Managing the Food and the Health and Safety Programs Chapter 12 Managing the Food and the Health and Safety Programs

Chapter Objectives List components for providing a complete food service program Describe the process for monitoring procedures for caring for injured or sick children Formulate plans for various emergencies, including natural or national disasters Understand the need for staff training and reporting child abuse

Food Service Program Food service programs are important because nutrition affects mental functioning and physical well-being of children Important to provide Variety of nutritional food choices Pleasant mealtimes Served to appeal to children’s taste buds Teacher participation by sitting down and eating with children For young infants, holding the baby while giving bottle

Food Service Program High-risk foods likely to cause choking Frankfurters / chunks of meat Raw carrots & celery Marshmallows Peanut butter (spoonfuls) Whole grapes / large pieces of fruit Nuts and seeds Popcorn / chips / raisins Raisins / cherries with pits Hard candy

USDA Child/Adult Care Food Program Available to various providers Nonprofit licensed or approved public or private child care centers Family child care homes that belong to a sponsoring agency, such as Red Cross For-profit private programs that received funding through Title XX Monies are based on income eligibility of families enrolled

Menu Planning Total daily food requirement depends on total number of hours child spends in center 8 hours or less 1 meal and 2 snacks or 2 meals and 1 snack 9 hours or more 2 meals and 2 snacks or 1 meal and 3 snacks A nutritious snack shall be offered in mid-morning and in mid-afternoon Children shall be offered food at intervals of not less than 2 hours and not more than 3 hours apart unless child is sleeping

10A NCAC 09 .0903 REQUIREMENTS FOR CHILDREN AGED 24 MONTHS AND OLDER Meals and snacks shall be planned according to the number of hours a child is in the center. These rules apply in all situations except during sleeping hours and nighttime care: (1) For preschool-aged children in the center at least two hours but less than four hours, and for all school-aged children, one snack shall be provided unless the child is present during the time the center is serving a meal, in which case, a meal shall be provided. (2) For children in the center at least four hours, but less than six hours, one meal shall be provided equal to at least one-third of the child's daily food needs.

(3) For children in the center at least six hours, but less than twelve hours, two meals and one snack or two snacks and one meal shall be provided equal to at least one-half of the child's daily food needs. (4) For children in the center more than twelve hours, two snacks and two meals shall be provided which are equal to at least two-thirds of the child's daily food needs.

(5) No child shall go more than four hours without a meal or a snack being provided. (6) A nutritious evening meal must be provided to each child who receives second shift care (from approximately 3:00 p.m. to 11:00 p.m.) and who is present when the regularly scheduled evening meal is served.

Breakfast USDA recommends 25% of RDI be offered Critical meal—affects Cognition, strength, attitude, endurance Less likely to be obese Can result in poor nutrition

Breakfast Should consist of minimum of Milk, bread, or cereal and fruit Cold cereal fortified with iron is an easy way to increase consumption of carbohydrates and iron Can be optional or nontraditional foods May be culturally driven

Snacks Should provide adequate nutrition Should be served at sufficient intervals between meals Good time for cultural diversity Should consist of Milk or meat/meat alternate, and bread/grain or fruit May be “typical” or nontraditional

Lunches Provide greatest nutrition in care Should consist of milk, meat/meat alternative, fruits and/or veggies (2 minimum), and a bread or grain Often contain too much fat/saturated fats Should consider cutting back on fat and offering greater variety From home—less nutritional

Children on Vegetarian Diets Vegan—nuts, seeds, legumes, fruits and vegetables Lacto-vegetarian—in addition, dairy products Ovo-vegetarian—in addition, egg products Lacto-ovo vegetarian—in addition, both dairy and egg products

Vegetarian Diets Caregiver needs to understand type of vegetarian child is and how to provide the needs of the child in a balanced way Can be a challenge, especially for vegan Ask parents for suggestions and help

Menu Planning Infants require individualized eating schedules Nutritious meals and snacks can be selected from the following food groups Bread, rice, cereal, and pasta group Vegetable group Fruit group Milk, yogurt, and cheese group Meat, poultry, fish, dry beans, eggs, and nut group Fats, oils, and sweets group

10A NCAC 09 .0902 GENERAL NUTRITION REQUIREMENTS FOR INFANTS The parent or health care provider of each child under 15 months of age shall provide the center an individual written feeding schedule for the child. This schedule must be followed at the center. This schedule must include the child's name, be signed by the parent or health care provider, and be dated when received by the center. Each infant's schedule shall be modified in consultation, with the child's parent and/or health care provider, to reflect changes in the child's needs as he or she develops. The feeding instructions for each infant shall be posted for quick reference by the caregivers, except in centers licensed for three to 12 children located in a residence.

NUTRITION REQUIREMENTS FOR INFANTS (b) Each infant will be held for bottle feeding until able to hold his or her own bottle. Bottles will not be propped. Each child will be held or placed in feeding chairs or other age-appropriate seating apparatus to be fed.

Menu Planning Considerations in menu planning Nutritional aspects (USDA Food Pyramid) Children’s appetites and food preferences Availability of equipment and utensils Preparation time and time available Governing rules and regulations Parent input Allergies and religious restrictions Food linked to children’s choking

Menu Planning Systematized planning Menu planning guides Menu rotation (every 4-6 weeks) Seasonal or plentiful foods Reduces cost and waste Helps in setting up shopping lists

Food Buying Effective buying Bulk purchases (if center has adequate storage) Cooperative buying arrangements (between centers) Purchasing items that are on sale or for special price

Food Purchasing Food = good quality, fresh, undamaged Buy from reputable places Buy by “sell by” or “use by” dates Avoid fresh products that have been frozen/defrosted Keep meats and poultry away from fresh foods Buy perishables last, put away first No dented cans

Food Preparation Cooks should Follow recipes Adhere to directions about cooking times and temperatures Know proper techniques for holding prepared food and for storing and using leftovers Practice good sanitation

Food Storage Food should be conveniently accessible to preparation areas Sufficient shelf space to accommodate large containers and packages Food items must be stored separately from nonfood items Food storage rooms should be dry and relatively cool (60º-70º) and free from insect/rodent infestation Perishable foods must be stored at temperatures to prevent spoilage 40º for refrigerator Oº for freezer

Food Storage Key to keeping food safe Refrigerated Foods Temperature control, labeling, and arrangement Protect from contamination—insects and people Proper temperature maintenance is critical Refrigerated Foods Wrap meats, poultry, and fish well + label Refrigerated products = refrigerate immediately (see Table 7-5)

Food Safety Important to prevent foodborne illness Involves Food purchasing Food storage Handling Preparation/cooking

Realty Check: E. coli and Children As many as 20,000 cases per year and children are most vulnerable Found in rare or uncooked ground meat, unpasteurized fruit juices, alfalfa sprouts, dry-cured salami, lettuce, raw milk, and game meat

E. coli and Children E. coli = Escherichia coli Most abundant species of bacteria in our environment Lives in intestines of humans and animals Strains from animals are different and can be harmful to humans, especially E. coli 0157:H7 E. coli 0157:H7 has been infected with a strain of virus producing toxins Most common place to find E. coli 0157:H7 is in ground beef Preventative measures have been taken meat packing industry

E. coli and Children To prevent in child care cook all ground meet to a temperature of 160°F and other meats to 155°F Avoid cross contamination Wash hands Do not serve raw milk or unfiltered apple juice Always handle diarrhea under strict universal hygiene conditions

Health and Safety Programs Children Health records must comply with state and local requirements Immunization records Medical screenings Description of any disability Assessment of child’s growth Acute or chronic health problems Screening results (vision, hearing, dental, etc.) Dates of significant communicable diseases (chicken pox)

Health and Safety Programs (Continued) Children Health records must comply with state and local requirements Prescribed medications Description of serious injuries sustained by child in the past Special instructions for the caregiver Medical Treatment Authorization Form (American Academy of Pediatrics, 2002)

Health and Safety Programs Staff Health records must comply with state and local requirements Health history Physical exam Vision and hearing screening Tuberculosis (TB) screening by Mantoux method

Health and Safety Programs (Continued) Staff Health records must comply with state and local requirements Review of immunizations Review of occupational health concerns Assessment of need for immunizations against influenza, pneumococcus, and hepatitis B Assessment of orthopedic, psychological, neurological, or sensory limitations and communicable diseases that may impair staff member’s ability to perform the job

Communicable Diseases Must be reported to all center facilities Directors and staff must be trained to recognize symptoms of communicable diseases Decisions must be made concerning the health of children and staff

Exclusion Policy Exclusion guidelines A fever over 100ºF orally or 99ºF auxiliary (under the arm) Signs of newly developing cold or uncontrollable coughing Diarrhea, vomiting, or upset stomach Unusual or unexplained loss of appetite, fatigue, irritability, or headache Any discharge or drainage from eyes, nose, or ears Any open sores

Exclusion Policy (Continued) HIV Children are protected under the Americans with Disabilities Act (1990) Infected children cannot be denied access to educational services or programs

Disaster Plan A disaster or emergency plan must be in place Director and staff must be trained to handle procedures Building evacuation Weather emergencies Terrorist threats Accident or injury

Disaster Plan (Continued) Store emergency supplies in evacuation area First aid kit Blankets Food and water Battery operated radio Flashlights and extra batteries Children’s books, crayons, paper

Disaster Plan (Continued) Blue Code (National preparedness) Review organization chart and chain of command. Each time director leaves the building, it should be clear who is in charge Make it a priority that no adult is left alone in the building. If necessary program a phone and teach one of the older children to use it to call for help if something happens to the caregiver Have a plan for if the building loses power including back-up lighting system, cell phone, laptop computer

Disaster Plan (Continued) Code Blue Design Train receptionist to answer phone to deliver a succinct message to all callers Make it clear that all staff will stay at center until Code Blue is over; ask other staff to come in to help Update Code blue materials every September when new information peaks Reassure staff that this planning is preventative—it will probably not be needed, but if it is, every attempt has been made to minimize damage

Emergency Planning Procedures should be in place Medical emergencies Ill children Minor and major accidents Emergency care Transportation Signed consent form Staff trained in first aid and CPR

Child Abuse Prevention on the premises 2 adults in center at all times Reduce caregiver’s stress and anxiety with breaks and low teacher to child ratios Pre-employment screening Criminal history checks Clear visibility in classrooms and common areas

Recognizing/Reporting Abuse Staff should have training on signs/symptoms of child abuse If child abuse is suspected, center is mandated to report suspicions, but reports should be made carefully Familiarity with state laws and local rules for reporting child abuse is essential for all child care directors

Legal Issues: Health and Safety Possibility of law suits can be minimized Promote open and trusting communications with parents Maintain well-trained staff in adequate numbers to ensure proper supervision Purchase adequate liability insurance and accident insurance on all the children Check applicants’ references carefully Keep records of staff meetings and training sessions Choose attorney who is familiar with child care laws in your state