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Health and Safety of Staff and Children 2011 Margaret Poppe RN, MSN.

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1 Health and Safety of Staff and Children 2011 Margaret Poppe RN, MSN

2 Child Care Workers Health Working in Child Care settings can be associated with: Increased exposure to infectious Diseases Muscle and Skeletal Injuries Falls Environmental Hazard Exposure Stress

3 Developmental Injury Risks for Children

4 Preventing Injuries in Child Care Settings What types of injuries: Minor (cuts, scrapes, bruises) Severe( head injuries and broken bones, internal injuries, dental injuries) How: – Falls – Collisions – Drowning Why: Physical ability Hazards Lack of supervision

5 6/12/2014 The National Training Institute for Child Care Health Consultants 5 Site Specific Safety Assessment Checklist Every child care facility should have daily and monthly safety checklists in place that are specific to their own facilities and environments. Create injury prevention and response policies and assure that all staff are aware. Adapted from :

6 6/12/2014 The National Training Institute for Child Care Health Consultants 6 Supervision Be alert and attentive Be aware of age-appropriate equipment Evaluate and inspect hazards Know and apply safe playground rules Teach children correct use of equipment Be consistent with adult-child ratio Intervene for inappropriate behavior Ensure safe clothing for children Assign staff to a zone and rotate Adapted from :

7 What is Sudden Infant Death Syndrome (SIDS)? SIDS is the unexpected death of seemingly healthy babies 12 months or younger. No cause of death is determined by – Death scene investigation and autopsy. – Review of babys medical history. Experts cannot predict which babies will die from SIDS. Reducing the Risk of SIDS in Child Care Speaker's Kit http://www.healthychildcare.org/sids.html Willinger M, James LS, Catz C. Defining the sudden infant death syndrome (SIDS): deliberations of an expert panel convened by the National Institute of Child Health and Human Development. Pediatr Pathol. 1991;11:677–684 Revised – 12/08

8 Triple Risk Model SIDS Critical development period External stressorsVulnerable infant Revised – 12/08 Reducing the Risk of SIDS in Child Care Speaker's Kit http://www.healthychildcare.org/sids.html

9 Rebreathing Theory Infants in certain sleep environments are more likely to trap exhaled CO 2 around the face – Lie prone and near-face-down/face-down – Soft bedding – Tobacco smoke exposure Infants rebreathe exhaled CO 2 : CO 2 & O 2 Infants die if they cannot arouse/ respond appropriately SIDS and Sleep-related Deaths: Current Statistics, Accomplishments & Challenges Fern R. Hauck, MD, MS, Department of Family Medicine,University of Virginia

10 Reasons that people place babies on their tummies They think that babies are more likely to choke or aspirate if they vomit or spit up They are worried that babies wont sleep as well Parental requests Reducing the Risk of SIDS in Child Care Speaker's Kit http://www.healthychildcare.org/sids.html Revised – 12/08

11 Anatomy when sleeping on stomach Revised - 0408 Reducing the Risk of SIDS in Child Care Speaker's Kit http://www.healthychildcare.org/sids.html

12 Anatomy when supine Revised – 12/08 Reducing the Risk of SIDS in Child Care Speaker's Kit http://www.healthychildcare.org/sids.html

13 Tummy to Play and Back to Sleep Supervised tummy time when babies are awake – Promotes healthy physical and brain development – Strengthens neck, arm, and shoulder muscles – Decreases risk of head flattening and balding – Encourages bonding and play between the supervising adult and the baby Back to sleep – Reduces the risk of SIDS – Comfortable and safe Revised – 12/08

14 Tummy Time Tummy time is for babies who are awake and being observed. It is needed to develop strong muscles. Have tummy time 2 to 3 times a day and increase the amount of tummy time per day as the baby gets stronger. There are lots of ways for babies to enjoy tummy time! Revised – 12/08 Reducing the Risk of SIDS in Child Care Speaker's Kit http://www.healthychildcare.org/sids.html

15 Safe Sleep Practices Always put healthy babies to sleep on their backs for naps and at bedtime. Revised – 12/08 Reducing the Risk of SIDS in Child Care Speaker's Kit http://www.healthychildcare.org/sids.html

16 Safe Sleep Practices Avoid overheating. – Do not overdress baby. – Never cover babys head with a blanket. – Room temperature should be comfortable for a lightly clothed adult. Revised – 12/08 Reducing the Risk of SIDS in Child Care Speaker's Kit http://www.healthychildcare.org/sids.html

17 Safe Sleep Practices Pacifiers may be offered to babies to reduce the risk of SIDS – If breastfed, wait until breastfeeding is well established (approximately 3 - 4 weeks of age), before offering a pacifier. – If the baby refuses the pacifier, dont force it. – If the pacifier falls out while the baby is asleep, you do not have to re-insert it. Revised – 12/08 Reducing the Risk of SIDS in Child Care Speaker's Kit http://www.healthychildcare.org/sids.html

18 Safe Sleep Environment Safe crib, firm mattress. Avoid chairs, sofas, air mattresses, water beds, and adult beds. Revised – 12/08 Reducing the Risk of SIDS in Child Care Speaker's Kit http://www.healthychildcare.org/sids.html

19 19 Emergencies in Child Care Facilities General emergencies Missing children Disgruntled or impaired parents/guardians or their authorized representatives Medical emergencies Natural disasters, including hurricanes, tornados, and severe storms Fire/smoke emergencies Bioterrorism/war emergencies (such as bomb threats) Nuclear or radiation emergencies Utility disruption Hazardous materials Chemical leaks The National Training Institute for Child Care Health Consultants, 2009

20 20 Grab and Go Kit List of emergency phone numbers, including parent contact information A charged cell phone or calling card or walkie talkies Water Non-perishable food, manual can opener First aid kit Blankets Radio, flashlights, extra batteries Handwashing solution that does not require running water Extra clothing/shoes Diapers, baby food and formula Prescription medicines for children and staff Other items as needed for safety and comfort Child records and attendance sheets The National Training Institute for Child Care Health Consultants, 2009

21 Musculoskeletal Injuries and Falls Risk Factors Heavy lifting and carrying Sitting on the floor or in child sized chairs with little back support Kneeling and squatting Reaching

22 Use Good Body Mechanics to Prevent Injury Use adult size furniture When rising from child size furniture ( use squat position, back straight, pelvis level, thighs tight Set up storage so you can reach from normal standing To get to child level squat or kneel keep spine straight

23 Lifting Children Feet apart, one foot along side of child one slightly back. Squat, bend at knees. Tighten stomach keep back straight Use leg strength Avoid twisting Putting child down same process, back straight

24 Other Ways to Prevent Injury Wear supportive non skid footwear Regular exercise & stretching Maintain proper body weight Floor sitting use the wall for support Use or request carts for moving heavy objects

25 OSHA Hazard Communication Standard 1910.1200 Requires that all employees be informed of the identities and hazards of the chemicals they are exposed to when working Warning labels should be visible on containers Products including sanitizing agents should have an MSDS (Material Safety Data Sheets) Training on proper handling, storage, usage should be provided for staff

26 Environmental Safety for Staff and Children Avoid use of high solvent cleaners especially carpets Store cleaning products in their original containers Pest management should choose the lowest number Health Hazard Rating (0-4) Only certified professionals should be employed for pest management or mold or mildew treatment

27 Environmental Safety Art Materials : ASTM-D-4236 or ACMI Staff should avoid personal use of adult art supplies such as rubber cement and aerosols or turpentine based materials

28 Infectious Disease Concerns ?

29 Why do Young Children Spread Illnesses so Easily ? Immature immune system & frequent illness Children need a lot of intimate hands on care Hand to mouth activity Children are in close contact Great number of unrelated children Age group mixing Children and staff bring mild illness to school

30 Chain of Infection Source of Germs Route of Transmission Host Attack the source of infection or the first link by identification, treatment and, if necessary, isolation of the sick person Attack the route of transmission or the second link by personal and general hygiene: Handwashing Protect the vulnerable person or the third link through immunization, balanced nutrition, and healthy practices. California Child Care Health Project

31 Modes of Transmission Droplets Fecal Oral Route Skin Blood or Body Fluids

32 Droplets

33 Stool or Fecal/Oral transmission

34 Skin Contact

35 Blood or Other Body Fluids

36 Group Activity

37 Break the Chain by Enforcing Exclusion Guidelines http://www.healthychildcare.org/PDF/InfDise ases/Videos/Module3Video2.wmv http://www.healthychildcare.org/PDF/InfDise ases/Videos/Module3Video2.wmv

38 Break the Chain by Enforcing Exclusion Guidelines Key Points The ill child is unable to take part comfortably in regular activities The ill child needs care that significantly interferes with providers ability to provide appropriate care for other children The child has signs or symptoms of a possible serious condition Signs or symptoms that indicate a contagious illness or condition or has a diagnosed contagious illness Caring for Our Children http://nrckids.org/SPINOFF/IE/IncExc.pdfhttp://nrckids.org/SPINOFF/IE/IncExc.pdf

39 Exclusion Cont. Diarrhea that cant be explained by diet change, is watery, and cant be contained in the diaper or managed by regular toileting 2 or more episodes of vomiting in 24 hours Others See VT licensing regulations

40 VT Exclusion Guidelines Axillary (armpit) temperature of 100°F or greater and behavior change Rectal (anus) temperature of 102°F or greater and behavior change Under 2 months old with temperature 100.4°F or higher rectal contact parent or EMS if not reachable http://dcf.vermont.gov/sites/dcf/files/pdf/cdd/care/EC P_Appendix_B.pdf

41 Break the Chain : Morning Health Check and Exclusion

42 Break the Chain : Immunizations

43 Concept of Herd Immunity If enough of the herd is immunized the whole herd is protected. ( 95%) Goal : Aim to get as many children and staff immunized as possible to protect the whole group.

44 Break the Chain :Hand Washing and Sanitizing Handwashing Activity

45 Policy Considerations What should be Done Why Who is responsible When will it be done How will it be done How will it be communicated and enforced

46 © The National Training Institute for Child Care Health Consultants, UNC-CH, 2007 46 What Should a Policy Include? 1.Title 2.Belief Statement 3.Intent Statement 4.Background 5.Procedure/Practice 6.Application

47 © The National Training Institute for Child Care Health Consultants, UNC-CH, 2007 47 What Should a Policy Include? 7. Communication 8. References 9.Review 10.Effective Date 11.Review Date

48 Policy Activity

49 Sanitizing Surfaces Breaks the Chain 1/4 cup household bleach to one gallon of cool water One tablespoon household bleach to one quart cool water Spray dont dip Contact time 2 minutes Mix ever day Safety issues

50 Safe Diapering Breaks the Chain

51 Evaluate This Diapering Set-up Courtesy of Cheryl Frank and Andrea Miller

52 OSHA Blood borne Pathogen Standard 1910.1030 Requires that any workplace that exposes employees to blood borne pathogens should have a written exposure plan. Staff should be oriented to the plan. –All body fluids should be considered potential sources of infection and precautions should be taken including Gloves and protective equipment as appropriate Hand washing Sanitizing Reporting exposure and following the exposure plan is program specific

53 Infectious Disease Policy & Procedures Checking childrens immunization status and informing parents of gaps Universal precautions Hand washing Diapering Cleaning & disinfecting Identifying an ill child or child care provider Informing parents that their child is ill Routinely informing all families about highly infectious condition or disease

54

55 Pregnant Employees Contact your physician for advice Risk for CMV Get tested for CMV antibody Work with 2 year olds and older during pregnancy Good hand washing Avoid saliva, toys, and utensils contaminated with saliva

56 OBESITY RISK : Organizational & Institutional: Childcare Attending childcare associated with obesity Need to Address Healthy Eating Standards Regulations, Quality Stars, NAPSACC – Meal pattern – Limit Juice, ban SSBs – Reduce energy density – Portion size Gubbels, et al: Int J Obesity 2010 May; Khan, et al; MMWR 2009;58:1-26; Rolls: Poc Nutr Soci, December 2009; Lehahy, et al: JADA 2008;108:41-48. Barbara A. Dennison, MD, Early Childhood Obesity Role of nutrition Factors Powerpoint presentation, 2010.New York State Department of Health School of Public Health, SUNY Albany

57 Why are young children getting fatter? They are eating too many calories. FITS, JADA, 2004; IOM, 2002; USDA, ERS, 2004 Barbara A. Dennison, MD, Early Childhood Obesity Role of nutrition Factors PowerPoint presentation, 2010.New York State Department of Health School of Public Health, SUNY Albany

58 Socio-ecologic Model: A Framework to Identify Levels of Influence Barbara A. Dennison, MD, Early Childhood Obesity Role of nutrition Factors PowerPoint presentation, 2010.New York State Department of Health School of Public Health, SUNY Albany

59 Frieden TR: Am J Public Health 2010;100:590-595 High Resource Low Resource Barbara A. Dennison, MD, Early Childhood Obesity Role of nutrition Factors PowerPoint presentation, 2010.New York State Department of Health School of Public Health, SUNY Albany

60 Licensing Regulations, Standards, Stars What is the minimum required? Is it enough? What is the role of child care in promoting healthy eating and physical activity? What are the challenges?

61 New Standards on Nutrition, Physical Activity, and Screen Time Recently released 2010 standards provide guidance beyond what we currently have in our licensing regulations. Preventing Childhood Obesity in Early Care and Education Programs http://nrckids.org/CFOC3/PDFVersion/prevent ing_obesity.pdf http://nrckids.org/CFOC3/PDFVersion/prevent ing_obesity.pdf

62 Highlights of New Guidelines General: Use USDA CACFP guidelines, meal pattern, menu, water, 100%juice Infants: Encourage breastfeeding, Consistent caregiver feeding, cue based, storage of human milk, bottle feeding techniques, introduction of age appropriate foods, soy based products Toddlers: Meal and snack pattern, serving size, self feeding Food brought from home: Quality and selection and preparation Nutrition education: Provide nutrition learning experiences for children, parents/guardians, including health, nutrition, and physical activity Policies: Infant feeding, food and nutrition, Physical activity : Active indoor and outdoor play, policies and practices, role modeling Limit screen time http://nrckids.org/CFOC3/PDFVersion/preventing_obesity.pdf Preventing Childhood Obesity in Early Care and Education Programs : http://nrckids.org/CFOC3/PDFVersion/preventing_obesity.pdf http://nrckids.org/CFOC3/PDFVersion/preventing_obesity.pdf

63 Nutrition Key Points The Child Care program must promote a Healthy Eating Environment Food Must Meet the Childrens Nutritional Needs ( USDA Child and Adult Care Food Program ) Meal or snack provided every 3 hours Fruit juice recommendation Food Served Must Be Safe

64 Eating Environment Recommendation Family style Separate serving utensil Encourage but do not force eating ( ideas?) Adults role model food choices that meet nutritional standards Socialize, talk about food, days events, color etc. Dont rush slow eaters Accommodate special diets Hold Infants for Bottle feeding

65 © The National Training Institute for Child Care Health Consultants, UNC-CH, 2007 65 Harms, Clifford and Cryer Environment Rating Scales

66 © The National Training Institute for Child Care Health Consultants, UNC-CH, 2007 66 Scale Characteristics: Items Each scale has items to evaluate: Physical environment Basic care Curriculum Caregiver/child interaction Schedule/program structure Provisions for parent/staff ECKERS Video Clip meals and snacks

67 USDA Child and Adult Program Recommendations Meal Pattern Recommendations : http://www.fns.usda.gov/cnd/care/ProgramBasi cs/Meals/Meal_Patterns.htm

68 Activity Food Policy

69 6/12/201404/18/07 The National Training Institute for Child Care Health Consultants 69 Requirements for Food Safety All children must be served food that is stored, prepared, and presented in a safe and sanitary environment. All child care facilities must follow the steps for safe food handling.

70 Storage Containers and Heating Bottles made of plastics containing BPA or phthalates should be avoided (labeled with #3, #6, or #7). Glass bottles or plastic bottles labeled BPA Free or with a #1, #2, #4, or #5 are acceptable.

71 Food Safety Hand washing before food preparation Formula storage and labeling ( prepared for 24 hours ) Warming Bottles Choking prevention Cut foods into pieces no larger than ½ inch. Teach children how to chew their food well. Food storage and labeling ( clearly labeled and dated ) Food Allergies posted Cleaning surfaces Refrigerator temperatures ( <40 degrees) Washing fresh fruits and vegetables VT Early Childhood Program Licensing Regulations: http://dcf.vermont.gov/cdd/child_care_licensinghttp://dcf.vermont.gov/cdd/child_care_licensing ( Early Childhood Programs pg. 30-33 and Regulations for Family Day Care Homes pg. 13 )

72 6/12/201404/18/07 The National Training Institute for Child Care Health Consultants 72 Nutritional Needs - Infants Exclusive breastfeeding is recommended for the first six months of life. Research shows breastfeeding has strong benefits for both mother and baby

73 Support for Breast Feeding Establish a supportive breastfeeding policy Train Staff In proper handling/storage of human milk. Provide positive breastfeeding promotion messages Provide a place to breastfeed or pump in privacy Assure all know that mothers may breastfeed her child wherever she and her child have a legal right to be (Vermont Act 117) Encourage expectant mothers to breastfeed Connect new mothers with others who have successfully combined breastfeeding and working. http://healthvermont.gov/wic/food- feeding/breastfeeding/childcare.aspx

74 6/12/201404/18/07 The National Training Institute for Child Care Health Consultants 74 Storing Breast Milk Store in firm plastic containers, either poly propylene (cloudy and a little flexible) or polycarbonate (clear and rigid), or glass. Store in the refrigerator no longer than 48 hours, and in the freezer for no longer than two weeks. All containers must be labeled with the childs name and serving date.

75 6/12/201404/18/07 The National Training Institute for Child Care Health Consultants 75 Serving Breast Milk Bottles of breast milk should be warmed by placing them in a pan of hot (not boiling) water for 5 minutes or until it reaches the desired temperature. Milk should never be heated in a microwave. The temperature of the milk should always be tested to reduce the risk of burns upon feeding.

76 6/12/201404/18/07 The National Training Institute for Child Care Health Consultants 76 Nutritional Needs - Infants Feed infants whenever they are hungry. Juice is not necessary for infants and may be detrimental. Hold infants when feeding.

77 6/12/201404/18/07 The National Training Institute for Child Care Health Consultants 77 Nutritional Needs - Infants Solid Foods May be introduced at 6 months of age, depending on the individual childs development. Finger feeding may be introduced at 8-10 months of age.

78 6/12/201404/18/07 The National Training Institute for Child Care Health Consultants 78 Nutritional Needs – Toddlers and Preschoolers Eating Characteristics Small frequent meals. Child chooses how much food they eat Portion Sizes Refer to CACFP and the Food Guide Pyramid for age appropriate portion sizes.

79 6/12/201404/18/07 The National Training Institute for Child Care Health Consultants 79 Nutritional Needs – Toddlers and Preschoolers Nutritional Requirements Variety needed for growth and health – CACFP and the Food Guide Pyramid Use as a guide for meals and snacks. Check for updates. Limit sweets, fat, and juice.

80 6/12/201404/18/07 The National Training Institute for Child Care Health Consultants 80 Special Needs and Allergies Special requirements obtained in writing Individualized adaptations Monitoring and rapid response plan

81 6/12/201404/18/07 The National Training Institute for Child Care Health Consultants 81 Menu Planning Plan menus in advance and work with a nutrition specialist. Snacks make up 20% of childrens daily energy and nutrient needs, so all foods need to be nutritious. Avoid high sugar, high fat or sticky foods.

82 Juice Recommendation 2010 Only 100% Juice or diluted full strength No more than 4-6 oz. per day from age 1-3 Infants to 12 months : No fruit juice No sweeteners At meal and snack time Conversations with Parents Why : teeth and obesity research

83 Menu Planning Checklist Meets the CACFP requirements Includes a good source of vitamin C Includes a good source of iron Includes a good source of vitamin A Includes foods with different textures Includes foods with different colors Includes new foods and favorite foods Represents cultural foods of the children Food safety standards are followed Includes a variety of fruits and vegetables?

84 Food Allergies All children with food allergies should have a plan which includes which foods need to be eliminated and actions to take in an emergency Allergies should be prominently posted Staff should receive training http://nrckids.org/CFOC3/PDFVersion/preventing_o besity.pdf

85 Nutrition Scenarios Communicating with Parents

86 Physical Activity Physical Activity Guidelines Promote active play everyday – 2-3 time outdoors weather permitting( toddlers 60-90 minutes, preschoolers 90-120 minutes) – 2+ structured adult led activities or games that promote movement – Opportunities to practice age appropriate gross motor and movement

87 Activity Creative Opportunities for Active Play

88 Examples/Resources http://www.aahperd.org/headstartbodystart/ne ws/takeItOutsideWeek/upload/movingwithbe ac-ball.pdf http://www.aahperd.org/headstartbodystart/ Motion Moments videos http://nrckids.org/Motion_Moments/index.ht m http://nrckids.org/Motion_Moments/index.ht m

89 Too Much TV The American Academy of Pediatrics (AAP) recommends that children two years old and under should not be exposed to television children over age two should limit daily media exposure to only 1-2 hours of quality programming

90 Resources Head Start Body Start Lead Structured Activities http://www.aahperd.org/headstartbodystart/news/t akeItOutsideWeek/structuredactivities.cfm http://www.aahperd.org/headstartbodystart/news/t akeItOutsideWeek/structuredactivities.cfm Eat Well Play Hard in Child Care Settings Curriculum http://www.health.state.ny.us/prevention/nutrition/ cacfp/ewphccs_curriculum/ http://www.health.state.ny.us/prevention/nutrition/ cacfp/ewphccs_curriculum/ Color me Healthy Preschoolers Eating and Moving http://www.colormehealthy.com

91 Curriculum and Other Ideas? Eat Well Play Hard : Choose Your Fun: http://www.health.state.ny.us/prevention/nutrition/cacfp/ewphccs_curriculum/do cs/choose_your_fun.pdf http://www.health.state.ny.us/prevention/nutrition/cacfp/ewphccs_curriculum/do cs/choose_your_fun.pdf

92 Licensing Regulations, Standards, Stars What is the minimum required? Is it enough? What is the role of child care in promoting healthy eating and physical activity? What are the challenges?

93 What causes you to feel stress at work ?

94 What is Work Related Stress ? The harmful physical and emotional responses that occur when the requirements of the job do not match capabilities, resources and needs of the worker ( NIOSH, 2002) Job challenge is a positive experience that energizes us psychologically and motivates us to learn new skills and master our jobs ( NIOSH 2002)

95 Program Strategies that Help Decrease Stressors Staff are responsible for one group of children in one room Written job descriptions and personnel policies ( family friendly) Regular staff meetings Staff involved in decision making Trained volunteers or parents for breaks Emergency relief

96 How Do You Manage Stress ?


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