prior to a diaper changing event, the process does not have to be repeated if no contamination of hands has occurred.

Question: Step 6 of Standard 3. All employees who will change diapers should undergo training and periodic assessment of diapering practices. A safety strap or harness should not be used on the diaper-changing table. If other products are used for sanitizing or disinfecting, they should also be fragrance-free and EPA registered 1. Step 1: Get organized. Before bringing the child to the diaper changing area, perform hand hygiene if hands have been contaminated since the last time hand hygiene was performed 2 , gather, and bring supplies to the diaper changing area.

Step 2: Carry the child to the changing table, keeping soiled clothing away from you and any surfaces you cannot easily clean and sanitize after the change. Step 4: Remove the soiled diaper and clothing without contaminating any surface not already in contact with stool or urine. Step 5: Put on a clean diaper and dress the child. Step 7: Clean and disinfect the diaper-changing surface.

Step 8: Perform hand hygiene according to the procedure in Standard 3. The procedure for diaper changing is designed to reduce the contamination of surfaces that will later come in contact with uncontaminated surfaces such as hands, furnishings, and floors 4. Taking the supplies out of their containers and leaving the containers in their storage places reduces the likelihood that the storage containers will become contaminated during diaper changing.

If the paper is large enough, there will be less need to remove visible soil from surfaces later and there will be enough paper to fold up so the soiled surface is not in contact with clean surfaces while dressing the child. Wet paper towels or a damp cloth may be used as an alternative to commercial baby wipes.

Infectious organisms are present on the skin and diaper even though they are not seen. Some states and credentialing organizations may recommend wearing gloves for diaper changing. This may reduce the presence of enteric pathogens under the fingernails and on hand surfaces.

Otherwise, retained contaminated gloves could transfer organisms to clean surfaces. Note that sensitivity to latex is a growing problem. See Appendix D for proper technique for removing gloves. A safety strap cannot be relied on to restrain the child and could become contaminated during diaper changing. Cleaning and disinfecting a strap would be required after every diaper change. Therefore, safety straps on diaper changing surfaces are not recommended. Prior to disinfecting the changing table, clean any visible soil from the surface with a detergent and rinse well with water.

If the disinfectant is applied using a spray bottle, always assume that the outside of the spray bottle could be contaminated. Therefore, the spray bottle should be put away before hand hygiene is performed the last and essential part of every diaper change 6. Diaper changing areas should never be located in food preparation areas and should never be used for temporary placement of food, drinks, or eating utensils.

Diapering poster. Reaffirmed April Accessed June 26, Household chemicals. Or are these terms interchangeable in the Standard and Rationale? More specifically, are the steps required for changing a pull-up with a bowel movement the same for changing a pull-up that is only wet? Answer: The same changing procedure should be used regardless of the contents.

All employees who will change disposable training pants, underwear and clothing should undergo training and periodic assessment of these practices. Changing a child from the floor level or on a chair puts the adult in an awkward position and increases the risk of contamination of the environment. Changing tables that are a comfortable height for caregivers help reduce the risk of back injury for the adults, which may occur from lifting the child onto the table 1. A safety strap or harness should not be used on the changing surface.

If other products are used for sanitizing or disinfecting, they should also be fragrance-free and EPA registered 2. Step 1: Get organized and determine whether to change the child lying down or standing up. Before bringing the child to the changing area, perform hand hygiene if hands have been contaminated since the last time hand hygiene was performed 3 , gather, and bring supplies to the changing area.

Step 2: Avoid contact with soiled items. Step 4: Put on clean disposable training pants or clean underwear and clothing, if necessary. Step 6: Clean and disinfect the changing surface. Dispose of the disposable paper liner used on the changing surface in a plastic-lined, hands-free covered can. If clothing was soiled, securely tie the plastic bag used to store the clothing and send the bag home. Remove any visible soil from the changing surface with a disposable paper towel saturated with water and detergent, and then rinse.

Wet the entire changing surface with a disinfectant that is appropriate for the surface material you are treating. Put away the disinfectant. Some types of disinfectants may require rinsing the changing table surface with fresh water afterward. Step 7: Perform hand hygiene according to the procedure in Standard 3. In the daily log, record what was in the disposable training pants or underwear and any problems e.

Changing these undergarments can lead to risk for spreading infection due to the contamination of surfaces from urine or feces 1. Taking the supplies out of their containers and leaving the containers in their storage places reduces the likelihood that the storage containers will become contaminated during changing.

Infectious organisms are present on the skin and disposable training pants or underwear even though they are not seen. Some states and credentialing organizations may recommend wearing gloves for changing. A safety strap cannot be relied on to restrain the child and could become contaminated during changing. Cleaning and disinfecting a strap would be required after every change. Therefore, safety straps on changing surfaces are not recommended.

Therefore, the spray bottle should be put away before hand hygiene is performed the last and essential part of every change 7. Changing areas should never be located in food preparation areas and should never be used for temporary placement of food, drinks, or eating utensils. Additionally, changing tables that are a comfortable height for caregivers help reduce the risk of back injury for the adults, which may occur from lifting the child onto the table 1.

Children with disabilities may require diapering, and the method of diapering will vary according to their abilities. However, principles of hygiene should be consistent regardless of method. Toddlers and preschool-aged children without physical disabilities frequently have toileting issues as well.

These include new siblings, stress in the family, or anxiety about changing classrooms or programs, all of which are based on their inability to recognize and articulate their stress and to manage a variety of impulses. Changing soiled underwear. Published Question: This standard recommends that children and staff members rub their hands with a soapy lather for at least 20 seconds. Why was this changed from 10 seconds?

Children and staff members should wash their hands using the following method:. Children and staff who need to open a door to leave a bathroom or diaper-changing area should open the door with a disposable towel to avoid possibly re-contaminating clean hands. If a child cannot open the door or turn off the faucet, he or she should be assisted by an adult. Use of antimicrobial soap is not recommended in early care and education settings. There are no data to support use of antibacterial soaps over other liquid soaps.

Premoistened cleansing towelettes do not effectively clean hands and should not be used as a substitute for washing hands with soap and running water. When running water is unavailable or impractical, the use of alcohol-based hand sanitizer Standard 3. The use of alcohol-based hand sanitizers is an alternative to traditional handwashing with soap and water if. Active supervision of children is required to monitor effective use and to avoid potential ingestion or inadvertent contact with eyes and mucous membranes.

Single-use towels should be used unless an automatic electric hand dryer is available. The use of cloth roller towels is not recommended because children often use cloth roller towel dispensers improperly, resulting in more than one child using the same section of towel. Running clean water over the hands removes visible soil. Wetting the hands before applying soap helps to create a lather that can loosen soil. The soap lather loosens soil and brings it into solution on the surface of the skin.

Rinsing the lather off into a sink removes the soil from the hands that the soap brought into solution. Alcohol-based hand sanitizers do not kill norovirus and spore-forming organisms, which are common causes of diarrhea in child care settings. Handwashing is the preferred method. However, while hand sanitizers are not recommended for children younger than 2 years, they are not prohibited.

Current handwashing procedure states that water remains on throughout the handwashing process. However, there is little research to prove whether a significant number of germs are transferred between hands and the faucet while performing hand hygiene. Comparison of four methods of hand washing in situations of inadequate water supply. West Afr J Med. CDC features. Wash your hands. Updated December 6, Accessed January 28, Handwashing: clean hands save lives.

Show me the science—how to wash your hands. Reviewed October 2, Guideline for hand hygiene in health-care settings. Isolation precautions. Reviewed October 9, Reviewed October 15, Reported adverse health effects in children from ingestion of alcohol-based hand sanitizers—United States, — Question: Is there evidence to address the flammability risk of hand sanitizers and the recommended countermeasures with this product?

Answer: Hand sanitizers are flammable as noted on product labels. Standard 5. The use of hand sanitizers by children and adults in child care programs is an appropriate alternative to the use of traditional handwashing if soap and water is not available and if hands are not visibly dirty 1,2.

Supervision of children is required to monitor effective use and to avoid potential ingestion or inadvertent contact of hand sanitizers with eyes and mucous membranes 3. The technique for using hand sanitizers is: For visibly dirty hands and soap is not available, rinsing under running water or wiping with a water-saturated towel should be used to remove as much dirt as possible before using a hand sanitizer. Apply the product to the palm of one hand read the label to learn the correct amount ; Rub hands together; and Rub the product over all surfaces of the hands and fingers until hands are dry 4.

Where alcohol-based hand sanitizer dispensers are used: The maximum individual dispenser fluid capacity should be as follows: 0. Standard Precautions should be used to handle potential exposure to blood, including blood-containing body fluids and tissue discharges, and to handle other potentially infectious fluids. Prior to using a disinfectant, clean the surface with a detergent and rinse well with water. If blood or bodily fluids enter a mucous membrane eyes, nose, mouth the following procedure should occur.

Flush the exposed area thoroughly with water. The goal of washing or flushing is to reduce the amount of the pathogen to which an exposed individual has contact. The optimal length of time for washing or flushing an exposed area is not known. Standard practice for managing mucous membrane s exposures to toxic substances is to flush the affected area for at least fifteen to twenty minutes.

In the absence of data to support the effectiveness of shorter periods of flushing it seems prudent to use the same fifteen to twenty minute standard following exposure to bloodborne pathogens 5. Touching a contaminated object or surface may spread illnesses.

Many types of infectious germs may be contained in human waste urine, feces and body fluids saliva, nasal discharge, tissue and injury discharges, eye discharges, blood, and vomit. Because many infected people carry infectious diseases without having symptoms, and many are contagious before they experience a symptom, staff members need to protect themselves and the children they serve by adhering to Standard Precautions for all activities.

Gloves have proven to be effective in preventing transmission of many infectious diseases to health care workers. Gloves are used mainly when people knowingly contact or suspect they may contact blood or blood-containing body fluids, including blood-containing tissue or injury discharges. Cleaning and disinfecting rugs and carpeting that have been contaminated by body fluids is challenging.

Extracting as much of the contaminating material as possible before it penetrates the surface to lower layers helps to minimize this challenge. Cleaning and disinfecting the surface without damaging it requires use of special cleaning agents designed for use on rugs, or steam cleaning 3. Therefore, alternatives to the use of carpeting and rugs are favored in the child care environment.

Either single-use disposable gloves or utility gloves should be used when disinfecting. Single-use disposable gloves should be used only once and then discarded immediately without being handled. If utility gloves are used, they should be cleaned after every use with soap and water and then dipped in disinfectant solution up to the wrist.

The gloves should then be allowed to air dry. The wearing of gloves does not prevent contamination of hands or of surfaces touched with contaminated gloved hands. Hand hygiene and sanitizing of contaminated surfaces is required when gloves are used. Ongoing exposures to latex may result in allergic reactions in both the individual wearing the latex glove and the individual who contacts the latex glove.

Reports of such reactions have increased 1. Natural fingernails that are long or wearing artificial fingernails or extenders is not recommended. Child care facilities should develop an organizational policy on the wearing of non-natural nails by staff 2.

Keeping objects and surfaces in a child care setting as clean and free of pathogens as possible requires a combination of:. Facilities should follow a routine schedule of cleaning, sanitizing, and disinfecting as outlined in Appendix K: Routine Schedule for Cleaning, Sanitizing, and Disinfecting. For example, if there is visible soil on a diaper changing or table surface, clean it with detergent and water before spraying the surface with a sanitizer or disinfectant.

E ach term has a specific purpose and there are many methods that may be used to achieve such purpose. To remove dirt and debris by scrubbing and washing with a detergent solution and rinsing with water. The friction of cleaning removes most germs and exposes any remaining germs to the effects of a sanitizer or disinfectant used later. To reduce germs on inanimate surfaces to levels considered safe by public health codes or regulations. To destroy or inactivate most germs on any inanimate object, but not bacterial spores.

Bacterial spores are dormant bacteria that have formed a protective shell, enabling them to survive extreme conditions for years. The spores reactivate after entry into a host such as a person , where conditions are favorable for them to live and reproduce 5. Only U. Environmental Protection Agency EPA -registered products that have an EPA registration number on the label can make public health claims that can be relied on for reducing or destroying germs.

The EPA registration label will also describe the product as a cleaner , sanitizer , or disinfectant. In addition, some manufacturers of cleaning products have developed "green cleaning products". Use fragrance-free bleach that is EPA-registered as a sanitizing or disinfecting solution 6.

If other products are used for sanitizing or disinfecting, they should also be fragrance-free and EPA-registered 5. All products must be used according to manufacturer's instructions. Employers should provide staff with hazard information, including access to and review of the Safety Data Sheets SDS as required by the Occupational Safety and Health Administration OSHA , about the presence of toxic substances such as, cleaning, sanitizing and disinfecting supplies in use in the facility.

The SDS explain the risk of exposure to products so that appropriate precautions may be taken. Question: Should child care providers and other adults who have contact with children be allowed to smoke electronic cigarettes in the presence of children? Answer: Electronic cigarettes, also known as e-cigarettes, are a fairly new alternative to traditional smoking cigarettes.

E-cigarettes are battery-operated products designed to deliver nicotine, flavor and other chemicals. They turn nicotine, which is highly addictive, and other chemicals into a vapor that is inhaled by the user U. FDA, Currently, the research on the safety of this product is limited. However, the use of e-cigarettes would fall into the same category tobacco, alcohol, and illegal drugs products that are prohibited from being used on the premises of the program both indoor and outdoor environments and in any vehicles used by the program at all times.

Additionally, children model adult behavior. Cigarette smoking in any form is not a healthy behavior. The use of tobacco, electronic cigarettes e-cigarettes , alcohol, and drugs should be prohibited on the premises of the program both indoor and outdoor environments , during work hours including breaks, and in any vehicles used by the program at all times.

The use of legal drugs e. Cigarettes and materials used to light them also present a risk of burn or fire. In fact, cigarettes used by adults are the leading cause of ignition of fatal house fires 9. The use of alcoholic beverages and legal drugs in family child care homes after children are not in care is not prohibited, but these items should be safely stored at all times.

Question: Why does this standard state that sunscreen should be applied thirty minutes before going outdoors, but the AAP reference listed on page states that sunscreen should be applied minutes before going outside? Answer: The recommendation of how many minutes prior to going outside sunscreen should be applied was revised from 30 minutes to minutes on January 30, , which was after the publication of CFOC , 3rd Edition.

Over-the-counter ointments and creams, such as sunscreen that are used for preventive purposes do not require a written authorization from a primary care provider with prescriptive authority. Sunscreen is needed on cloudy days and in the winter at high altitudes.

Sun reflects off water, snow, sand, and concrete. UVA protection is designated by a star rating system, with four stars the highest allowed in an over-the-counter product. Sunscreen should be applied thirty minutes before going outdoors as it needs time to absorb into the skin.

If the children will be out for more than one hour, sunscreen will need to be reapplied every two hours as it can wear off. If children are playing in water, reapplication will be needed more frequently. Children should also be protected from the sun by using shade and sun protective clothing.

Exposure to UV light is highest near the equator, at high altitudes, during midday 10 AM to 4 PM , and where light is reflected off water or snow 5. Sunscreen needs to be applied every two hours because it wears off after swimming, sweating, or just from absorbing into the skin 1. There is a theoretical concern that daily sunscreen use will lower vitamin D levels.

UV radiation from sun exposure causes the important first step in converting vitamin D in the skin into a usable form for the body. Current medical research on this topic is not definitive, but there does not appear to be a link between daily normal sunscreen use and lower vitamin D levels 7. This is probably because the vitamin D conversion can still occur with sunscreen use at lower levels of UV exposure, before the skin becomes pink or tan.

However, vitamin D levels can be influenced significantly by amount of sun exposure, time of the day, amount of protective clothing, skin color and geographic location 8. These factors make it difficult to apply a safe sunscreen policy for all settings.

A health consultant may assist the program develop a local sunscreen policy that may differ from above if there is a significant public health concern regarding low vitamin D levels. Most insects do not carry human disease and most insect bites only cause mild irritation.

Insect repellents may be used with children older than 2 months in child care where there are specific disease outbreaks and alerts. It does not require written permission from a primary care provider. Most product labels for registrations containing DEET recommend consultation with a physician if applying to a child less than six months of age.

Do not use products that combine insect repellent and sunscreen. This is because sunscreen may need to be re-applied more often and in larger amounts than repellent. Sunscreens may increase absorption of DEET through the skin. Other Types of Insect Repellents Picaridin and IR are other products registered at the Environmental Protection Agency EPA identified as providing repellent activity sufficient to help people avoid the bites of disease carrying mosquitoes 4.

Para-menthane-diol PMD or pil of lemon eucalyptus products, according to their product labels, should NOT be used on children under three years of age 4,5. General Guidelines for Use of Insect Repellents with Children As noted above, insect repellents may be applied to children older than two months. When applying insect repellent on a child, use just enough to cover exposed skin. Do not apply under clothing. Avoid applying to areas around the eyes and mouth.

Do not use over cuts or irritated skin. Do not use near food. After returning indoors, wash treated skin immediately with soap and water. If the child gets a rash or other skin reaction from an insect repellent, stop using the repellent, wash the repellent off with mild soap and water, and call a local poison center for further guidance 4. Remove leaf litter and clear tall grasses and brush around homes and buildings and at the edges of lawns; b.

Place wood chips or gravel between lawns and wooded areas to restrict tick migration to recreational areas; c. Mow the lawn and clear brush and leaf litter frequently; d. Keep playground equipment, decks, and patios away from yard edges and trees; e. Ensure that children wear light colored clothing, long sleeves and pants, tuck pants into socks; and f. Conduct tick checks of children when returning indoors 7. How to Remove a Tick 8 : It is important to remove the tick as soon as possible. Use the following steps: a.

If possible, clean the area with an antiseptic solution or soap and water. Take care not to scrub the tick too hard. Just clean the skin around it; b. Use blunt, fine tipped tweezers or gloved fingers to grasp the tick as close to the skin as possible; c.

Pull slowly and steadily upwards to allow the tick to release; d. Wash the area around the bite with soap; f. Following the removal of the tick, wash your hands, the tweezers, and the area thoroughly with soap and warm water. Take care not to do the following: a. Do not use sharp tweezers.

Do not use a twisting or jerking motion to remove the tick. Do not handle the tick with bare hands. Do not try to make the tick let go by holding a hot match or cigarette close to it. Do not try to smother the tick by covering it with petroleum jelly or nail polish. Any child who meets these criteria should have a Routine and Emergent Care Plan completed by their primary care provider in their medical home.

In addition to the information specified in Standard 9. A template for a Care Plan for children with special health care needs is provided in Appendix O. The Care Plan should be updated after every hospitalization or significant change in health status of the child. The child care health consultant should be involved to assure adequate information, training, and monitoring is available for child care staff.

Child care health consultants are very helpful in assisting in implementing Care Plans and in providing or finding training resources. For additional information on care plans and approaches for the most prevalent chronic diseases in child care see the following resources:. Digital thermometers should be used with infants and young children when there is a concern for fever.

Tympanic ear thermometers may be used with children four months and older. Glass or mercury thermometers should not be used. Mercury containing thermometers and any waste created from the cleanup of a broken thermometer should be disposed of at a household hazardous waste collection facility.

Oral under the tongue temperatures can be used for children over age four. Types of Thermometers for Child Care. Mercury thermometers can break and result in mercury toxicity that can lead to neurologic injury. To prevent mercury toxicity, the American Academy of Pediatrics AAP encourages the removal of mercury thermometers from homes. This includes all child care settings as well 1. Although not a hazard, temporal thermometers are not as accurate as digital thermometers 2.

Safety and child abuse concerns may arise when using rectal thermometers. Many state or local agencies operate facilities that collect used mercury thermometers. Typically, the service is free. For more information on household hazardous waste collections in your area, call your State environmental protection agency or your local health department. Any prescription medication should be dated and kept in the original container.

The container should be labeled by a pharmacist with:. All medications, refrigerated or unrefrigerated, should:. Medication should not be used beyond the date of expiration. In the event medication cannot be returned to the parent or guardian, it should be disposed of according to the recommendations of the US Food and Drug Administration FDA 1. Documentation should be kept with the child care facility of all disposed medications. The current guidelines are as follows:. Proper disposal of medications is important to help ensure a healthy environment for children in our communities.

There is growing evidence that throwing out or flushing medications into our sewer systems may have harmful effects on the environment Content in this standard was modified on August 23, and November 10, All children should be monitored to prevent them from eating substances that do not provide nutrition often referred to as pica 1,2.

Question: I cannot find any information in the new CFOC as to how long a bottle of breast milk can be kept after it is fed to an infant. It states that a bottle of formula should be discarded after one hour. I would think that it should be the same, since saliva is introduced into the bottle regardless of its contents, but I want to make sure.

Can you offer some guidance? Both re-sources state that breast milk should be discarded after it is fed to an infant. Expressed human milk should be transported and stored in clean and sanitary bottles with nipples that fit tightly or in equivalent clean and sanitary sealed containers to prevent spilling during transport to home or to the facility.

Only cleaned and sanitized bottles, or their equivalent, and nipples should be used in feeding. Frozen human milk may be transported and stored in single-use plastic bags and placed in a freezer with a separate door or a stand-alone freezer, and not in a compartment within a refrigerator. This is especially important when a frozen bottle is thawed in running tap water. There may be several bottles for different children being thawed and warmed at the same time in the same place.

Human milk should be thawed in the refrigerator if frozen. If there is insufficient time to thaw the milk in the refrigerator before serving, it may be thawed in a container of warm water, gently swirling the bottle periodically to evenly distribute the temperature in the milk and mix the fat, which may have separated. Frozen milk should never be thawed in a microwave oven because uneven hot spots in the milk may cause burns in the child and excessive heat may destroy beneficial components of the milk.

Although human milk does not need to be warmed, some children prefer their milk warmed to body temperature, around When warming human milk, it is important to keep the container sealed while warming to prevent contamination. Human milk can be warmed. Human milk should never be warmed directly on the stove or in the microwave.

It should feel warm, not hot. Avoid bottles made of plastics containing bisphenol A BPA or phthalates, sometimes labeled with recycling code 3, 6, or 7. Human milk cannot be served if it does not meet the requirements for sanitary and safe milk. Although human milk is a body fluid, it is not necessary to wear gloves when feeding or handling human milk. Some infants around 6 months to 1 year of age may be developmentally ready to feed themselves and may want to drink from a cup.

There are many different factors that can affect how long human milk can be stored in various locations, such as storage temperature, temperature fluctuations, and cleanliness while expressing and handling human milk. These factors make it difficult to recommend exact times for storing human milk in various locations, but the Human Milk Storage Guidelines table can be helpful.

By following this standard, early care and education staff is able, when necessary, to prepare human milk and feed a child safely, thereby reducing the risk of inaccuracy or feeding the child unsanitary or incorrect human milk. The formula should be of the same brand that is served at home and should be of ready-to-feed strength or liquid concentrate to be diluted using cold water from a source approved by the health department.

Powdered infant formula, though it is the least expensive formula, requires special handling in mixing because it cannot be sterilized. Before opening the can, hands should be washed. The can and plastic lid should be thoroughly rinsed and dried. Also, a scoop can be contaminated with a potential allergen from another type of formula. Iron-fortified formula should be refrigerated until immediately before feeding. For bottles containing formula, any contents remaining after a feeding should be discarded.

Any prepared formula must be discarded within one hour after serving to an infant. Some infants will require specialized formula because of allergy, inability to digest certain formulas, or need for extra calories. The appropriate formula should always be available and should be fed as directed. For those infants getting supplemental calories, the formula may be prepared in a different way from the directions on the container. Formula should not be used beyond the stated shelf life period 3.

The bottles must be sanitary, properly prepared and stored, and must be the same brand in the early care and education program and at home. Avoid bottles made of plastics containing bisphenol A BPA or phthalates sometimes labeled with 3, 6, or 7. Use glass bottles with a silicone sleeve a silicone bottle jacket to prevent breakage or those made with safer plastics such as polypropylene or polyethylene labeled BPA-free or plastics with a recycling code of 1, 2, 4, or 5.

Question: I have concerns about the standards recommending glass and ceramic containers due to concerns about using plastic. I had a center that had a glass bottle drop and shatter in their infant room. Answer: BPA-free plastic bottles, those labeled 1, 2, 4, or 5, can be used to avoid the use of glass. For those child care and early education facilities that choose to use glass bottles, a relatively new option is to use a bottle sleeve with the glass bottle to reduce the risk of shattered glass.

Efficacy on this product is still being proven. Overall, glass is safer than plastic with BPA. Bottles and infant foods do not have to be warmed; they can be served cold from the refrigerator. Bottles should not be left in a pot of water to warm for more than 5 minutes.

Infant foods should be stirred carefully to distribute the heat evenly. Bottles used for infant feeding should be made of the following substances 3 :. Bisphenol A BPA -free plastic; plastic labeled 1, 2, 4, or 5, or. Bottles of human milk or infant formula that are warmed at room temperature or in warm water for an inappropriate period provide an ideal medium for bacteria to grow. Infants have received burns from hot water dripping from an infant bottle that was removed from a crock-pot or by pulling the crock-pot down on themselves by means of a dangling cord.

Caution should be exercised to avoid raising the water temperature above a safe level for warming infant formula or infant food. Food safety for moms to be: once baby arrives. Updated November 8, Pediatric oral burns: a ten-year review of patient characteristics, etiologies and treatment outcomes. Int J Pediatr Otorhinolaryngol. Environmental Working Group. Guide to baby-safe bottles and formula.

Updated October, Tableware and feeding utensils should meet the following requirements:. Food should not be put directly on the table surface for two reasons. First, even washed and sanitized tables are more likely to be contaminated than disposable plates or washed and sanitized dishes.

Second, eating from plates reduces contamination of the table surface when children put down their partially eaten food while they are eating. Although highchair trays can be considered tables, they function as plates for seated children. The tray should be washed and sanitized before and after use 4.

The use of disposable items eliminates the spread of contamination and disease and fosters safety and injury prevention. Single-service items are usually porous and should not be washed and reused. Items intended for reuse must be capable of being washed, rinsed, and sanitized. Medium-weight plastic should be chosen because lighter-weight plastic utensils are more likely to have sharp edges and break off small pieces easily.

Older children can cut their mouth tissues in the same way. Foam can break into pieces that can become choking hazards for young children. Imported dishware may be improperly fired and may release toxic levels of lead into food. There is no safe level of lead in dishware. If there is a question about whether tableware is safe and sanitary, consult the regulatory health authority or local health department.

In centers using commercial cooking equipment to prepare meals, ventilation should be equipped with an exhaust system in compliance with the applicable building, mechanical, and fire codes. These codes may vary slightly with each locale, and centers are responsible to ensure their facilities meet the requirements of these codes All gas ranges in centers should be mechanically vented and fumes filtered prior to discharge to the outside. All vents and filters should be maintained free of grease build-up and food spatters, and in good repair.

An exhaust system must collect fumes and grease-laden vapors properly at their source.

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