Health, Safety, and Nutrition

Health, Safety, and Nutrition
Time required for this course: 8 hours Materials for Course: Module 1: Flipchart and Markers, VCR/TV, Colored Markers/Crayons, Dolls large enough to practice caregiving skills, Sticky Notes, Gloves, Soap, Paper Towels, Water, Index Cards with glossary terms and definitions, Colored Dot Stickers, Plastic Bags, Diapers and Diaper Wipes. Module 2: Flipchart and Markers, Sticky Notes, Hazards to place around training room, and Look-a-Likes activity materials. Module 3: Flipchart and Markers, VCR/TV, Video: Nutrition for Infants and Children, One Week Menu, and Sticky Notes. The goal of the Health, Safety, and Nutrition course is to provide caregivers with a comprehensive understanding of the various elements of a safe and healthy child care environment. This includes a safe and healthy environment, as well as a basic understanding of childhood nutritional needs. The eight-hour course is presented in three modules. Module 1: A Healthy Environment Module 2: A Safe Environment Module 3: Children and Nutrition HSAN July 1, 2016

Icons Several icons are used throughout this course as a visual reference. This icon represents a new topic in the text. This is a visual cue for you to answer any questions about the previous section before moving along to the next one. This icon is used to identify an exercise that involves in-class practices and feedback. This icon is used to identify a specially designed activity that requires active class participation. This icon is used to identify a section that is accompanied by a video. Note to Trainer: These are the icons used in the Participant Guide as a visual reference. Health, Safety, and Nutrition

Icons This icon is used to identify a key point in the material. This icon is used to identify an online resource. You will need a computer with an internet connection to view these resources. This icon is used to identify an exercise that involves a role-playing scenario. This icon is used to identify an activity that requires you to reflect on the information taught in the course by asking you a question. The answers to these questions will require you to think about your role as a child care professional and may influence your actions. Note to Trainer: These are the icons used in the Participant Guide as a visual reference. Health, Safety, and Nutrition

Health, Safety and Nutrition
Module 1: A Healthy Environment Approximate time required for this module: 225 minutes Materials: Flipchart and Markers, VCR/TV, Colored Markers/Crayons, Dolls large enough to practice caregiving skills, Sticky Notes, Gloves, Soap, Paper Towels, Water, Index Cards with glossary terms and definitions, Colored Dot Stickers, Plastic Bags, Diapers and Diaper Wipes. Welcome to Module 1: A Healthy Environment. This module will discuss the elements of a healthy child care environment. Throughout this module, we will take a general look at the elements of a healthy environment; the characteristics of healthy children and environments, along with how those relate to providing safe child care; and also identifying, preventing, and controlling communicable disease. Health, Safety, and Nutrition

Module Goal and Learning Objectives
Participants will be able to identify and discuss the elements of a healthy environment. Learning Objectives After successfully completing this module, you will be able to: Identify the characteristics of a healthy environment Describe the characteristics of a healthy child Identify communicable diseases Describe methods of preventing the spread of communicable disease Explain the process of communicable disease control Identify proper hygiene practices for children and caregivers Identify safe food handling, preparation, and storage practices Describe the proper method of administering medication and documenting the use of medication in a program Goal Participants will be able to identify and discuss the elements of a healthy environment. Learning Objectives After successfully completing this module, you will be able to: Identify the characteristics of a healthy environment Describe the characteristics of a healthy child Identify communicable diseases Describe methods of preventing the spread of communicable disease Explain the process of communicable disease control Identify proper hygiene practices for children and caregivers Identify safe food handling, preparation, and storage practices Describe the proper method of administering medication and documenting the use of medication in a program Health, Safety, and Nutrition PG – 1

Activity: Spreading Germs
Module 1 Activity: Spreading Germs Approximate time required for this activity: 10 minutes Place a colored dot on each participant’s hand. Ask participants to walk around the room and stick their dot on a person wearing the same color of clothing to demonstrate how easy it is to pass germs. Because the children are in close contact, germs spread quickly. This illustrates why it is important to recognize—and respond immediately and appropriately to—signs of illness in the children in your care. Health, Safety, and Nutrition

Activity: Important Terms
Module 1 Activity: Important Terms Health Appetite Impermeable Surface Safety Hazards Nutrition Sanitize Immunizations Clean Disinfect Vaccine Communicable Disease Evacuation Plan Isolation Area Approximate time required for this activity: 10 minutes Give each person either a glossary term or a definition, each attached to a puzzle piece. Each person must find the person who has the piece that matches his own. Once pairs have been created, they share glossary terms and their definitions with the entire class. Health – The total well-being of a person—including the physical, mental, and social self—in the absence of disease or other abnormal conditions. Appetite – A desire to eat. Impermeable Surface – A surface that is resistant to water, chemicals, and other fluids. These surfaces are required in areas such as changing stations, playpens, cots, and sleeping mats. Safety Hazards – Things in the environment that can be identified as dangerous to one’s health and welfare. Nutrition – The processes by which a person, animal, or plant takes in and utilizes food substances. Sanitize – The process of destroying or reducing organisms to a safe level; including properly cleaned equipment and surfaces, such as sinks and sleep mats. Immunizations – The process of administering a vaccine to make an individual protected from contracting an infectious disease. Clean – To remove dirt, debris, and germs by scrubbing and washing with soap (or detergent) and water. The process does not necessarily kill germs, but lowers the risk of spreading infection. Disinfect – To kill germs on surfaces or objects by using chemicals. This process does not necessarily clean dirty surfaces or remove all germs, but by killing germs on a surface after cleaning, it can further lower the risk of spreading infection. Vaccine – A product that protects an individual from contracting an infectious disease by stimulating their immune system. Communicable Disease – Disease that can be spread from one person to another. Evacuation Plan – Procedures for getting children and staff out of a building; applied during fire drills and other emergency situations. Isolation Area – A designated area for a child who becomes ill at the facility, which must be away from the other, healthy children. Health, Safety, and Nutrition

What are the Qualities of a Healthy Environment?
Module 1 What are the Qualities of a Healthy Environment? Characteristics of a healthy environment that promote good health practices include: Clean work and play areas Proper Hygiene practices Implementation and routine practice of a written health policy How do you know if your program has a written policy? Why should policies be written? Approximate time required for this lesson: 10 minutes Child care programs have a responsibility to maintain an environment that will promote children’s health. What does “health” mean to you? (Allow time for responses.) Health is the total well-being of the physical body, including the emotional, social, and mental self, and the absence of disease or abnormal conditions. Government agencies have roles in licensing and inspecting child care programs. These roles assist and promote healthy environments for children. The Rules and Regulations Course discusses the roles governments play in child care through licensing, regulating, and inspecting activities. What kinds of things contribute to a healthy environment? (Write responses on the whiteboard, chalkboard, or flip chart.) Characteristics of a healthy environment that promote good health practices include: clean work and play areas. proper hygiene practices. implementation and routine practice of a written health policy. Written policies regarding health practices are essential to maintaining a healthy environment in your child care program. All policies should be accessible to all staff At hire, employees should be given a copy of the policies Rules should be posted and given to families How do you know if your program has a written policy? Ask! If you do not know whether or not your child care program has policies that address health issues, contact your program director It is essential that you understand and follow your child care program’s policies Why is it important to have policies written? To ensure parents and child care professionals are aware of procedures To make sure everyone follows the same rules Following your program’s written health policies will help to ensure that the children in your care have an environment that is as free of disease as possible. Health, Safety, and Nutrition PG – 2

Module 1 Key Point Establishing and following a written policy is an effective way of maintaining a safe and healthy child care program. Key Point: Establishing and following a written policy is an effective way of maintaining a safe and healthy child care program. Health, Safety, and Nutrition PG – 2

What are the Qualities of a Healthy Child?
Module 1 What are the Qualities of a Healthy Child? How are each of the senses used to observe a child? Why is it important to use more than one sense at a time to observe warning signs? Approximate time required for this lesson: 25 minutes Observation plays an essential role in determining a healthy environment and assists the caregiver in assessing the state of a child’s health. A healthy child has a good appetite, appearance, and activity level. We can use our senses—sight, touch, sound, and smell—when checking for signs of wellness and/or illness. A healthy child looks healthy. We must use all of our senses when checking for signs of wellness and/or illness. Our senses are sight, touch, taste, sound, and smell. (Write these on a whiteboard, chalkboard, or flip chart.) How is each of the senses used to observe a child? Why is it important to use more than one sense at a time to observe warning signs? (You cannot make a complete observation based on one small detail. For example, a red eyelid may not mean the presence of Pink Eye.) Sight – look at the child’s complexion; observe for signs of pain or discomfort, such as limping, droopy eyes, or a runny nose Sound – listen to how the child is breathing, or if they are coughing or sniffling; listen to their words about how they are feeling Touch – does the child feel warm to the touch; does the child flinch when you touch them Smell – pay attention to how the child smells; for example, their breath Why is it important to use more than one sense at a time to observe warning signs? You cannot make a complete observation based on one small detail. For example, a red eyelid may not mean the presence of pink eye. Health, Safety, and Nutrition PG – 3

Module 1 Appetite Can eat a substantial amount of food at times Will consume a variety of foods Is interested in eating Appears content after meals and snacks Signs of a physically healthy child fall into general categories and include: Appetite Can eat an appropriate amount of food at times Will consume a variety of foods Is interested in eating Appears content after meals and snacks Health, Safety, and Nutrition PG – 3

Module 1 Appearance Has clear, bright eyes Has clear skin Has well-developed muscles Gains steadily in height and body weight Appearance Has clear, bright eyes Has clear skin Has age-appropriate muscles Gains steadily in height and body weight Health, Safety, and Nutrition PG – 3

Module 1 Activity Has plenty of energy Is alert Sleeps soundly Has few aches and pains Activity Has plenty of energy (not hyperactive) Is alert Sleeps soundly Has few aches and pains The following are also taken into consideration when we evaluate a child’s health: Emotional health: A healthy child usually reflects happy, cheerful feelings. Social heath: A healthy child is friendly most of the time, interacts with other children, and enjoys quiet activities that require concentration. Mental health: A healthy child is interested in new experiences, and is usually confident and adaptable. Health, Safety, and Nutrition PG – 3

Module 1 Key Point The three A’s of a healthy child are: Appetite, Appearance and Activity. Key Point: The three A’s of a healthy child are: Appetite, Appearance and Activity. Signs of a healthy child may be different for children with special needs. The term “special needs” refers to children who have medical, physical, emotional, or behavioral conditions that delay or affect development. Caregivers should ask parents the signs of well-being their child displays every day, so the need for medical attention can be identified if these signs are not observed. It is important to note that sometimes a child has a special need that influences them throughout their life, but they may also have a short-term illness that requires special attention for a brief period of time. Would a child with special needs display different qualities than these? (No. The term “special needs” refers to children who have medical, physical, emotional, or behavioral conditions that delay or affect development.) Might a child with special needs have different health standards? (Maybe. Caregivers should ask parents the signs of well-being their child displays every day, so that the need for medical attention can be distinguished if these are not observed.) Can you give examples of short-term illnesses? In the examples provided, the short-term illness is listed first and shows a comparison to an example of a long-term illness. Ear infection vs. hearing loss A common cold vs. asthma A sprained ankle vs. a foot deformity Distress over a fight with another child vs. depression caused by a significant life event Health, Safety, and Nutrition PG – 3

Activity: Draw a Healthy or Sick Child
Module 1 Activity: Draw a Healthy or Sick Child Draw a healthy or sick child in the space provided. List the healthy or unhealthy characteristics, along with some visual indicators of the child’s condition, next to your drawing. Approximate time required for this lesson: 10 minutes Activity: Draw a Healthy or Sick Child Form small groups and assign them the task of drawing either a healthy or an ill child. Participants will list the characteristics of the child next to their drawing. Ask groups to share the results. *Alternate activity: Prepare two flip charts, one labeled, “Healthy Child” and the other labeled, “Ill Child.” Participants should write characteristics of a healthy or ill child on sticky-notes (one per note) and place each note on the appropriate list. Review the list with the entire class. Health, Safety, and Nutrition PG – 5

Module 1 Daily Health Checks Daily health checks are a good way of preventing, identifying, and controlling illness in a child care environment. Approximate time required for this lesson: 5 minutes Daily health checks are a good way of preventing, identifying, and controlling illness in a child care environment. By visually inspecting or questioning a child about his or her health on a daily basis, you help ensure that your program is as disease-free as possible. Exclusion of a child may result from this activity, but that is not your main goal. The main goal is to know the children in your care, and to provide good care. Most caregivers do their daily health checks in casual contact in their initial meeting and throughout the day, not as a formal exam. Ideally, it is done with each child upon entering and leaving your program. Sometimes it is hard to take a moment with each child, as people come and go at roughly the same time. So it is important to be observant throughout the day. Ultimately, daily health checks will help you know your children, reduce the spread of infection, draw attention to children with obvious signs of illness, and foster good communication with parents. The signs to observe in a daily health check fit into three categories: Behavior, Face, and Body. Health, Safety, and Nutrition PG – 6

Module 1 Daily Health Checks Behavior Physical General mood (unusually quiet, irritable, drowsy, or restless) Unusual behavior Activity level Breathing difficulties (labored) Severe coughing or sneezing Hoarseness Skin color (flushed or pale, dry or clammy, hot) Unusual spots, rashes Swelling or bruises Sores Discharge from nose, ears, eyes Eyes red, irritated, sensitive to light Behavior General mood (unusually quiet, irritable, drowsy, or restless) Unusual behavior Activity level Breathing difficulties (labored) Severe coughing or sneezing Hoarseness Physical Skin color (flushed or pale, dry or clammy, hot) Unusual spots, rashes Swelling or bruises Sores Discharge from nose, ears, eyes Eyes red, irritated, sensitive to light Health, Safety, and Nutrition PG – 6

Module 1 Daily Health Checks What other signs have you observed in children as part of a daily health check? Fever (over 101oF, taken orally) Vomiting (all, or even part, of food consumed recently) Bowel movement changes (changes in color, odor, frequency) Pain (screaming, crying, head-rolling) Skin Marks (rashes, bruises) What other signs have you observed in children as a part of a daily health check? Fever (over 101 degrees Fahrenheit, taken orally) Vomiting (all, or even part, of food consumed recently) Bowel movement changes (changes in color, odor, frequency) Pain (screaming, crying, head-rolling) Skin Marks (rashes, bruises) In the appendix of your participant’s guide, there is an example of a Daily Health Checklist form designed to monitor daily observations of a child. What are the benefits of having a chart like this? (It helps track patterns that alert caregivers to warning signs.) It is important to remember that children’s health records are confidential. Health, Safety, and Nutrition PG – 7

Module 1 Key Point Daily health checks are essential for ensuring the health of children in care. Key Point: Daily health checks are essential for ensuring the health of children in care. Health, Safety, and Nutrition PG – 7

Determining if a Child Has a Fever
Module 1 Determining if a Child Has a Fever You should take a child’s temperature when the child is displaying symptoms such as: Warm or hot to the touch Sweating more than usual Flushed appearance Sleepiness Unusual breathing Poor appetite May be more thirsty than usual We know a child has a fever by taking the child’s temperature under the arm and getting a reading of 100oF or under the tongue and getting a reading of 101oF. Approximate time required for this lesson: 10 minutes We are about to discuss ways you can tell if a child may not be feeling well, is sick enough to be excluded from child care, has a common childhood illness, or perhaps might have a communicable disease. The appendix of your participant’s guide has a wealth of information on these topics for further study. We will not be able to cover all of this information in class, so I encourage you to read this information on your own. Fever is a condition that can be observed through the sense of touch. The body will feel warmer/ hotter than usual. Fever may be a warning sign that the body has an infection and needs treatment before the infection can become harmful. Remember, as child care professionals our job is to identify possible signs, not to diagnose. How do you know when to take a child’s temperature? (The child has one or more of these symptoms: sweating; flushed; sleepy; dry and hot; unusual breathing; poor appetite; and is warm or hot to the touch.) How do we know if a child has a fever? (We take a child’s temperature and look for 100 degrees Fahrenheit under the arm or 101 degrees orally.) For a child over three, we can take the temperature orally (in the mouth) or auxiliary (under the arm). For an infant, we put a thermometer under the arm, or in the armpit. Rectal temperatures are not recommended because the practice can be uncomfortable, dangerous, and may spread disease. Remember, as child care professionals, our job is to identify possible signs, NOT to diagnose. Caring for Our Children: National Health and Safety Performance Standards Guidelines for Early Care and Education Programs provides specific information about how to properly and safely take a child’s temperature. According to their standards: “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. However, while a tympanic thermometer gives quick results, it needs to be placed correctly in the child’s ear to be accurate.” “Oral (under the tongue) temperatures can be used for children over age four. Individual plastic covers should be used on oral or rectal thermometers with each use or thermometers should be cleaned and sanitized after each use according to the manufacturer’s instructions. Axillary (under the arm) temperatures are less accurate, but are a good option for infants and young children when the caregiver/teacher has not been trained to take rectal temperatures.” American Academy of Pediatrics, American Public Health Association, National Resource Center for Health and Safety in Child Care and Early Education Caring for our children: National health and safety performance standards; Guidelines for early care and education programs. 3rd Edition. Elk Grove Village, IL: American Academy of Pediatrics; Washington, DC: American Public Health Association. Another tool for taking a temperature is a disposable temperature strip. However, disposable temperature strips are not the most accurate method of taking a child’s temperature. The use of mercury thermometers is not recommended. If you use a mercury thermometer and break it, call the Poison Control Center immediately. Poison Control: The appendix of your participant’s guide has a wealth of information on these topics. Since we will not be able to cover all of this information in this course, you are encouraged to read it on your own, as well as seek additional information on this subject. The following are general guidelines for taking a temperature with a digital thermometer: Turn on the thermometer Cover the bulb end with a disposable sheath Place the bulb under the child’s arm or in his/her mouth, depending on his/her age Remove the thermometer when it beeps; this will usually take about one minute Discard the disposable sheath Read the temperature displayed Be sure to closely follow the manufacturer’s instructions provided with the device you are using. Health, Safety, and Nutrition PG – 8

If You Could Just Help Me Out This Once
Module 1 If You Could Just Help Me Out This Once Approximate time required for this activity: 5 minutes Ask participants to role-play the parts of a caregiver and parents while a third classmate acts as an observer. This can be done from the skit “If You Could Just Help Me Out This Once,” included with the Guide, or ad-libbed. It is important to know your program’s policies regarding children who are sick, and to be able to enforce them every day. It is your job to help families understand the policies and the reasons they exist. After the skit, review the questions that Jones asked the parent. What would you have said? How would you have handled this situation, or another one like it? Skit - “If You Could Just Help Me Out This Once” Jones [caregiver] Brown [parent] Jones: “Good morning, Mr. Brown. I didn’t expect to see you and Michael today.” Brown: “He’s a lot better today.” Jones: “Oh? Does he still have a temperature and diarrhea?” Brown: “Well.... yes, but it’s not as bad as yesterday. His temperature is only 101 degrees and the diarrhea has tapered off some. Would you mind keeping him today?” Jones: “How often is he having diarrhea?” Brown: “Oh, only about five times a day.” Jones: “Remember when you first started bringing Michael, I explained my policy on keeping sick children? As you know, I will not keep a sick child with diarrhea. The health department says it’s not a good idea because the other children could get it.” Brown: “I really would like to stay home with Michael, but I can’t miss work. If you could just keep him this once, I promise never to put you in this bind again! Please, I really need to get to work now.” Jones: “I’m sorry, Mr. Brown. I really wish I could help you out, but just as I am concerned with Michael’s well-being, I must think about the other children. I cannot take him when he still has diarrhea.” Brown: “Well... I guess I can understand. I wouldn’t want all the other little ones to get what Michael has. But I still don’t know what to do. I don’t have any sick days. I’ll lose my job if I don’t go in.” Jones: “Why don’t you call your boss and explain the situation. Doesn’t he have little ones? He’s probably been through this himself.” Brown: “No, you don’t understand. There are plenty of people waiting for my job. My boss thinks if you miss work, no matter what the reason, you can be replaced.” Jones: “Do you have a friend or family member who could watch Michael?” Brown: “My sister has to work, but she has great benefits where she works. She’s always taking days off... maybe she could watch Michael for me. I’ll call her before she leaves. Besides, she owes me a favor.” Health, Safety, and Nutrition PG – 9

Responding to an Illness
Module 1 Watch the child closely, apply first aid/CPR as needed, and be ready to discuss your observations with parents and/or paramedics. Your observations should be documented. Isolate the child until parents and/or paramedics arrive. Call the parents, and if necessary, suggest to the parents that the child needs medical attention. Call Approximate time required for this lesson: 15 minutes Knowing the signs of illness in children is very important, but responding quickly to these signs is equally important. The response to illness can range from isolating the child and calling the parents to calling As a child care provider, being trained in first aid and CPR can be a tremendous resource in being able to respond quickly to a child’s illness. Depending on the type and severity of the symptom, a caregiver may do one or more of the following: Watch the child closely, apply first aid/CPR as needed, and be ready to discuss your observations with parents and/or paramedics. Your observations should be documented. Isolate the child until parents and/or paramedics arrive. Call the parents, and if necessary, suggest to the parents that the child needs medical attention. Call Using your knowledge of communicable disease control and health issues in children, you will need to decide which step is the most appropriate. Remember, not all of these options may need to be used for every situation. For example, if a child seems sleepy, you may choose to watch the child closely and discuss this with the parents. If the day continues and the child is not only sleepy, but is also warm, you may need to take the child’s temperature. At that point, if the child has a fever, you would need to isolate the child and call the parents. If the child is having difficulty breathing—depending on the severity—you may either call the parents to suggest seeking medical attention, or you may call Health, Safety, and Nutrition PG – 10

Module 1 Dehydration Watch for the following signs: Dry to very dry mouth Little to no tears when crying Less active than usual, or very fussy Infant will wet less than 6 diapers a day, a child will make fewer trips to the restroom than he normally does It is very important to watch for signs of dehydration when a child in your care suffers from fever, diarrhea, or vomiting. Dehydration can also occur if a child has been very active for a long period without consuming water or other liquids. Please locate the note-taking aid entitled, “Signs of Dehydration” in your participant’s guide and follow along with me as I review this information. Watch for the following signs: Dry to very dry mouth Little or no tears when crying Less active than usual, or very fussy Infant will wet less than 6 diapers a day; a child will make fewer trips to the restroom than he normally does Health, Safety, and Nutrition PG – 11

Module 1 Dehydration If dehydration is severe, the following will occur: Eyes are sunken Hands and feet are cool and blotchy Pulse may seem weak and fast Child will not urinate for hours If dehydration is severe, the following will occur: Eyes are sunken Hands and feet are cool and blotchy Pulse may seem weak and fast Child will not urinate for hours Health, Safety, and Nutrition PG – 11

Module 1 Dehydration The steps to prevent dehydration are dependent on the child’s symptoms, and can include: For mild diarrhea, do not give milk; it has a high concentration of minerals and salt which could be dangerous to a child with diarrhea. For vomiting, stop giving solid food, and give water at 30 to 60 minute intervals. For both diarrhea and vomiting, stop the child’s normal diet and give electrolytes. Do not give a child sports drinks or any other similar drink made for adults. The steps to prevent dehydration are dependent on the child’s symptoms, and can include: For mild diarrhea, do not give milk; it has a high concentration of minerals and salt which could be dangerous to a child with diarrhea. For vomiting, stop giving solid food, and give water at 30 to 60 minute intervals. For both diarrhea and vomiting, stop the child’s normal diet and contact with parents. Do not give a child sports drinks or any other similar drink made for adults. The child’s parents should be called and involved throughout caregivers observations. In case of diarrhea or vomiting, make sure you: Monitor food and drink intake so you can relay this information to parents or a health care provider. Take and record the child’s temperature in short, regular intervals. Write observations about frequency, color and characteristic. Communicate with parents. Health, Safety, and Nutrition PG – 11

Module 1 Heat Exhaustion Heat exhaustion can occur when someone is exposed to high temperatures and strenuous physical activity. The child’s emergency contact should be notified. Lay the person down in a cool and quiet place, with feet raised a little bit. Loosen any tight clothing. Supply water or sports drinks to drink. Use other cooling measures, such as towels soaked in cool water as compresses. If signs of symptoms worsen or do not improve within an hour, seek medical attention. Seek immediate medical attention if the person’s body temperature reaches 104 degrees or higher. Heat exhaustion can occur when someone is exposed to high temperatures and strenuous physical activity. Without prompt treatment, heat exhaustion can lead to heat stroke, which is life threatening. Symptoms may include excessive sweating and a rapid pulse rate. Other symptoms include: cool, moist skin, dizziness, faintness, muscle cramps, headache, and nausea. Take action! Steps to treating heat exhaustion: The child’s emergency contact should be notified. Lay the person down in a cool and quiet place, with feet raised a little bit. Loosen any tight clothing. Supply water or sports drinks to drink. Use other cooling measures, such as towels soaked in cool water as compresses. If signs of symptoms worsen or do not improve within an hour, seek medical attention. Seek immediate medical attention if the person’s body temperature reaches 104 degrees or higher. Health, Safety, and Nutrition PG – 12

Heat Stroke Module 1 Here’s what to do if you observe these conditions: Anyone who has heat stroke should receive medical attention. If you suspect heatstroke, call While waiting for emergency Medical Services (EMS) to arrive: Remove clothing and wrap the person in a cold wet sheet, or sponge with cold or tepid water. Fan the person by hand, with an electric fan, or with a hairdryer set to cold. When his or her temperature drops to 101oFahrenheit, place the person in the recovery position. Cover the person with a dry sheet and continue to fan. If his or her temperature rises again, repeat the cooling procedure. A caregiver should know the signs of illness in children and be prepared to take appropriate action. Heat stroke is very common in Florida, so caregivers in this state must familiarize themselves with its signs and take appropriate action. A heat stroke occurs because of prolonged exposure to very hot conditions. The mechanism in the brain that regulates body temperature stops functioning, and the body’s temperature rapidly rises to 104 degrees Fahrenheit. The person becomes flushed, with hot, dry skin and a strong, rapid pulse. He or she quickly becomes confused or unconscious. Here’s what to do if you observe these conditions: Anyone who has heat stroke should receive medical attention. If you suspect heat stroke, call While waiting for EMS to arrive… Remove clothing and wrap the person in a cold, wet sheet; or sponge them with cold or tepid water. Fan the person, either by hand, with an electric fan, or with a hair dryer set to cold. When his or her temperature drops to 101oF, place the person in the recovery position. For more information, view the National Safety Council’s fact sheet. Cover the person with a dry sheet and continue to fan. If his or her temperature rises again, repeat the cooling procedure. A caregiver should know the signs of illness in children and be prepared to take appropriate action. Health, Safety, and Nutrition PG – 12

Module 1 Key Point It is important to recognize and respond appropriately to signs of illness in the children in your care, both for their well-being and for the prevention of illness and disease within your program Key Point: It is important to recognize and respond appropriately to signs of illness in the children in your care, both for their well-being and for the prevention of illness and disease within your program. Health, Safety, and Nutrition PG – 12

Bacteria, Viruses, Fungi, and Parasites
Module 1 Bacteria, Viruses, Fungi, and Parasites Bacteria are small organisms seen with an ordinary microscope. Viruses are smaller than bacteria and only grow in living cells. Fungi grow best in warm, moist places. Parasites are organisms that live on or in animals and people, and benefit by deriving nutrients at the expense of the host. Approximate time required for this lesson: 20 minutes Understanding what communicable illnesses are, how they spread and how to prevent them are important steps in establishing a healthy environment for children. A communicable disease is one that can be spread from one person to another. This usually results from the interaction between people, the environment, and germs. A communicable disease, also known as an infectious disease, is spread from one person to another. As a child care provider, it is important to understand how communicable diseases are spread and how to implement good practices for infectious disease control. There are four types of germs: Bacteria Virus Fungi Parasites Small organisms seen with an ordinary microscope Can cause strep throat, impetigo, pinkeye, and some pneumonia Antibiotics help stop growth Smaller than bacteria Grow only in living cells Can cause colds, chicken pox, measles, German measles, mumps Antibiotics have no effect Rest is the best action; body fights better when rested Vaccines against common viruses are available Grow best in warm, moist places Can cause athlete’s foot and ringworm Effective medication is available Medications work best when conditions favorable to fungal growth are removed Organisms that live on or in animals and people Common examples include pinworms, roundworms, head lice Effective medications are available for most Health, Safety, and Nutrition PG – 14

Module 1 Key Point As a child care provider, it is important to know the difference between the four types of germs: bacteria, viruses, fungi, and parasites. Key Point: As a child care provider, it is important to know the difference between the four types of germs: bacteria, viruses, fungi, and parasites. Health, Safety, and Nutrition PG – 14

Transmission of Communicable Diseases
Module 1 Transmission of Communicable Diseases Respiratory Fecal/Oral Direct contact Blood borne There are four ways illnesses and diseases are transmitted. One way is through the respiratory system, entering through the nose and throat and transmitted through nasal or throat discharges. Some examples of illnesses that are transmitted this way are the common cold, flu, strep throat, and chicken pox. Another way germs are spread is through bowel movements, and contact with soiled hands or objects in the mouth. Examples of illnesses that are transmitted this way are salmonella and hepatitis A. Direct contact with an infected area or infested body area can transmit diseases such as impetigo, ringworm, head lice, or scabies. Lastly, HIV/AIDS and hepatitis B and C are types of blood borne illnesses. These can be transmitted through contact with blood. Have you ever cared for a child who had a communicable illness? What actions did you take? (Allow time for discussion.) What symptoms have you observed routinely in a program which were not an indication of communicable illness, and therefore not a cause for isolation? Talk about the sorts of signs displayed by well children that you see every day. (Allow time for discussion.) Health, Safety, and Nutrition PG – 15

Module 1 Key Point As a child care provider, it is important to understand the four ways illnesses and diseases are transmitted in order to minimize the spread of communicable diseases. Key Point: As a child care provider, it is important to understand the four ways illnesses and diseases are transmitted in order to minimize the spread of communicable diseases. Health, Safety, and Nutrition PG – 15

Activity: Communicable Illness Charades
Module 1 Activity: Communicable Illness Charades Approximate time required for this activity: 10 minutes Using the Communicable Illness Chart located in the appendix of the participant’s guide, ask small groups to act out symptoms while other students guess the name of the disease. *Alternate activity: One group describes the illness until it is correctly guessed by another group, and then trade tasks. In both cases, allow participants to look at the chart while playing the game. Health, Safety, and Nutrition

Pink Eye Health, Safety, and Nutrition

Head Lice Health, Safety, and Nutrition

Ring Worm Health, Safety, and Nutrition 36 36

Common Cold Health, Safety, and Nutrition 37 37

Chicken Pox Health, Safety, and Nutrition 38 38

Serious Communicable Diseases
Module 1 Serious Communicable Diseases Haemophilus Influenzae type B, or Hib Hepatitis B Hepatitis C HIV Approximate time required for this lesson: 10 minutes Some conditions of communicable diseases are more dangerous than others. Four of these are: Haemophilus Influenzae B (Hib) Hepatitis B Hepatitis C Human Immunodeficiency Virus (HIV) Hib Hib is an infection that can lead to other conditions which can cause secondary infections in many areas of the body, including: Meningitis, a nervous systems disease that causes inflammation of the brain and spinal cord covering. Pneumonia, an inflammation of the lungs. Epiglottis infection, a throat infection that causes a child to choke to death. Hib does not cause the flu. Hib is caused by a germ that spreads through coughing and sneezing; it is common in children who are in close contact with one another. Since medical treatment for Hib is difficult, vaccination is important. One in four children who develop meningitis due to Hib suffer from mental retardation, permanent hearing damage, or death. Epiglottis due to Hib occurs most often in children years of age. Hepatitis B is an infection of the liver. It is vaccine-preventable with three doses of Hepatitis vaccines usually given during the first 3 months of life; however, the doses may be administered as late as 11 to 12 years of age. It is most commonly spread from mother to infant at birth. Other methods of transmission include IV drug use using contaminated needles; sexual intercourse; and the exposure of open wounds or mucous membranes to contaminated blood. Symptoms include fatigue, loss of appetite, jaundice, dark urine, light stools, nausea, vomiting, and abdominal pain. Hepatitis B is a serious infection in which premature death from liver cancer occurs in 15% to 25% of persons with chronic infection. A person who has no symptoms is still infectious to others. Hepatitis C is a disease of the liver. There is no vaccine Hepatitis C. Hepatitis C can be spread from infected mother to baby during birth. Other methods of infection are IV drug use, blood transfusion. Symptoms of Hepatitis C include jaundice, fatigue, dark urine, abdominal pain, loss of appetite, and nausea. HIV HIV is a virus that causes an increasing loss of immune function that results in the body becoming unable to fight off infections. HIV is most commonly spread by sharing contaminated needles for intravenous drug use, sexual intercourse, exposure to infected blood through a blood transfusion, and from pregnant woman to fetus. HIV is less commonly spread by infected mothers who breastfeed their infants, healthcare workers (after being stuck by a contaminated needle), exposure of open wounds, or mucus membranes to contaminated blood. Symptoms of HIV in children include: failure to grow and gain weight; constant diarrhea without cause; enlarged liver and spleen; swollen lymph glands; constant thrush (yeast infection of the mouth and throat) and Candida (vaginal yeast infection); pneumonia and other bacterial, viral, fungal and parasitic infections. Late stage HIV is called Acquired Immunodeficiency Syndrome (AIDS). Many children are infected with HIV for years without developing symptoms. Once infected, a person becomes potentially infectious to others for life. It is important that you check with the health department each year to get updates on diseases, vaccines, changes in treatment guidelines, and similar information. Health, Safety, and Nutrition PG – 16-17

Module 1 Chicken Pox Slight fever Fine blisters, first on scalp, then on face and body Approximate time required for this lesson: 10 minutes Now that you are aware of the symptoms of many serious communicable diseases, let’s review some of the more common childhood diseases and their symptoms. Common childhood illnesses include: Chicken pox Common cold Flu Diarrhea related diseases Conjunctivitis Giardiasis Allergic Reactions/Anaphylaxis RSV (Respiratory Synctial Virus) Lice Slight fever Fine blisters, first on scalp, then on face and body Health, Safety, and Nutrition PG – 18

Module 1 Common Cold Runny nose Watery eyes Chills Malaise (ill feeling) Usually no fever Lethargic (sluggish) Common Cold Runny nose Watery eyes Chills Malaise (ill feeling) Usually no fever Lethargic (sluggish) Health, Safety, and Nutrition PG – 18

Influenza (Flu) Module 1 (Review the information on the Centers for Disease Control and Prevention (CDC) website ( regarding flu pandemic in child care.) High fever Chills Headache Sore throat Muscle pain Sneezing Can develop chest pain and cough Flu Review the information on the Centers for Disease Control and Prevention (CDC) website ( regarding flu pandemic in child care, frequently. High fever Chills Headache Sore throat Muscle pain Sneezing Can develop chest pain and cough Health, Safety, and Nutrition PG – 18

Diarrhea-Related Disease
Module 1 Diarrhea-Related Disease Loose or watery stools Nausea Vomiting Stomachache Headache Fever Diarrhea-Related Disease Loose or watery stools Nausea Vomiting Stomachache Headache Fever Health, Safety, and Nutrition PG – 19

Module 1 Conjunctivitis (Eye Infection; Pink eye) Red eye or eyes Discharge from one or both eyes Crusted lid or lids Conjunctivitis (Eye Infection; Pink eye) Red eye or eyes Discharge from one or both eyes Crusted lid or lids Health, Safety, and Nutrition PG – 19

Module 1 Giardiasis Parasite found in the stools Diarrhea, bloating, abdominal cramps Weight loss and weakness Giardiasis Parasite found in the stools Diarrhea, bloating, abdominal cramps Weight loss and weakness Health, Safety, and Nutrition PG – 19

Allergic Reactions/ Anaphylaxis
Module 1 Allergic Reactions/ Anaphylaxis Rashes Swelling of Throat Difficulty breathing Allergic Reactions/Anaphylaxis Rashes Swelling of throat Difficulty breathing Health, Safety, and Nutrition PG – 19

RSV (Respiratory Synctial Virus)
Module 1 RSV (Respiratory Synctial Virus) Wheezing and cough Blue color around lips Rapid breathing RSV (Respiratory Syncytial Virus) Wheezing and cough Blue color around lips Rapid breathing Health, Safety, and Nutrition PG – 19

Module 1 Lice Itchy scalp Nits (eggs) Small, red bumps or sores from scratching Lice Itchy scalp Nits (eggs) Small, red bumps or sores from scratching Health, Safety, and Nutrition PG – 20

Module 1 Key Point Responding in a correct and timely manner when a child displays a symptom or symptoms of a communicable disease is an excellent way of preventing communicable diseases in a child care program. Key Point: Responding in a correct and timely manner when a child displays a symptom of a communicable disease is an excellent way of preventing communicable diseases in a child care program. Health, Safety, and Nutrition PG – 20

Module 1 Isolation Severe coughing Difficult or rapid breathing Stiff neck Diarrhea Temperature 101 degrees Fahrenheit or over Conjunctivitis (Red eyelids or eyeballs and drainage) Exposed or open skin lesions Unusually dark urine Gray or white stool Yellowish skin or eyes Isolation still requires direct supervision. Approximate time required for this lesson: 65 minutes What are some good ways to reduce the spread of disease in a child care program? (Write responses on the whiteboard, chalkboard, or flip chart. Answers might include: isolation; written policies; immunization; proper handling of bodily fluids or Universal Precautions; proper hygiene; proper and sanitary food handling.) There are several methods used to reduce the spread of disease in a child care program. It is important to be aware of these techniques and to employ them in your child care program. These techniques include isolation, written policies, immunization, and Universal Precautions. Isolation The purpose of isolation is to keep a child safe and comfortable until a parent or guardian picks her up and to prevent the spread of illness between other people at the child care program. We should isolate a child if we see: Severe coughing Difficult or rapid breathing Stiff neck Diarrhea Temperature 101 degrees Fahrenheit or over Conjunctivitis (Red lids or eyeballs and drainage) Exposed or open skin lesions Unusually dark urine Gray or white stool It is important to note that this is not a complete list. Be sure to consult the written policies of your child care program. Isolation still requires direct supervision. Health, Safety, and Nutrition PG – 21

Module 1 Immunization Immunization is another essential factor in preventing the spread of disease among children and caregivers. Children who are attending child care programs are especially in need of receiving all recommended vaccines on time and must provide documentation of those vaccinations. In Florida, all children who are enrolled in a child care program must provide documentation of current immunizations. It is possible to admit children who do not have current immunizations into care when certain conditions are met. Immunization Immunization is an essential factor in preventing the spread of disease among children and protecting children from diseases. Children who are attending child care programs are especially in need of getting all of the recommended vaccines on time, to protect the child, other children, caregivers, and family members. As we have seen, several childhood diseases are preventable through vaccination. In Florida, all children who are enrolled in a child care program must provide documentation of current immunizations. Exemptions to Immunization It is possible to admit children who do not have current immunizations into care when certain conditions are met. If a child either temporarily or permanently cannot receive an immunization due to a medical condition, the physician must complete the section of the DH 680 Florida Certificate of Immunization stating the exemption. If a family has religious or philosophical objections to immunization, the family must provide a DH 681 Religious Exemption From Immunization form to the child care program. In order to be in compliance with licensing regulations, there must be an appropriate form on file for every child in care regarding immunizations. Caregiver Immunization In addition to ensuring that children do not unintentionally contribute to the spread of infectious conditions or diseases, caregivers and other adults present in the child care environment should also stay current with appropriate immunizations and provide proper documentation. Immunizations can help save a child’s life, but there are steps we can take as caregivers that are as important. Health, Safety, and Nutrition PG – 21

Module 1 Key Point Remember, there are religious and philosophical objections to immunization, but there must be proper documentation for each child on record at the child care program. Key Point: Remember, there are religious and philosophical objections to immunization, but there must be proper documentation for each child on record at the child care program. Health, Safety, and Nutrition PG – 21

Activity: Calculating Immunizations
Module 1 Activity: Calculating Immunizations Kathy is 24 months old Flu (Influenza) yearly; If she is in a high-risk group she would also need: Pneumococcal Polysaccharide Vaccine (PPSV); Hepatitis A (HepA); and Meningococcal Timmy is 18 months old Hepatitus B (HepB); Diphtheria, Tetanus, and Pertussis or (DTaP); Inactivated Poliovirus (IPV); Flu (Influenza) yearly; and Hepatitis A (HepA) Heather is 15 months old Hepatitus B (HepB); Diphtheria, Tetanus, and Pertussis or (DTaP); Haemophilus influenza type b (Hib); Pneumococcal Conjugate (PCV13); Inactivated Poliovirus (IPV); Flu (Influenza) yearly; Measles, Mumps, and Rubella or (MMR); Varicella; and Hepatitis A (HepA) Approximate time required for this activity: 10 minutes Before we discuss other ways of reducing the spread of disease in a child care program, practice calculating immunizations. Locate the chart titled, Recommended Childhood and Adolescent Immunization Schedule in your participant’s guide. Immunizations can help save a child’s life, but there are steps we can take, as caregivers, that are just as important. Use the immunization schedule to determine which immunizations are needed for each of the five children presented. Consider the age of each child, and which immunizations are appropriate for the child. After you have determined which immunizations are needed for a child, check your answer. Use the age of the child and the Immunizations Chart in the participant’s guide, have participants determine what immunizations are needed, if exemptions were not given, for the children described below. Catch-up immunization is used when a child did not get their immunization on schedule. For additional information go to: Kathy is 24 months old - (Flu (Influenza) yearly. If she is in a high risk group she would also need: Pneumococcal Polysaccharide Vaccine (PPSV); Hepatitis A (HepA) and Meningococcal (MCV).) Timmy is 18 months old - (Hepatitus B (HepB); Diphtheria, Tetnus, and Pertussis or (DTaP); Inactivated Poliovirus (IPV); Flu (Influenza) yearly and Hepatitis A (HepA).) Heather is 15 months old - (Hepatitus B (HepB); Diphtheria, Tetnus, and Pertussis or (DTaP); Haemophilus influenza type b (Hib); Pneumococcal (PCV); Inactivated Poliovirus (IPV); Flu (Influenza) yearly; Measles, Mumps, and Rubella or (MMR); Varicella and Hepatitis A (HepA). Health, Safety, and Nutrition PG – 22

Activity: Calculating Immunizations
Module 1 Activity: Calculating Immunizations Jennifer is 4 months old May receive at this time Rotavirus; Diphtheria, Tetanus, and Acellular Pertussis (DTaP); Haemophilus influenza type b (Hib); Pneumococcal Conjugate (PCV13); Inactivated Poliovirus (IPV) Brian is 4 years old Flu (Influenza) yearly; may also receive Diphtheria, Tetanus, and Pertussis or (DTaP); Inactivated Poliovirus (IPV); Measles, Mumps, and Rubella or (MMR); and Varicella; if he is in a high-risk group, he would also need: Hepatitis A (HepA); Pneumococcal Polysaccharide Vaccine (PPSV); and Meningococcal Jennifer is 4 months old - (Rotavirus, Diphtheria, Tetnus, and Acellular Pertussis (DTaP); Haemophilus influenza type b (Hib); Pneumococcal (PCV); Inactivated Poliovirus (IPV).) Brian is 4 years old - (Diphtheria, Tetnus, and Pertussis or (DTaP); Inactivated Poliovirus (IPV); Flu (Influenza) yearly; Measles, Mumps, and Rubella or (MMR) and Varicella. If he is in a high risk group he would also need: Hepatitis A (HepA); Pneumococcal Polysaccharide Vaccine (PPSV) and Meningococcal (MCV). Health, Safety, and Nutrition PG – 22

Best Practices for Avoiding Contamination
Module 1 Best Practices for Avoiding Contamination Wear gloves. Throw disposable gloves away after one use. Do not get any bodily fluid in your eyes, nose, or mouth; or near an open sore. Clean and disinfect any surfaces and non-disposable cleaning equipment, such as mops, that contact a bodily fluid. A common and inexpensive disinfectant can be made by mixing ¼ cup of bleach and 1 gallon of water. Discard fluid and fluid-contaminated materials in a tightly secured plastic bag. Several dangerous and potentially lethal diseases can be transmitted through direct contact with blood. For this reason, it is important to be careful about making contact with bodily fluids, especially blood or any bodily fluid containing blood. The process for avoiding the transmission of diseases through contact with bodily fluids is referred to by the Centers for Disease Control and Prevention as Standard Precautions. Universal Precautions is another term for the same type of procedures, and this is the term used by the Occupational Safety & Health Administration (OSHA). It is important to understand that while both terms will be used throughout this course, they are referring to the same set of procedures. Caring for Our Children: National Health and Safety Performance Standards Guidelines for Early Care and Education Programs states, “Child care facilities should adopt the use of Standard Precautions developed for use in hospitals by The Centers for Disease Control and Prevention (CDC). 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.” American Academy of Pediatrics, American Public Health Association, National Resource Center for Health and Safety in Child Care and Early Education Caring for our children: National health and safety performance standards; Guidelines for early care and education programs. 3rd Edition. Standard : Prevention of Exposure to Blood and Body Fluids. Elk Grove Village, IL: American Academy of Pediatrics; Washington, DC: American Public Health Association. Standard Precautions for Preventing Disease Transmission The procedures for Standard Precautions in a child care environment are described by the American Academy of Pediatrics. “Procedures for Standard Precautions should include: Surfaces that may come in contact with potentially infectious body fluids must be disposable or of a material that can be disinfected. Use of materials that can be sterilized is not required. The staff should use barriers and techniques that: Minimize potential contact of mucous membranes or openings in skin to blood or other potentially infectious body fluids and tissue discharges; and Reduce the spread of infectious material within the child care facility. Such techniques include avoiding touching surfaces with potentially contaminated materials unless those surfaces are disinfected before further contact occurs with them by other objects or individuals. When spills of body fluids, urine, feces, blood, saliva, nasal discharge, eye discharge, injury or tissue discharges occur, these spills should be cleaned up immediately, and further managed as follows: For spills of vomit, urine, and feces, all floors, walls, bathrooms, tabletops, toys, furnishings and play equipment, kitchen counter tops, and diaper-changing tables in contact should be cleaned and disinfected as for the procedure for diaper changing tables in Standard , Step 7; For spills of blood or other potentially infectious body fluids, including injury and tissue discharges, the area should be cleaned and disinfected. Care should be taken and eye protection used to avoid splashing any contaminated materials onto any mucus membrane (eyes, nose, mouth); Blood-contaminated material and diapers should be disposed of in a plastic bag with a secure tie; Floors, rugs, and carpeting that have been contaminated by body fluids should be cleaned by blotting to remove the fluid as quickly as possible and then disinfected by spot-cleaning with a detergent-disinfectant. Additional cleaning by shampooing or steam cleaning the contaminated surface may be necessary. Caregivers/teachers should consult with local health departments for additional guidance on cleaning contaminated floors, rugs, and carpeting.” While Standard Precautions must be used by caregivers as described by the Occupational Safety & Health Administration, there are many other best practices that will help caregivers maintain a clean, healthy environment that is free of any harmful or detrimental elements. Use the following best practices when maintaining a healthy child care environment: Wear gloves. Throw disposable gloves away after one use. Do not get any bodily fluid in your eyes, nose, or mouth; or near an open sore. Clean and disinfect any surfaces and non-disposable cleaning equipment, such as mops, that contact a bodily fluid. A common and inexpensive disinfectant can be made by mixing ¼ cup of bleach and 1 gallon of water. Discard fluid and fluid-contaminated materials in a tightly secured plastic bag. Health, Safety, and Nutrition PG – 23

Module 1 Best Practices for Avoiding Contamination Wash your hands in accordance with CDC guidelines after cleaning up bodily fluids. Change diapers on non-porous surfaces. Do not share personal hygiene items, such as toothbrushes, dental floss, or rinsing cups. Use disposable sheaths on thermometers. Wash contaminated linens and clothing separately from other laundry. Use ¼ cup of bleach in the wash load. Place children’s contaminated items or clothes in a tightly sealed plastic bag to be taken home and washed. Wash your hands in accordance with CDC guidelines after cleaning up bodily fluids. Change diapers on non-porous surfaces. Do not share personal hygiene items, such as toothbrushes, dental floss, or rinsing cups. Use disposable sheaths on thermometers. Wash contaminated linens and clothing separately from other laundry. Use ¼ cup of bleach in the wash load. Place children’s contaminated items or clothes in a tightly sealed plastic bag to be taken home and washed. Health, Safety, and Nutrition PG – 23

Module 1 Best Practices for Avoiding Contamination Do not allow babies and toddlers to share teething toys. Sanitize these items after each use. Teach children not to pick off scabs or bandages. Cover and treat open wounds on both children and caregivers. Do not allow babies and toddlers to share teething toys. Sanitize these items after each use. Teach children not to pick off scabs or bandages. Cover and treat open wounds on both children and caregivers. Health, Safety, and Nutrition PG – 23

Module 1 Key Point Caregivers should use Standard Precautions to avoid contact with blood and bodily fluids, and remove children from any area where exposure to communicable diseases is possible. Key Point: Caregivers should use Standard Precautions to avoid contact with blood and bodily fluids, and remove children from any area where exposure to communicable diseases is possible. Health, Safety, and Nutrition PG – 23

Module 1 Changing a Glove Grasp the palm of the glove. Pull the glove off toward fingers, turning it inside out. Throw the glove into a plastic bag that can be sealed. Run your ungloved index finger under the remaining glove cuff. Pull the glove off, turning it inside out. Put the soiled glove in the plastic bag. Approximate time required for this activity: 5 minutes The most effective way of preventing the spread of disease and germs in the child care setting is proper personal hygiene. One of the most important things you can do is to wear gloves when working with any bodily fluid. Demonstrate the safe removal of gloves to avoid contamination. Grasp palm. Pull glove off toward fingers, turning it inside out. Throw the glove into a plastic bag that can be sealed. Run your ungloved index finger under the remaining glove cuff. Pull the glove off, turning it inside out. Put the soiled glove in the plastic bag. It is important to avoid snapping the gloves – this will avoid the spray of germs. Health, Safety, and Nutrition PG – 24

Module 1 Changing a Diaper Get organized. Carry the baby to the changing table. Clean the child’s diapering area. Remove the soiled diaper (and clothing if soiled) without contaminating any surface. Put on a clean diaper. Clean the baby’s hands. Clean and disinfect the diaper area. Wash your hands. Use a daily journal to document diaper changes. Approximate time required for this activity: 20 minutes Now, let’s talk about proper diapering and handwashing procedures. Please find the documents “Steps for Changing a Diaper,” “Proper Techniques at Diaper Changing Stations and Potty Chairs,” and “How to Wash Hands,” all located in the appendix of your participant’s guide. Divide participants into groups to practice proper hand-washing and diapering techniques. Within each group, one person will read directions for the task, one will perform the task, and a third will observe the person performing the task. A volunteer from each group will report the key activities of each task. Write these on a flip chart. *Alternate activity: Change a diaper and wash hands while the class reads the instructions. Ask the participants to point out the errors that you make deliberately. You are going to learn the safe way to change a diaper. It is important to follow appropriate procedures for diaper changing because anything that comes in contact with urine or stool is a source of germs. Turn to the appendix for a complete set of instructions. You will find more information on proper sanitary procedures in the appendix of your participant’s guide. 1. Get Organized. Before you bring the child to the diaper-changing area, use the proper handwashing technique and gather what you will need: a fresh diaper, wipes, gloves, a plastic bag for soiled clothes, and a dab of diaper cream if the baby requires it and you have written consent from the parent or guardian. Put on disposable gloves. 2. Carry the baby to the changing table. Keep soiled clothes away from you and surfaces that are not easily cleaned or sanitized. Always keep a hand on the child throughout the process. Never leave a child unattended on the changing table. 3. Clean the child’s diapering area. Unfasten the diaper, but leave the soiled diaper under the child. Lift the child’s legs as needed to use disposable wipes to clean the child’s genitalia and buttocks, and to prevent recontamination. Use disposable wipes to clean the child. Remove stool and urine with a single front to back wipe, and use a fresh wipe each time. Always put the used wipes in the used diaper. Make a mental note of any skin problems, such as redness, and report them to the parents later. 4. Remove the soiled diaper (and clothing if soiled) without contaminating any surface. Fold the diaper over and secure it with the tabs. Put it into a covered, lined can. A “step” can is recommended. If soiled, bag clothes and securely tie or zip the plastic bag to send them home. Check for spills under the baby. Remove the gloves and put them directly into the step can. Wipe your hands with a disposable wipe. 5. Put on a clean diaper. Slide the diaper under the baby, then adjust and fasten it. 6. Clean the baby’s hands. Use the proper handwashing procedure in a sink, if you can. If holding the baby for handwashing is not possible, use a disposable wipe or follow this procedure: Wipe the child’s hands with a damp paper towel moistened with a drop of liquid soap. Wipe the child’s hands clean with a paper towel moistened with clean water. Dry the child’s hands with a dry paper towel. 7. Clean and disinfect the diaper area. Dispose of the paper liner, if used. (Some programs use a disposable rice-paper liner under the baby and over the table. It is not a substitute for sanitizing. It is an extra layer of protection.) Clean any visible soil on the diaper table. Disinfect the table by spraying the entire surface until it is wet with an EPA-registered disinfectant or bleach solution. Follow proper sanitizing procedure. 8. Wash your hands. Use the proper handwashing procedure. 9. Use a daily journal to document diaper changes. A journal is not required, but is a good idea. Record the day and time of each diaper change in the daily log. Include diaper contents and problems you noted. Health, Safety, and Nutrition PG – 24

Module 1 Handwashing Wet your hands with clean, running water and apply soap to your hands. Rub your hands together to make a lather. Scrub the backs of your hands, between fingers, under nails, and under jewelry. Continue scrubbing for at least 20 seconds (sing “Happy Birthday” two times). Rinse your hands well under running water. Dry your hands using a clean towel. Discard the used disposable towel in the trash can lined with a fluid-resistant (plastic) bag. Retrieve a new, clean disposable towel. Turn the faucet off using the towel as a barrier between your hands and the faucet handle. Discard the used disposable towel in a trash can lined with a fluid-resistant (plastic) bag. It is also important that children in your care practice good personal hygiene. What kinds of good practices do you encourage in the children in your care, and how do you teach them to perform these activities? (You can teach a child to wash his hands thoroughly by telling him to sing “Happy Birthday” to himself twice as he washes, then rinses, his hands.) Keeping hands clean is one of the most important things we can do to stop the spread of germs and stay healthy. You are going to learn the correct way to wash your hands. You will find more information on proper sanitary procedures in the appendix of your participant’s guide. Wet your hands with clean, running water and apply soap to your hands. Rub your hands together to make a lather. Scrub the backs of your hands, between fingers, under nails, and under jewelry. Continue scrubbing for at least 20 seconds (sing “Happy Birthday” two times). Rinse your hands well under running water. Dry your hands using a clean towel. Discard the used disposable towel in the trash can lined with a fluid-resistant (plastic) bag. Retrieve a new, clean disposable towel. Turn the faucet off using the towel as a barrier between your hands and the faucet handle. Discard the used disposable towel in a trash can lined with a fluid-resistant (plastic) bag. Additional Tips: Trash cans with foot-pedal operated lids are preferable. Consider using hand lotion to prevent chapping of your hands. If using lotions, use liquids or tubes that can be squirted, so your hands do not have direct contact with a container spout. Direct contact with the spout could contaminate the lotion inside a container. When assisting a child in handwashing, either hold the child (if an infant) or have the child stand on a safety step at a height at which the child’s hands can hang freely under the running water. Assist the child in performing all of the above steps and then wash your own hands. Health, Safety, and Nutrition PG – 24

Module 1 Key Point Proper personal hygiene is the most effective way of preventing the spread of germs and diseases in a child care setting. Key Point: Proper personal hygiene is the most effective way of preventing the spread of germs and diseases in a child care setting. Health, Safety, and Nutrition PG – 24

Module 1 The Right Response During small group time, you notice Charles is having difficulty breathing and is wheezing. What should you do? Assume this could be life threatening. Call and Charles’ parents. Approximate time required for this activity: 20 minutes Direct participants to pages 26 and 27 in the participant’s guide where they will locate a set of scenarios entitled, “Your Response to Signs of Illness in Children.” Divide the class into small groups and ask them to identify the types of illnesses in each scenario and what action a caregiver should take. After all groups have finished reviewing the scenarios, a member from each group should report on their findings. Participants should write answers in their participant’s guides during this activity. Scenario A During small group time, you notice Charles is having difficulty breathing and is wheezing. What should you do? Assume this could be life-threatening. Call Charles’ parents and Health, Safety, and Nutrition PG – 25

Module 1 The Right Response At the dramatic play center, you notice Chelsea scratching the back of her head vigorously. What should you do? Check for lice, scabies, and/or rash. If there are lice, send Chelsea home with information. Sanitize the dress-up clothes, carpet, stuffed animals, and all other cloth items. Scenario B At the dramatic play center, you notice Chelsea scratching the back of her head vigorously. What should you do? Check for lice, scabies, and/or rash. If there are lice, send Chelsea home with information. Sanitize dress-up clothes, carpet, stuffed animals, and all other cloth items. Health, Safety, and Nutrition PG – 25

Module 1 The Right Response While at the sensory table, Chancie sneezes into the water. What should you do? Ask Chancie to blow her nose and wash her hands. Change the water at the sensory table. Sanitize during the water change. Make sure all children wash their hands before and after using the sensory table. Scenario C While at the sensory table, Chancie sneezes into the water. What do you do? Ask Chancie to blow her nose and wash her hands. Change the water at the sensory table. Sanitize during water change. Make sure all children wash their hands before and after using the sensory table. Health, Safety, and Nutrition PG – 25

Module 1 The Right Response Later in the day, the snack center is set up as a green grocery. Children come with a little straw basket to select crunchy vegetables for snack time. Chancie is shopping. She nibbles a few vegetables, but then complains of a stomachache. What should you do? Monitor Chancie closely. She may be sick; or she may dislike the raw vegetables, and this morning’s sneeze was only coincidental. Scenario D Later in the day, the snack center is set up as a green grocery. Children come with a little straw basket to select crunchy vegetables for snack time. Chancie is shopping. He nibbles a few vegetables, but then complains of a stomach ache. What should you do? Monitor Chancie closely. He may be sick, or he may dislike the raw vegetables, and this morning’s sneeze was only coincidental. Health, Safety, and Nutrition PG – 25

Module 1 The Right Response In the free-art center, Chu-lin is helping a teaching assistant mix dry tempura powder. Suddenly, her face becomes red and she begins to cough. What should you do? This was a “trick” question. Do not mix dry tempura paint or dry papier-mâché in the presence of young children. There are other hazards that may occur during art projects, such as accidental ingestion; allergic reactions; and accidents such as slips, falls, cuts, etc. If this situation does occur, call Poison Control. Scenario E In the free-art center, Chu-lin is helping a teaching assistant mix dry tempura powder. Suddenly, her face becomes red and she begins to cough. What should you do? This was a “trick” question. Do not mix dry tempura paint or dry paper mache in the presence of young children. There are other hazards that may occur during art projects, such as accidental ingestion, allergic reactions, and accidents such as slips, falls, cuts, etc. Health, Safety, and Nutrition PG – 26

Module 1 The Right Response After playing in an outdoor learning center, you notice blister-like sores on Chaka’s arm. What should you do? Understand that this might be the sign of a communicable illness or disease. Call the parents and suggest they seek prompt medical attention. Isolate the child until the parents arrive. Chaka should be seen by a doctor. Document your observations. Scenario F After playing in an outdoor learning center, you notice blister-like sores on Chaka’s arm. What should you do? Understand that this might be the sign of a communicable illness or disease. Call the parents and suggest they seek prompt medical attention. Isolate the child until the parents arrive. Chaka should be seen by a doctor. Document observations. Health, Safety, and Nutrition PG – 26

Module 1 The Right Response Charlotte ate very little at lunch today; now she has her head on a table and is complaining of a stomachache. What should you do? Watch her closely and be ready to react to further signs of illness. Notify and discuss the signs with her parents. If she is unable to participate in normal activities, she should be sent home. Scenario G Charlotte ate very little at lunch today and now she has her head on a table, complaining of a stomachache. What should you do? Watch her closely and be ready to react to further signs of illness. Notify and discuss the signs with parents. If she is unable to participate in normal activities, she should be sent home. Health, Safety, and Nutrition PG – 26

Module 1 The Right Response Chico is difficult to awaken after a long nap. He is warm to the touch, and then vomits as you lead him to the bathroom. What should you do? Understand that these might be the signs of a communicable illness or disease. Call the parents and suggest they seek prompt medical attention. Isolate the child until the parents arrive. Chico should be seen by a doctor. Scenario H Chico is difficult to awaken after a long nap. He is warm to the touch, and then vomits as you lead him to the bathroom. What should you do? Understand that this might be the sign of a communicable illness or disease. Call the parents and suggest they seek prompt medical attention. Isolate the child until the parents arrive. Chico should be seen by a doctor. Health, Safety, and Nutrition PG – 26

The Role of Sanitation in Preventing Illnesses
Module 1 The Role of Sanitation in Preventing Illnesses The process of cleaning, sanitizing, and disinfecting areas and items that children are most likely to have close contact with will reduce their potential exposure to germs. Think about some items that should be cleaned, sanitized, and/or disinfected as often as possible. Toys Crib rails Restrooms Diapering areas Drinking fountains Computer keyboard and mouse Hands-on learning items Books Approximate time required for this lesson: 10 minutes In addition to practicing—and encouraging children to practice—good personal hygiene, it is just as important to clean and disinfect the child care environment. The process of cleaning and disinfecting areas and items which children are most likely to have close contact will reduce the number of germs. Name some items that should be sanitized as often as possible. (Possible answers include: toys, crib rails, restrooms, diapering areas, drinking fountains, computer keyboards, hands-on learning items, and toys that get placed in mouths.) The appendix of your participant’s guide contains a recipe for an inexpensive disinfectant solution. Also in the appendix of the participant’s guide is a sample cleaning guideline that outlines what needs to be cleaned and/or disinfected, how often, and the staff assigned to the responsibility. How do these differ from practices used in the home? Health, Safety, and Nutrition PG – 27

Module 1 Food Safety Food must be in sound condition, free from spoilage and contamination. Food preparation areas, and food equipment and table ware must be properly maintained and sanitary. Staff members must properly handle and prepare food. Food must be maintained at proper temperatures. Approximate time required for this lesson: 20 minutes Child care programs that serve meals or snacks must ensure that the food they provide is safe for human consumption. Child care facilities must have a food and nutrition policy that not only addresses nutrition and food allergens, but also food safety. Food must be in sound condition, free from spoilage and contamination. Food preparation areas, and food equipment and table ware must be properly maintained and sanitary. Staff members must properly handle and prepare food. Food must be maintained at proper temperatures. Health, Safety, and Nutrition PG – 28

Special Requirements and Prohibited Foods
Module 1 Special Requirements and Prohibited Foods Meat, poultry, fish, dairy products, and processed foods shall have been inspected under the United States Department of Agriculture (USDA) requirements No raw milk or unpasteurized juice may be served without the written consent of the parent or legal guardian No home-canned food may be served No home-grown eggs may be served No recalled food products may be served All raw fruits and vegetables shall be washed thoroughly before being served or cooked To learn more about food borne illness and disease, go to: Let’s talk about special food requirements and foods that may NOT be served at child care programs. Meat, poultry, fish, dairy products, and processed foods shall have been inspected under the United States Department of Agriculture (USDA) requirements No raw milk or unpasteurized juice may be served without the written consent of the parent or legal guardian No home-canned food may be served No home-grown eggs may be served No recalled food products may be served All raw fruits and vegetables shall be washed thoroughly before being served or cooked To get information on recalls and alerts, go to: Health, Safety, and Nutrition PG – 28

Preparation and Serving Areas
Module 1 Preparation and Serving Areas Clean food contact surfaces, cutting boards, dishes, utensils, and counter tops with hot soapy water after preparing each food item and before you go on to the next item. Use smooth, nonabsorbent food contact surfaces that do not harbor bacteria. Food equipment and tableware must be properly cleaned by pre-rinsing or scraping, washing, rinsing, sanitizing, and air drying. Infant bottles and “sippy” cups provided by a facility must be washed and sanitized between each use. Because illness-causing bacteria can survive in many places around food preparation and serving areas, good sanitation is very important. To prevent the spread of illness-causing bacteria: Clean food contact surfaces, cutting boards, dishes, utensils, and counter tops with hot soapy water after preparing each food item and before you go on to the next item. As an extra precaution sanitize washed surfaces and utensils. Use smooth, nonabsorbent food contact surfaces that do not harbor bacteria. Food equipment and tableware must be properly cleaned by pre-rinsing or scraping, washing, rinsing, sanitizing, and air drying. Table ware and food equipment must be cleaned by either using a dishwasher with a sanitizing cycle or by using the three step cleaning process. Infant bottles and “sippy” cups provided by a facility must be washed and sanitized between each use. Those brought from home must be labeled with the child’s first and last name and returned home daily. Health, Safety, and Nutrition PG – 28

Module 1 Food Handling Wash hands thoroughly Wear proper head covering and disposable gloves Examine purchased/delivered food Maintain a Food Acceptance Log Separate food items to avoid cross contamination Thaw food safely Wash fruits and vegetables before serving or cooking Child care personnel who prepare or serve food should know how to wash hands properly. Facilities must have a separate hand washing station that includes posted signs demonstrating the proper hand washing technique…. Washing hands the right way can help stop the spread of illness-causing bacteria. Anyone distributing snacks or serving food must use items such as napkins, disposable gloves, utensils, or similar items to prevent skin contact with food. And, those working in food preparation areas must wear a proper head covering, such as a hair net or hat. Food must be examined when it is purchased, delivered, or harvested from a local garden to make sure it is not spoiled, dirty, or contaminated with insects. This includes prepared food that is provided by a caterer. All pre-prepared food transported into a facility must be recorded in a log that is retained for at least four months. When preparing meals, use separate cutting boards, utensils and plates for produce and for meat, poultry, seafood, and eggs. These food types should remain separated at all times to prevent cross-contamination. Thaw meat, poultry, and seafood in the refrigerator, in cold water, or in the microwave. Bacteria can multiply rapidly at room temperature. Never thaw foods on the counter. All raw fruits and vegetables must be washed thoroughly before being served or cooked. Even if you plan to peel fruits and vegetables, it is important to wash them first because bacteria can spread from the outside to the inside as you cut or peel them. A sample Food Acceptance Log in the Appendix. Health, Safety, and Nutrition PG – 28

Food Temperatures: Cooked Foods
Module 1 Food Temperatures: Cooked Foods Food Minimum Internal Temperature Fruits, Vegetables, Grains, and Legumes 135 0F Roasts (Fresh Beef, Pork, and Lamb) 145 0F (with a 3 minute rest time) Fish 145 0F Eggs Cook until yolk and whites are firm Egg Dishes 160 0F Ground meats (Beef, Pork and Lamb) and fresh Ham (raw) Poultry - whole, parts, or ground 165 0F Leftovers Foods cooked in microwave Sauces, Gravy, Soups, and Casseroles Food must be maintained at proper temperatures to avoid food related illness or death. The bacteria that causes food poisoning multiplies quickest in the “Danger Zone” between 40°F and 140°F. Cooked food is safe only after it’s been heated to a high enough temperature to kill harmful bacteria. Color and texture alone won’t tell you whether your food is done. Instead, use a food thermometer to be sure. Food must be cooked and/or reheated in accordance with the table shown on screen. Health, Safety, and Nutrition PG – 29

Food Temperatures: Refrigerated Food
Module 1 Food Temperatures: Refrigerated Food Category Food Refrigerator Salads Egg, chicken, ham, tuna & macaroni salads 3 to 5 days Hot dogs opened package 1 week unopened package 2 weeks Luncheon meat opened package or deli sliced Bacon & Sausage Bacon 7 days Sausage, raw — from chicken, turkey, pork, beef 1 to 2 days Hamburger & Other Ground Meats Hamburger, ground beef, turkey, veal, pork, lamb, & mixtures of them Category Food Refrigerator Fresh Beef, Veal, Lamb & Pork Steaks 3 to 5 days Chops Roasts Fresh Poultry Chicken or turkey, whole 1 to 2 days Chicken or turkey, pieces Soups & Stews Vegetable or meat added 3 to 4 days Leftovers Cooked meat or poultry Chicken nuggets or patties Pizza After cooking, to keep food safe while serving, you can use a heat source like a chafing dish, warming tray, or slow cooker. Any leftovers should be refrigerated within two hours. Refrigerators must be maintained at 41 degrees Fahrenheit or below. But, there are limits on how long you can safely refrigerate food, since cooling only slows the growth of bacteria. Refrigerated food containers should be labeled to ensure safe food storage limits are not exceeded. Food must be refrigerated according to the guidelines provided by foodsafety.gov. Health, Safety, and Nutrition PG – 29

Food Temperature: Frozen Foods
Module 1 Food Temperature: Frozen Foods Food Item Months Bacon and Sausage 1 to 2 Months Casseroles 2 to 3 Months Frozen Dinner and Entrees 3 to 4 Months Ham, Hot Dogs, and Lunchmeats Meat (Uncooked) 4 to 12 Months Meat (Uncooked Ground) Meat (Cooked) Poultry (Cooked) 4 Months Soups and Stews Freezers must be at 0 degrees Fahrenheit or below to maintain food safety. Frozen foods remain safe indefinitely, but to ensure quality, observe the time limits shown on screen. Frozen foods must be labeled by date and type of food item. To maintain safe food temperatures, milk and food must not sit out for longer than 15 minutes prior to the beginning of the meal to avoid contamination and spoilage unless maintained at 41 degrees Fahrenheit or below for cold foods or 135 degrees Fahrenheit or above for hot foods. An accurate thermometer is required inside each cold storage unit to verify adequate temperatures are maintained. Food temperature charts can be found in the appendix of your participant’s guide. Refrigerated Foods When storing foods that must be refrigerated, take into consideration the types of accommodations you can take to ensure that food stays fresh, safe, and delicious. According to the American Academy of Pediatrics, “All food stored in the refrigerator should be tightly covered, wrapped, or otherwise protected from direct contact with other food. Hot foods to be refrigerated and stored should be transferred to shallow containers in food layers less than three inches deep and refrigerated immediately. These foods should be covered when cool. Any pre-prepared or leftover foods that are not likely to be served the following day should be labeled with the date of preparation before being placed in the refrigerator. The basic rule for serving food should be, ‘first food in, first food out’. In the refrigerator, raw meat, poultry and fish should be stored below cooked or ready to eat foods.” American Academy of Pediatrics, American Public Health Association, National Resource Center for Health and Safety in Child Care and Early Education Caring for our children: National health and safety performance standards; Guidelines for early care and education programs. 3rd Edition. Standard : Preparation for and Storage of Food in the Refrigerator. Elk Grove Village, IL: American Academy of Pediatrics; Washington, DC: American Public Health Association. It is important to note, raw meats that are refrigerated have the potential to contaminate other foods stored in the same refrigerator. This is why it is imperative that raw meats be stored in a location in the refrigerator below cooked or ready to eat foods. Non-Refrigerated Foods When storing foods that do not require refrigeration, they must also be accommodated in a way that ensures they remain clean, fresh, delicious, and safe to eat. The American Academy of Pediatrics states, “Foods not requiring refrigeration should be stored at least six inches above the floor in clean, dry, well-ventilated storerooms or other approved areas. Food products should be stored in such a way (such as nonporous containers off the floor) as to prevent insects and rodents from entering the products. ” American Academy of Pediatrics, American Public Health Association, National Resource Center for Health and Safety in Child Care and Early Education Caring for our children: National health and safety performance standards; Guidelines for early care and education programs. 3rd Edition. Standard : Storage of Foods Not Requiring Refrigeration. Elk Grove Village, IL: American Academy of Pediatrics; Washington, DC: American Public Health Association. Dry Bulk Foods Bulk foods are usually bought in a large container and then transferred to a smaller, air-tight, labeled container when they are prepared to be consumed. Bulk foods can help consumers save money, as well as reduce the waste produced by excess packaging materials. Many families, schools, and child care programs purchase and use dry bulk foods such as cereals, nuts, and pretzels to reduce costs while providing healthy and nutritious meals. Health, Safety, and Nutrition PG – 29

Module 1 Key Point Safe and sanitary food practices help keep a child care program free of germs and diseases, and include using clean utensils and equipment; applying correct storage and cooking techniques; employing clean, healthy workers; and practicing safe food-handling procedures. Can you offer tips on ensuring a clean, healthy child care program? Or examples of food-related activities you think may be unsafe? Let’s make a list for each. Key Point: Safe and sanitary food practices help keep a child care program free of germs and diseases, and include using clean utensils and equipment; applying correct storage and cooking techniques; employing clean, healthy workers; and practicing safe food-handling procedures. Health, Safety, and Nutrition PG – 29

Activity: Five Best and Five Worst Food Handling Practices
Module 1 Activity: Five Best and Five Worst Food Handling Practices Considering the information you have just learned and your own experiences, create a list of five best and five worst food-handling practices Approximate time required for this activity: 5 minutes Form 2 groups. Ask one group to prepare, on a flip chart, a “Top 10 Best Food Practices” list. Ask the other group to prepare a flip chart for the 10 worst food-related activities they’d ever seen. Present the lists. (You can cover the list so only one activity shows at a time.) Sample Best Practices: Washing hands before preparing, serving, and eating food Keeping food at proper temperatures Ensuring cross-contamination does not exist Employ clean and healthy food preparation workers Use clean utensils Sample Worst Practices: Not washing hands Storing foods at unsafe temperatures Cutting raw meat and then vegetables with the same knife Allowing food preparation workers to work when they are ill Not properly washing utensils Health, Safety, and Nutrition PG – 30

Administering Medication
Module 1 Administering Medication Accept medications Store medications Administer medications, and Document medications What should caregivers pay attention to while administering medication? Why is it important to ensure that caregivers administer medication properly? Approximate time required for this lesson: 5 minutes Occasionally, some children may be required to take medication during their time at your child care program. A child care program is not required to administer medication but if medication is going to be administered in your child care program, you must follow guidelines outlined in the Florida Administrative Code. The administration of medication in a child care program is governed by Chapter 65C-20 and Chapter 65C-22, Florida Administrative Code, and must conform to other statutes, regulations, and procedures. In the appendix of your participant’s guide, there is a sample administration of medication form and a sample authorization and log for dispensing medication form. As you review these documents, please pay close attention to how you must: Accept medications Store medications Administer medications, and Document medications Deciding whether or not to administer medication is a major responsibility of the caregiver. What should caregivers pay attention to while administering medication? (Pay attention to the name of the recipient, dose, route, time, and date of the last dose, according to the child’s medication log; whether or not the medicine is in its original package; permission slip from parent with signature; and which person(s) in the program are authorized to administer medication.) Why is it important to ensure that caregivers administer medication properly? What might be the consequences of improperly administering medications? (Proper administration of medication ensures avoiding consequences such as overdose or underdose, hindrance to the treatment of a condition, or complications to the child’s illness.) Health, Safety, and Nutrition PG – 31

Module 1 Key Point It is important to note that programs have the right to decide whether or not to administer medication. Deciding whether or not to administer medication is a major responsibility of the caregiver. Key Point: It is important to note that programs have the right to decide whether or not to administer medication. Deciding whether or not to administer medication is a major responsibility of the caregiver. In addition to the Department of Children and Families’ website, there are many other websites, which provide valuable information about health, safety, and nutrition. Explore the websites to discover additional useful information about some of the topics we have covered in this module. Centers for Disease Control and Prevention U.S. Department of Health & Human Services Florida Department of Health National Resource Center for Health and Safety in Child Care and Early Education Health, Safety, and Nutrition PG – 31

Module 1 Conclusion You have achieved this module’s learning objectives if you can: Identify the characteristics of a healthy environment Describe the characteristics of a healthy child Identify communicable diseases Describe methods of preventing the spread of communicable disease Explain the process of communicable disease control Identify proper hygiene practices for children and caregivers Identify safe food handling, preparation, and storage practices Describe the proper method of administering medication and documenting the use of medication in a program Module 1 Summary Here is a summary of key points for Module 1: A Healthy Environment. Establishing and following a written policy is an effective way of maintaining a safe and healthy child care program. The three A’s of a healthy child are: Appetite, Appearance, and Activity. Daily health checks are essential for ensuring the health of children in care. It is important to recognize and respond appropriately to signs of illness in the children in your care, both for their well-being and for the prevention of illness and disease within your program. As a child care provider, it is important to know the difference between the four types of germs: bacteria, viruses, fungi, and parasites. As a child care provider, it is important to understand the four ways illnesses and diseases are transmitted in order to minimize the spread of communicable diseases. Responding in a correct and timely manner when a child displays a symptom of a communicable disease is an excellent way of preventing communicable diseases in a child care program. Remember, there are religious and philosophical objections to immunization, but there must be proper documentation for each child on record at the child care program. Caregivers should use Standard Precautions to avoid contact with blood and bodily fluids, and remove children from any area where exposure to communicable diseases is possible. Proper personal hygiene is the most effective way of preventing the spread of germs and diseases in a child care setting. Safe and sanitary food practices help keep a child care program free of germs and diseases, and include using clean utensils and equipment; applying correct storage and cooking techniques; employing clean, healthy workers; and practicing safe food-handling procedures. It is important to note that programs have the right to decide whether or not to administer medication. Deciding whether or not to administer medication is a major responsibility of the caregiver. Conclusion Congratulations! You have completed Module 1: A Healthy Environment. You have achieved this module’s learning objectives if you can: Identify the characteristics of a healthy environment Describe the characteristics of a healthy child Identify communicable diseases Describe methods of preventing the spread of communicable disease Explain the process of communicable disease control Identify proper hygiene practices for children and caregivers Identify safe food handling, preparation, and storage practices Describe the proper method of administering medication and documenting the use of medication in a program Health, Safety, and Nutrition PG – 32

Module 2: A Safe Environment Approximate time required for this module: 140 minutes Materials: Flipchart and Markers, Sticky Notes, Hazards to place around training room, and Look-a-Likes activity materials. Welcome to Module 2: A Safe Environment. This module will describe safety issues, characteristics of safe environments, and how caregivers can take advantage of opportunities to prevent and reduce accidents and injuries. This module will also address procedures for reporting accidents and taking appropriate action during accidents and incidents. Methods to prevent potential safety and fire hazards will be explained, and evacuation procedures will be discussed. Lastly, Florida laws and requirements regarding transportation of children and use of federally-approved car seats and vehicle restraints will be addressed. Health, Safety, and Nutrition

Participants will be able to identify and discuss the need for a safe environment. Learning Objectives After successfully completing this module, you will be able to: Identify processes to plan for, establish, and maintain a safe child care environment Identify procedures for reporting accidents and incidents Explain methods used to prevent potential safety and fire hazards Explain procedures used in case of emergency Explain procedures for using car seats and other methods of restraining a child in a vehicle Goal Participants will be able to identify and discuss the need for a safe environment. Learning Objectives After successfully completing this module, you will be able to: Identify processes to plan for, establish, and maintain a safe child care environment Identify procedures for reporting accidents and incidents Explain methods used to prevent potential safety and fire hazards Explain procedures used in case of emergency Explain procedures for using car seats and other methods of restraining a child in a vehicle Health, Safety, and Nutrition PG – 33

Elements of a Safe Environment
Module 2 Elements of a Safe Environment The characteristics of a safe child care environment are: Potential hazards are kept at a minimum, or are completely avoided The surroundings are neat and orderly The children are constantly supervised Caregivers have knowledge of, and practice, safety policies and procedures A safety hazard is anything in the environment that can be dangerous to a child’s health or welfare. Approximate time required for this lesson: 15 minutes It is critical that child care programs understand safety rules and abide by guidelines for establishing a safe environment. The characteristics of a safe child care environment are: Potential hazards are kept at a minimum, or are completely avoided The surroundings are neat and orderly The children are constantly supervised Caregivers have knowledge of, and practice, safety policies and procedures Take a look around the room. Is this a safe environment for a child? A safety hazard is anything in the environment that can be dangerous to a child’s health or welfare. Can you name some hazards that were not a part of the activity we just did together? Child care programs need to utilize protective equipment for safety and emergency preparedness. What are some types of equipment you might find, and be expected to operate, at a child care program? (Examples may include a first aid kit, fire extinguisher, smoke detector, and emergency phone numbers list. Write responses on the whiteboard, chalkboard, or flip chart.) Now, let’s think about some scenarios where you might use this equipment. (Examples might include) First aid kits: (on a field trip) Fire extinguisher: (kitchen fire) Smoke detectors: (closet fire) Emergency phone number list: (child eats a plant outside) Please take a moment to locate the first aid kit Checklist and the Emergency Telephone Numbers Form in the appendix of your participant’s guide and familiarize yourselves with this information. Health, Safety, and Nutrition PG – 34

Activity: Safety Hazard Hunt
Module 2 Activity: Safety Hazard Hunt Approximate time required for this activity: 10 minutes Set props around the room before the participants arrive. To begin the activity, tell the participants how many hazards are in the room, and then ask them to pretend they are a four-year-old child walking around through the room. They are to silently find all of the hazards they can, and sit down when they are finished. When all (or most) of the participants are sitting, lead a discussion listing the hazards. *Alternate activity: Form four groups. Assign each group one of the four different environments (indoor, outdoor, bathroom, napping) and ask them what kind of hazards may be found in each. Participants should write their answers on sticky-notes; these should be placed on flip charts pages which have been prepared with headings for each environment. Share the results with the group. Health, Safety, and Nutrition

Poisoning Module 2 Follow these poison control prevention practices to ensure that children are not exposed to poisonous materials, unclean items, or unsafe food-handling practices: Keep all chemicals out of the reach of children Follow safe food handling and storage guidelines Follow the directions for dosage found on the medicine package’s label Teach children not to put unfamiliar items in their mouths Keep emergency phone numbers by the phone Approximate time required for this lesson: 25 minutes One of the most life-threatening hazards that child care professionals could encounter is poisoning. It is very important that child care professionals do everything possible to prevent children from coming in contact with poisonous materials. Any substance that can cause harmful effects if used improperly is a potential poison. For example, household cleaners and prescription medication are very dangerous if not used properly. Other sources of poisons include the flowers or leaves of particular plants, and the venom of certain insects and animals. To prevent poisoning, keep chemicals out of children’s reach, follow safe food-handling procedures, obey directions found on medicine labels, and teach children not to place unfamiliar items (plants, liquids, objects, etc.) in or near their mouths. All child care programs need to have an emergency phone number list that includes a phone number for the Poison Control Center. Take a moment to locate an example of an Emergency Telephone Numbers list in the appendix of your participant’s guide. Follow these poison control prevention practices to ensure that children are not exposed to poisonous materials, unclean items, or unsafe food-handling practices: Keep all chemicals out of the reach of children Follow safe food handling and storage guidelines Follow the directions for dosage found on the medicine package’s label Teach children not to put unfamiliar items in their mouths Keep emergency phone numbers by the phone (a sample is found in the appendix) Room-by-Room Safety Checks To help keep children safe from poisoning, Florida’s Poison Control Centers recommends that you perform a safety check room by room. Systematically check each of the following rooms for commonly found poisonous items: Kitchen Ammonia Cleaners Detergents Alcoholic beverages Bathroom Air fresheners Cologne/perfume Medicines/vitamins/herbal supplements Rubbing alcohol Garage Antifreeze Fertilizer Gasoline/kerosene Paint/paint thinner Laundry Room Laundry detergents Bleach Fabric softener Yard Bug/weed/pest killer Mushrooms Plants/berries/flowers Shrubs/trees "For Kids & Parents - Florida's Poison Control Centers." Florida’s Poison Control Centers. Florida Poison Information Center Network, n.d. Web. 30 Nov For a more complete list of commonly found household poisons, tips for performing a room-by-room safety check, as well as a Poison Control Checklist, visit Florida’s Poison Control Center’s website For Kids and Parents. Florida’s Poison Control Centers Poison Fact Sheet for Parents Health, Safety, and Nutrition PG – 35

Module 2 Key Point No person is immune to poisoning and small children are especially at risk. Key Point: No person is immune to poisoning and small children are especially at risk. Health, Safety, and Nutrition PG – 35

Activity: Poison Hazards by Season
Module 2 Activity: Poison Hazards by Season Each season has potential poisons that may not be present at other times of the year, and we need to be alert to those, as well as to ones that are present year-round. Think about some of the poisons and hazards that tend to occur during each season. Spring and Summer Fall and Winter Winter Holidays Approximate time required for this activity: 10 minutes Each season has potential poisons that may not be present at other times of the year, and we need to be alert to those, as well as to ones that are present year-round. Think about some of the poisons and hazards that tend to occur during each season. Below each image, you will find some examples of seasonal poisons/hazards. Be sure to record this information, along with any other examples you know. Activity: Poison Hazards by Season Ask participants to discuss poisons that tend to occur during different seasons. Write responses on the whiteboard, chalkboard, or flip chart. Spring and Summer: insecticides and garden chemicals; snakes and spiders; plants, bulbs and seeds; leaves, berries, and flowers; mushrooms (all wild mushrooms should be considered dangerous); food poisoning at picnics; gasoline; spring cleaning products. Fall and Winter: kerosene; antifreeze; leaves, berries, and bulbs; cold and flu medication; improperly handled, prepared, or stored food at holiday gatherings. Winter holidays: holly, mistletoe, poinsettia plants, tinsel, ornaments and decorations that look like candy or food that are not in original packaging; alcohol, which is very hazardous to small children; and medication and personal items brought in by family members, which are attractive to children because these things are new to them. Health, Safety, and Nutrition PG – 35-36

Activity: Look a-Likes
Module 2 Activity: Look a-Likes Hazardous Item What It Looks Like to a Child Medicine Candy Powdered cleanser Powdered sugar or grated cheese Lamp oil or rubbing alcohol Bottled water Pine cleaner Apple juice Motor oil Honey Shaving cream Whipped cream Alcoholic beverages and mouthwash Juice drinks Dishwashing liquids Sports drinks Hazardous sprays/pesticides Hairspray Rodent Killing Pellets Hard Candy Approximate time required for this activity: 10 minutes Bring items that children might mistake as edible (medicine, powdered cleanser, lamp oil, pine cleaner, motor oil) and discuss what they look like to children (candy, powdered sugar, bottled water, apple juice, honey). Be aware that children can easily be fooled by look-a-likes. Many hazardous items can look like appetizing treats to children who do not know better. Think about each of the potentially hazardous items shown before clicking to reveal some examples of the way a child might perceive them. Health, Safety, and Nutrition PG – 36

Accidents and Injuries
Module 2 Accidents and Injuries It is very important to document any accident involving or injury received by children in your care. Approximate time required for this lesson: 25 minutes In the event of an accident or incident, it is important to document in full detail. What sorts of accidents or incidents are common in a child care setting? (Write responses on the whiteboard, chalkboard, or flip chart. Examples may include falls, bumps and collisions, bites from other children, high chair and walker injuries, and injuries sustained on playground equipment.) Sometimes, the physical environment and the children’s behavior play major roles in the occurrence of an accident or injury. Sometimes, an accident or injury may have been prevented. Special safety considerations are directed toward children with disabilities. Caregivers need to take into account any equipment a child uses when taking precautions. It is very important to document any accident or injury received by children in your care. Locate the Sample Accident and Injury Report Form in the appendix and review the information that belongs in each section. Each section will be shown with the accompanying information below an annotated image of the form. The name of your program and whether it is a child care facility or a family child care home should be written in this blank. The child’s name and age goes here. Remember, a separate report should be filed for each child involved and the report should never name the other children involved. It is important to record the date and time that the accident or incident occurred. This is where you would describe the details of what occurred. Did the child fall down? Was the child pushed? Did the child vomit? Events that led to the accident or incident, equipment or other persons involved, and similar details should also be recorded. Write the nature of the injury here. This would be a description, such as a two-inch cut on the child’s arm, a skinned knee, a bruise, or a high fever. Write the names of any other caregivers, parents, teachers, or adults who saw the accident in this space. Describe the action that was taken here. This includes any first aid treatment, removal of a hazard, or modifications of policies. If you contacted the child’s parent or guardian, record the time and how they were contacted on this line. Any other persons contacted, such as the Poison Control Center, paramedics, or police, should be recorded here. Describe any medical treatment or first aid here. Did the child receive any medication or bandages, or ice for swelling? Be sure to have the facility director or family child care home operator and a parent or guardian sign and date the form. When you record accidents or incidents involving more than one child, your report should NEVER name the other child involved. A separate report must be filled out for each child involved in an accident or incident. Health, Safety, and Nutrition PG – 37

Module 2 Key Point It is important to complete the accident and injury report form as soon as possible, and to accurately reflect what occurred, while keeping the names of children involved confidential. Key Point: It is important to complete the accident and injury report form as soon as possible, and to accurately reflect what occurred, while keeping the names of children involved confidential. Health, Safety, and Nutrition PG – 37

Activity: Accident and Injury Report Form
Module 2 Activity: Accident and Injury Report Form On September 18th, at Happy Mornings Preschool, 4-year-old Johnny fell off a tricycle on the playground right after lunch (1:00 p.m.). He skinned his knee, which you cleaned with soap and water. While applying a bandage, you asked your co-workers if anyone saw the accident. Brenda, another caregiver, said she saw Johnny fall, called the parents immediately, and notified the director of the child care center. Approximate time required for this activity: 10 minutes Ask participants to complete the Sample Accident/Injury Report Form found in the appendix by using an accident or injury they have experienced or witnessed in a child care program. Or, the Trainer may provide an accident/incident scenario. Review and discuss the results with the group. Ask participants why it is important to keep these records. Health, Safety, and Nutrition PG – 37

Accidents and Injuries
Module 2 Accidents and Injuries Crib Safety Toy Safety Crib Safety Accidents and injuries can be prevented by observing good safety practices with toys and cribs. First, before purchasing a crib, it should be inspected to ensure that it is in compliance with the current United States Consumer Product Safety Commission and ASTM safety standards. It is important to always keep the crib’s side rails in the “up” position, and never leave a child unattended in a crib. Never use a crib for a time-out or as punishment. Caregivers should inspect cribs before each use to ensure that hardware is tightened and that there are not any safety hazards. Before placing a child in a crib or similar environment, remove any jewelry from the child because it is a major choking hazard. Regarding crib toys, “Crib gyms, crib toys, mobiles, mirrors, and all objects/toys are prohibited in or attached to an infant’s crib. Items or toys should not be hung from the ceiling over an infant’s crib.” American Academy of Pediatrics, American Public Health Association, National Resource Center for Health and Safety in Child Care and Early Education Caring for our children: National health and safety performance standards; Guidelines for early care and education programs. 3rd Edition. Elk Grove Village, IL: American Academy of Pediatrics; Washington, DC: American Public Health Association. As a caregiver, it is important to ensure a child’s crib is completely free of any hazards or items that present a potential for suffocation, such as blankets, bumper pads, overlays or other objects. Toy Safety Regarding toy safety, implement these best practices: Follow the manufacturer’s age recommendations for toys. Pay attention to warning signs on toy packaging and labels. Check toys for broken or missing parts, then either repair or discard them. Avoid using toys smaller than 1 ¼ inches. Toys with strings or cords attached should not be used, since they can be choking hazards. Projectile toys should be prohibited. Keep in mind that vending machine toys are not regulated to ensure they meet safety regulations. Trampolines should never be available in a child care program. Walkers should not be used, unless they are included by an Individual Family Service Plan. Health, Safety, and Nutrition PG – 37-38

Module 2 Infant Safety While we are studying crib safety, it is a good time to talk about SIDS, or Sudden Infant Death Syndrome. SIDS is not a cause of death, but rather a classification for a manner of death. Does anyone know the memory aid that helps us to remember how to place a baby in a sleeping position? Now that we have discussed crib safety it is a good time to mention SIDS, or Sudden Infant Death Syndrome. SIDS is not a cause of death, but rather a classification for a manner of death. To help prevent SIDS, use the Back to Sleep practice endorsed by the Eunice Kennedy Shriver National Institute of Child Health and Human Development as part of their Safe to Sleep campaign. This practice involves placing a baby on their back, not their stomach, when placing them in a crib. This practice reduces the chances of suffocation by ensuring that the child is not suffocated by the mattress or bedding in the crib. Does anyone know the memory aid that helps us to remember how to place a baby in a sleeping position? (Back-to-Sleep; we place a baby on her back, not her stomach, to sleep.) Health, Safety, and Nutrition PG – 38

Module 2 Back to Sleep More information on safe sleep practices is in the appendix of your participant’s guide. For more information about SIDS and the Back to Sleep campaign, take the Department of Children and Families’ course Safe Sleep Practices for Child Care. Abusive Head Trauma and Shaken Baby Syndrome are severe forms of physical abuse. It is caused by someone shaking an infant and causing injury or death. Shaking an infant can cause severe injury because they have weak neck muscles, growing brains, and thin skulls. Shaking a baby or young child can cause permanent brain damage, paralysis, blindness, seizures, developmental delays, broken bones or death. To prevent Shaken Baby Syndrome: Make sure those who care for young children know the dangers of shaking a baby Be careful during play or physical activity For more information about abuse and neglect campaign, take the Department of Children and Families’ course Identifying and Reporting Child Abuse and Neglect. Additional Resources Centers for Disease Control and Prevention website for Sudden Unexpected Infant Death and Sudden Infant Death Syndrome Explore all of the resources available through The Safe Sleep Campaign to become knowledgeable about safe sleep practices. Preventing Abuse Head Trauma in Children Health, Safety, and Nutrition PG – 38

Support for Injured Children
Module 2 Support for Injured Children Always be honest, but positive. Using positive words and non-verbal behaviors will help the child remain calm. Do not tell the child that something will not hurt if it will or if you do not know if it will or not. Remain calm. Being prepared for emergencies will help you achieve this. After the incident is over, and you are out of the child’s sight, you may (or may not) “fall apart.” Allow yourself to have a natural reaction to what you have just witnessed. Treat the child as a person. Do not ignore the injury or the child’s feelings. Approximate time required for this lesson: 15 minutes How a child responds when injured depends greatly on how the adults around him/her are responding. If the atmosphere is controlled and calm, he/she will probably respond in a similar manner. If the adults are distraught and uncontrolled, his/her initial fears may escalate to panic and hysteria. Always be honest, but positive. Using positive words and non-verbal behaviors will help the child remain calm. Do not tell the child that something will not hurt if it will or if you do not know if it will or not. Remain calm. Being prepared for emergencies will help you achieve this. After the incident is over and you are out of the child’s sight, you may (or may not) “fall apart.” Allow yourself to have a natural reaction to what you have just witnessed. Treat the child as a person. Do not ignore the injury or the child’s feelings. Health, Safety, and Nutrition PG – 39

Module 2 Support for Injured Children Encourage the child to express his or her feelings. It is normal to cry when frightened or injured. Do not tell him not to cry or shame him for doing so. Allow the child to have as much control as possible. For example, ask, “Do you want to look at it?” and “Would you like me to stay here with you?” Let the child hold a brown cloth over an area that is bleeding. (A brown cloth will not show blood.) Encourage the child to express his or her feelings. It is normal to cry when frightened or injured. Do not tell him/her not to cry or shame him/her for doing so. Allow the child to have as much control as possible. For example, ask, “Do you want to look at it?” and “Would you like me to stay here with you?” Let the child hold a brown-colored cloth over an open cut or wound so they cannot see the red blood as brightly as they would on a white-colored cloth. Health, Safety, and Nutrition PG – 39

Module 2 Support for Injured Children Encourage the child to talk or think about something pleasant. Talk about a favorite pet or activity, sing songs, or tell stories. Explain unfamiliar procedures and equipment step-by-step. Children react better when they understand what is going on. (Adults do too!) Do not ignore the presence of “scary” people or things. Do not say, “That? Oh, that’s nothing. Ignore it.” Encourage the child to talk or think about something pleasant. Talk about a favorite pet or activity, sing songs, or tell stories. Explain unfamiliar procedures and equipment step-by-step. Children react better when they understand what is going on. (Adults do too!) Do not ignore the presence of “scary” people or things. Do not say, “That? Oh, that is nothing. Ignore it.” Health, Safety, and Nutrition PG – 39

Module 2 Support for Injured Children Determine the advantages and disadvantages of your presence during treatment. Often, medical staff can do a quicker and more thorough job if you leave the room. Ask the child what her preference is, and ask staff if you can accommodate that wish. If you leave the room, do not take all of your belongings, so the child will know you’re coming back. Tell the child where you will wait. Console her right after treatment. Bring a favorite toy or blanket to the emergency room. Tell the child that doctors and nurses help people and take care of them when they are sick or hurt. Determine the advantages and disadvantages of your presence during treatment. Often, medical staff can do a quicker and more thorough job if you leave the room. Ask the child what his/her preference is, and ask medical staff if you can accommodate that wish. If you leave the room, do not take all of your belongings, so the child will know you are coming back. Tell the child where you will wait. Console him/her right after treatment. Bring a favorite toy or blanket to the emergency room. Tell the child that doctors and nurses help people and take care of them when they are sick or hurt. Health, Safety, and Nutrition PG – 39

Module 2 Support for Injured Children Take an “emergency bag” with you to the hospital that contains paper, crayons, story books, small toys, and similar items. Watch your language! Be alert to what you say and how you say it. If you say, “We are going to sew up the cut on your arm,” the child may imagine the sewing machine he/she sees at home. Instead, say, “The doctor is going to fix your cut and you are going to feel better after he does that.” Avoid all medical terms. Say, “Let me help you to hold still,” not “We are going to hold you down.” Take an “emergency bag” with you to the hospital that contains paper, crayons, story books, small toys, and similar items. Watch your language! Be alert to what you say and how you say it. If you say, “We are going to sew up the cut on your arm,” the child may imagine the sewing machine he/she sees at home. Instead, say, “The doctor is going to fix your cut and you are going to feel better after he does that.” Avoid all medical terms. Say, “Let me help you to hold still,” not “We are going to hold you down.” PG – 39 Health, Safety, and Nutrition

Module 2 Support for Injured Children Talk to the child at eye level. Children are empowered when they look at and talk to adults at an eye-to-eye level. Do not stand over an injured child to talk to him/her. After treatment, the child may have a possible regression in behavior. He/she may be suddenly sucking his/her thumb and wetting his/her bed; he/she may develop a fear of strangers or become aggressive. Recommend a psychological service if the behavior is hurting himself/herself or other people, or if it is prolonged. Talk to the child at eye level. Children are empowered when they look at and talk to adults at an eye-to-eye level. Do not stand over an injured child to talk to him/her. After treatment, the child may have a possible regression in behavior. He/she may be suddenly sucking his/her thumb and wetting his/her bed; he/she may develop a fear of strangers or become aggressive. Recommend a psychological service if the behavior is hurting himself/herself or other people, or if it is prolonged. Health, Safety, and Nutrition PG – 40

Module 2 Support for Injured Children After treatment, encourage the child to role-play and talk about how he/she feels. This will bring about closure and help you, the caregiver, become aware of any issues the child might have. Consider using the experience in a learning center activity so that any children who witnessed the accident or injury can have closure as well. After treatment, encourage the child to role-play and talk about how he/she feels. This will bring about closure and help you, the caregiver, become aware of any issues the child might have. Consider using the experience in a learning center activity so that any children who witnessed the accident or injury can have closure as well. It is also important to remember to take the child’s medical and enrollment records with you to the emergency room. Health, Safety, and Nutrition PG – 40

Module 2 Key Point A child’s response to an injury or accidents depends on the adults and others around him/her. Key Point: A child’s response to an injury or accidents depends on the adults and others around him/her. Health, Safety, and Nutrition PG – 40

Activity: Safety Checklist for Child Care Settings
Module 2 Activity: Safety Checklist for Child Care Settings Locate the Safety Checklist for Child Care Settings in the appendix. Complete the checklist for your child care program. Discuss these items with your child care program director and fellow child care professionals to try to find ways of improving safety conditions in your center. Approximate time required for this activity: 5 minutes Locate the Safety Checklist for Child Care Settings in the appendix. Complete the checklist for your child care program. Discuss these items with your child care program director and fellow child care professionals to try to find ways of improving safety conditions in your center. Activity: Safety Checklist for the Child Care Setting Direct the participants to locate “Safety Checklist for Child Care Settings” in the appendix of their participant’s guide on pages items that their child care program always does or rarely does. Results are discussed without naming particular programs and the list is not collected or shared. Health, Safety, and Nutrition PG – 41

Preventing Injuries and Accidents
Module 2 Preventing Injuries and Accidents What are some of the roles a caregiver plays in injury prevention? Careful, constant supervision Maintaining a neat and orderly environment Having an established daily routine that children are familiar with, so that they know what to expect Establish a clear set of rules and behaviors so that children know what is expected of them and which behaviors are unacceptable Teaching children safe behaviors Providing age-appropriate and skill-level-appropriate toys and games Having a person on the premises at all times who knows first aid and/or CPR Approximate time required for this lesson: 10 minutes We have discussed some prevention methods and protocols for reporting and responding to injuries and accidents. Now, we will examine systematic ways of recognizing hazardous situations and taking preventative measures. It is important for caregivers to inspect their child care program environment regularly and take steps to prevent injury. Caregivers have responsibilities in developing a safe environment for the children in their care. What are some of the roles a caregiver plays in injury prevention? (Write responses on the whiteboard, chalkboard, or flip chart. Examples may include: careful, constant supervision; maintaining a neat and orderly environment; teaching children safe behaviors; providing age and skill-level appropriate toys and games; having a person on the premises at all times who knows first aid and/or CPR.) Constant supervision is the number one tool in the child care professional’s arsenal of injury and accident prevention. Caregivers who are aware of where children are at all times, and can spot potentially unsafe behaviors and conditions, are at a great advantage when it comes to preventing accidents. Maintaining a neat and orderly environment means keeping walkways and traffic areas clear of obstacles, toys, materials, and other tripping hazards. Caregivers who use an established daily routine can help control unwanted and unsafe behaviors by ensuring that children know what activities they are participating in and what they can expect to have happen next. This helps to prevent frustration and confusion, which can lead to outbursts—and potentially—accidents and injuries. Make it an everyday priority to teach children safe behaviors and reinforce good behaviors that children exhibit. Providing age-appropriate and skill-level-appropriate toys, games, and activities helps children to learn and grow. Ensure that daily activities are challenging but achievable, in order to help children learn new skills without becoming angry or frustrated with tasks that are too far above or below their skill level. Perhaps the most important tool in a child care professional’s accident prevention arsenal is a person who is experienced in first aid and cardiopulmonary resuscitation, or CPR. In the event that an accident or injury is unavoidable, this person can ensure that an unfortunate situation does not become catastrophic, or even worse, fatal. The purpose of CPR is to keep the vital organs alive by keeping the blood flowing through the body until emergency personnel arrive. Instructors throughout the state that are certified through organizations, such as the American Red Cross or American Heart Association, offer CPR training. Individuals are certified for a specific period and certification must be renewed. In Florida, while you may take your CPR training online, you MUST be certified through an instructor. First aid training typically includes how to: Recognize and handle medical emergencies Prevent spread of disease Sustain life during emergencies Handle injuries and illness First aid training may be taken online or through an instructor. First aid certification is only valid for a specific period and must be renewed. Health, Safety, and Nutrition PG – 41

Module 2 Key Point Every caregiver has important roles to play in injury prevention, and it is their responsibility to secure a safe environment for the children in their care. Key Point: Every caregiver has important roles to play in injury prevention, and it is their responsibility to secure a safe environment for the children in their care. Health, Safety, and Nutrition PG – 41

Ways to Accomplish a Safe Environment Health, Safety, and Nutrition
Safe Talk Module 2 As a child care professional, one of your daily priorities should be to help children learn safe behaviors; another should be to encourage them to exhibit these behaviors in an effortless manner. Ways to Accomplish a Safe Environment Example Encourage children to engage in activities and play where they can be seen. “Everyone, remember to stay where I can see you on the playground.” Remind children about the classroom rules and why they were established. “Walk slowly and safely in the classroom.” “We use walking feet inside so you do not get hurt.” Help children understand the importance of cleaning up after activities, and keeping walkways and traffic areas clear. “Remember to be safe. We need to pick up our toys from the floor and put them on the shelf where they belong, so our friends are safe.” Provide children with age-appropriate and skill-level-appropriate materials and supplies. “Here are your safety scissors. It is best for us to use these so we can cut our paper during art time.” Remind children what they are supposed to be doing and what they can expect to have happen next. “After we clean up our art supplies, we are going to eat lunch. Who would like to play on the playground after lunch?” Approximate time required for this lesson: 20 minutes As a child care professional, one of your daily priorities should be to help children learn safe behaviors; another should be to encourage them to exhibit these behaviors in an effortless manner. You can achieve this by talking to children about safety, and discussing the kinds of behaviors and activities that are safe or unsafe. Some examples of ways you can accomplish this include: Health, Safety, and Nutrition PG – 42

Module 2 Activity: Safe Talk Scenario 1: Dante is standing on his tiptoes on a chair, trying to reach a toy on a high shelf. Scenario 2: Bobby, Nikki, and Juan are playing in the sandbox. Bobby is throwing sand at the other two children. Scenario 3: An overexcited Ali is running back and forth between two learning centers. Approximate time required for this activity is 5 minutes. Participants form 4 groups and role-play a situation in which a child is doing something unsafe. The person playing the caregiver should have a “safe talk” with the child. Observers discuss the scenario and the method(s) used. Scenario 1: Dante is standing on his tiptoes on a chair, trying to reach a toy on a high shelf. Sample answer: Explain to Dante that his behavior is unsafe. “Dante, chairs are for sitting; if you need help, you can always come ask me.” Scenario 2: Bobby, Nikki, and Juan are playing in the sandbox. Bobby is throwing sand at the other two children. Sample answer: Remind Bobby of the classroom rules about treating people with respect. “Bobby, are you following our safety rules? Remember to be respectful to our friends. Do we have any rules about how we treat our friends?” Scenario 3: An overexcited Ali is running back and forth between two learning centers. Sample answer: Try to help Ali calm down, and find out why he is overexcited. Try encouraging a more appropriate activity. “Ali, you seem full of energy today. Remember to use your walking feet inside. After reading time is over, we can go run outside. Does that sound like fun?” Health, Safety, and Nutrition PG – 42

Activity: What Can You See?
Module 2 Activity: What Can You See? Playgrounds Near Electrical Outlets Restrooms Playpens Approximate time required for this activity: 10 minutes As we’ve just seen, part of being able to teach a child safe behavior involves being able to recognize dangerous or hazardous behaviors or situations. In the next few minutes, I am going to give you scenarios that may contain unsafe conditions. Please point out the hazard and recommend preventive measures. Activity: What Can You See? Divide the participants into four groups. Have each group identify the safety hazards that may be found in one of four locations: at playgrounds, near electrical outlets, in restrooms, and in indoor play areas. Each time a participant points out a hazard, the group develops a way to make it safer. Both the hazard and its correction are written on one of 4 flip chart pages, each labeled with the name of one location. Results are shared. * Alternate activity: Groups brainstorm a list of basic safety rules in each of these environments for children. Let’s begin on the playground. Sharp corners or objects (Remove or cover.) Rusted or decrepit equipment (Remove and replace.) Loose-fitting bolts holding equipment together (Remove or repair.) Unfenced area (Fence at least part of the area in accordance with 65C-20 and 65C-22.) Retention pond, ditch, or swale nearby (Fence at least part of the area.) Large tree blocking caregiver’s view (Caregiver moves around to provide constant supervision.) Lack of sufficient ground cover/resilient surfacing. Let’s move near electrical outlets. Unused plugs (Use safety plugs.) Children have toys near outlets (Constant supervision must be maintained to keep children from sticking toy parts into outlets; move toys.) Too many cords in one outlet (Relocate some of the equipment.) Let’s go into the restroom. Hot water faucets (Lower the water temperature; paint hot water faucet red and let children know what that means. See, “Tap Water Scalds” in the appendix of the participant’s guide.) Child locks himself in the bathroom (Install a lock that opens from outside.) Wet floor (Clean up all spills immediately.) Cabinets contain cleaning materials (Install safety latches on cabinets or move the cleaning material to a locked closet or cabinet.) Let’s take a look at the playpen. Small toys (Allow nothing smaller than 1 ¼ inches.) Rips and tears in play pen pad (Replace them.) Sharp objects in or near play pen (Monitor and supervise the children at all times—how did that get there?) Health, Safety, and Nutrition PG – 42-43

Childproofing Your Environment
Safety Hazard Suggested Remedy Sharp corners or objects Remove or cover Rusted or decrepit equipment Remove equipment and replace Loose-fitting bolts holding equipment together Remove equipment or repair Access to vehicular traffic Constant supervision must be maintained Fence the area in accordance with 65C-20 and 65C-22 Unfenced area Retention pond, ditch, or swale nearby Swimming Pool and Hot Tubs Ensure safety equipment is installed, such as drain covers, barriers, and alarms Ensure there is a certified lifeguard present or provide one person with a certified lifeguard certificate or equivalent Large tree blocking caregiver’s view Caregiver moves around to provide constant supervision Lack of sufficient ground cover/resilient surfacing Provide a safe fall zone under equipment Unused electrical outlets Use safety plugs Children have toys near outlets Constant supervision must be maintained to keep children from sticking toy parts into outlets; move the toys Too many cords in one outlet Relocate some of the equipment Hot water faucets Lower the water temperature; paint hot water faucet red and let children know what it means; see, Tap Water Scalds in the appendix Child can lock himself in the bathroom Install a lock that opens from outside Wet floor Clean up all spills immediately Cabinets contain cleaning materials Install safety latches on cabinets or move the cleaning materials to a locked closet or cabinet Small toys Allow nothing smaller than 1 ¼ inches Rips and tears in playpen pad Replace it Sharp objects in or near playpen Remove the objects or replace the playpen Module 2 Childproofing Your Environment Part of being able to teach a child safe behavior involves being able to recognize dangerous or hazardous behaviors or situations. It is not enough just to recognize danger, you must take actions that will minimize the risk of accident or injury. Take a moment to review the safety hazards and suggested remedies listed on screen. Can you think of any other safety hazards that one might find in a child care environment? What would you do to minimize the risks associated with these hazards? Chart on-screen may be found in the appendix. For more information about keeping children safe, please see Childproofing Your Home 12 Safety Devices to Protect Your Children, in the appendix. For more information about water safety, take the Department of Children and Families’ course Water Safety in Child Care Programs. Health, Safety, and Nutrition

Emergency Preparedness Plan
Module 2 Emergency Preparedness Plan Responding appropriately to accidents, injuries, and incidents are some of the main responsibilities of an effective child care professional. Your child care program must have written plans and procedures for evacuating the facility, establishing a shelter-in-place, and a lockdown procedure. Approximate time required for this lesson: 15 minutes Responding appropriately to accidents, injuries, and incidents are some of the main responsibilities of an effective child care professional. Every child care program should have a written plan for responding to fires, hurricanes, tornadoes, chemical spills and other dangerous situations that may call for evacuation of the center, the shelter-in-place procedure, or the lockdown procedure. Although most child care programs would be closed in the event of a hurricane, you should secure your facility by bringing in or anchoring objects outside, gathering supplies, and sandbagging to prevent flood damage. Your child care program must have written plans and procedures for evacuating the facility, establishing a shelter-in-place, and a lockdown procedure. Facility Emergency Preparedness Plans must describe how they will meet the needs of all children, including children with special needs, during and following an emergency event. The Centers for Disease Control and Prevention and Ready.gov have a number of resources to assist in the protection of children in a disaster. A child care program must be prepared to provide care for children at all times. This is especially critical for children with disabilities and/or chronic medical conditions, who may have physical, equipment, medical, social, and emotional needs. It is important that the program’s emergency preparedness plan state that the appropriate accommodations and provisions must be available during an emergency. It is also important to remember that infants and toddlers have specific needs that need to be met during an emergency. This includes having the necessary supplies for feeding and diapering. All children, in particular younger children, will process the emergency very differently from adults so child care programs should maintain as normal of a routine as possible and provide developmentally appropriate activities for them. The program’s licensing counselor should be notified in the event of an emergency that may result in limiting the ability to provide care for children in a healthy and safe environment, such as structural damage. In the event of a fire, bomb threat, indoor chemical spill, or other event that requires children and staff to safely exit the building, an evacuation plan is needed. Typically referred to as a fire drill, the evacuation procedure is a written plan that details each caregiver and staff member’s responsibilities while safely escorting children out of the building. A fire drill must be performed and documented at least once per month to ensure that everyone is familiar with the procedure. The shelter-in-place procedure involves creating a safe place to stay under cover until a disastrous situation has passed. The shelter-in-place procedure is appropriate during inclement weather, such as a tornado or thunderstorm; a chemical spill outside of the child care program; or any other situation where the children and staff are safer inside the building than they would be outside. The lockdown procedure is used when there is an outside threat that may pose harm to the staff or children inside the program. A lockdown procedure involves creating the illusion that the building is vacant and currently unused. This means all lights should be turned off, all doors should be locked, and everyone should remain quiet until the threat passes. For more information about emergency preparedness, take the Department of Children and Families’ course Fire Safety and Emergency Preparedness in Florida’s Child Care Programs. You can also visit the Ready website for more information about emergency preparedness. Additional Resources Caring for Children in a Disaster Keeping Children with Disabilities Safe in Emergencies Infants & Young Children Health, Safety, and Nutrition PG – 44

Module 2 Key Point Caregivers should familiarize themselves with their child care program’s written policies regarding the evacuation, shelter-in-place, and lockdown procedures. Key Point: Caregivers should familiarize themselves with their child care program’s written policies regarding the evacuation, shelter-in-place, and lockdown procedures. Health, Safety, and Nutrition PG – 44

Module 2 Key Point When creating any written emergency response plan, there should be a designated position assigned to each task that is required for effective execution of the plan. Key Point: When creating any written emergency response plan, there should be a designated position assigned to each task that is required for effective execution of the plan. Health, Safety, and Nutrition PG – 44

Module 2 Emergency Procedures Evacuation Procedure Shelter-in-Place Procedure Lockdown Procedure Evacuation Procedure Child care programs must have evacuation plans in place and perform periodic evacuation drills to prepare for fires and other disasters. A sample Fire Drill Record is located in the appendix. Effective evacuation plans: Describe, in writing, the role of each position in the child care program – it is important not to designate specific people in the plan because that person may not be there during an emergency; by designating the position, anyone working in that position will know they are responsible for that step in the plan Involve each and every member of the staff, including child care professionals, the director, food service staff, maintenance staff, or any other person employed in the program; also include parents and volunteers Are reviewed regularly for accuracy, and are updated when necessary Detail escape routes, including alternate routes when necessary Display the location of emergency equipment Designate meeting locations, including alternate meeting locations when necessary Include removing the daily attendance record during evacuation and taking roll call at the designated meeting location once everyone has been safely evacuated Include monthly practice drills, some of which are unannounced to children and/or staff Effective evacuation drills: Describe how to initiate the procedure Designate which staff members must escort specific children Follow the established evacuation routes Instruct caregivers to gather everyone at a designated meeting place Designate a staff member to get the daily attendance record on the way out of the building and order a roll call once everyone is outside Designate a specific staff member to call and include a backup staff member to do this Shelter-in-Place Procedure Child care programs should have a written plan for the shelter-in-place procedure. This procedure is used when dealing with inclement weather, such as tornados. They are also used for a chemical spill, or other hazardous material spill, outside of the child care program. For a situation that requires a shelter-in-place procedure, you should: Call (in cases of hazardous spills near your child care program) Seek shelter inside the child care program, away from windows Turn off all fans, and heating and cooling systems Listen carefully to emergency broadcast stations for instructions Be prepared to evacuate; situations might change rapidly Lockdown Procedure A lockdown procedure is important in the event there is a threat, such as an armed assailant, near the child care program. The purpose of a lockdown procedure is to give the impression that there is no one present at the child care program. A lockdown procedure includes: Gathering all children and staff inside the building Calling 9-1-1 Locking all doors and windows once everyone is inside Turning off all lights, televisions, radios, and anything else that might make the building appear to have people inside Keeping children calm and quiet Remaining quiet and out of sight until police arrive Health, Safety, and Nutrition PG – 45-46

Module 2 Key Point Florida Law requires children to be secured by either a federally-approved child restraint seat or safety belt, and child care professionals should know the requirements for both the child care program and for sharing with families. Approximate time required for this lesson: 10 minutes Caring for Our Children: National Health and Safety Performance Standards Guidelines for Early Care and Education Programs provides specific information about child passenger safety when transporting children. When children are transported in a motor vehicle other than a school bus, or a bus operated by a common carrier, the following should apply: A child should be transported only if the child is restrained in a developmentally-appropriate restraint system that is in accordance with state and federal law, and is installed according to the manufacturer’s instructions Age-appropriate and size-appropriate vehicle child restraint systems should be used for children under eighty pounds and under four-feet-nine-inches tall, and for all children considered too small to fit properly in a vehicle safety belt Child passenger restraint systems must meet federal motor vehicle safety standards contained in the Code of Federal Regulations, Title 49, Section and carry such notice of compliance For children who are obese or overweight, it is important to find a car safety seat that fits the child properly All children under the age of thirteen should be transported in the back seat of a car For maximum safety, infants and toddlers should ride in a rear-facing orientation A booster seat should be used when the child has outgrown a forward-facing child safety seat Car safety seats should be labeled with the child passenger’s name and emergency contact information Car safety seats should be replaced if they have been recalled The temperature of all metal parts of vehicle child restraint systems should be checked before use to prevent burns American Academy of Pediatrics, American Public Health Association, National Resource Center for Health and Safety in Child Care and Early Education Caring for our children: National health and safety performance standards; Guidelines for early care and education programs. 3rd Edition. Standard : Child Passenger Safety. Elk Grove Village, IL: American Academy of Pediatrics; Washington, DC: American Public Health Association. Key Point: Florida Law requires children to be secured by either a federally-approved child restraint seat or safety belt, and child care professionals should know the requirements for both the child care program and for sharing with families. Additional Resource For more information regarding seat belt laws, visit the Florida Department of Motor Vehicles’ website. Health, Safety, and Nutrition PG – 47

Child Passenger Safety
Module 2 Child Passenger Safety Children must never be left in a vehicle unsupervised. There are four primary aspects to remember when installing a car seat: The location, where the seat is placed inside the vehicle The direction the car seat is facing inside the vehicle The seat belt path; whether or not the belts are correctly threaded through the seat’s slots Tightness; how firmly the seat is held in place Approximate time required for this lesson: 10 minutes Children must never be left in a vehicle unsupervised. Not only is it illegal, but the health and safety of a child could be at risk. The temperatures in cars can raise quickly, which can lead to the death of a child in a short period of time. When transporting children, remember that two adults need to do a visual sweep of the entire vehicle to ensure no child has been left behind. There are four primary aspects to remember when installing a car seat: The location, where the seat is placed inside the vehicle The direction the car seat is facing inside the vehicle The seat belt path; whether or not the belts are correctly threaded through the seat’s slots Tightness; how firmly the seat is held in place Here are some tips to make sure a car seat is installed correctly: The child sits comfortably and properly in the device Seat belts are properly threaded The device is firmly held to the seat by the seat belts Shoulder harness straps fit snugly but comfortably Children with special needs may have appropriate restraints; if so, they must be available and in proper use In most areas, law enforcement officers will help you install child safety seats or will check to make sure you have installed yours properly Here are some common errors made with car seats: The straps are too loose. All straps on the child should be snug and comfortable. All straps holding the device to the car’s seat should be tight. Neglecting to fasten the top anchor strap. This allows the seat to pitch forward in a crash. It might not be fastened because of parental apathy, lack of awareness that the anchor exists, unwillingness to bolt the anchor plate to the car, or uncertainty of how to install the anchor plate. Not using all of the straps provided, or not using them according to the manufacturer’s directions. Letting the children climb out of or refuse to use the car seat. This is most common in toddlers who dislike being restrained. They must be taught that the car will not move unless they are in their seats. Bundling infants in blankets before putting them in their seats. Belts cannot be adjusted properly. Improper placement of the car seat inside the vehicle. Placing a car seat in the front seat of the car. Reclining an infant seat with an adjustable tilt feature too far down. A 45-degree angle must be maintained to support the developing neck of the infant. In addition to the Department of Children and Families’ website, there are many other websites that provide valuable information about health, safety, and nutrition. Several of these are displayed on screen. Consumer Product Safety Commission Centers for Disease Control and Prevention: Children’s Mental Health American Academy of Pediatrics: Children and Disasters Florida’s Poison Control and Centers Florida Highway Safety and Motor Vehicles: Vehicle and Child Safety Health, Safety, and Nutrition PG – 47

Module 2 Conclusion You have achieved this module’s learning objectives if you can: Identify processes to plan for, establish, and maintain a safe child care environment Identify procedures for reporting accidents and incidents Explain methods used to prevent potential safety and fire hazards Explain procedures used in case of emergency Explain procedures for using car seats and other methods of restraining a child in a vehicle Module 2 Summary Here is a summary of key points for Module 2: A Safe Environment. No person is immune to poisoning and small children are especially at risk. It is important to complete the accident and injury report form as soon as possible, and to accurately reflect what occurred, while keeping the names of children involved confidential. A child’s response to an injury or accident depends on the adults and others around him/her. Every caregiver has important roles to play in injury prevention, and it is their responsibility to secure a safe environment for the children in their care. Caregivers should familiarize themselves with their child care program’s written policies regarding the evacuation, shelter-in-place, and lockdown procedures. When creating any written emergency response plan, there should be a designated position assigned to each task that is required for effective execution of the plan. Florida Law requires children to be secured by either a federally-approved child restraint seat or safety belt, and child care professionals should know the requirements for both the child care program and for sharing with families. Conclusion Congratulations! You have completed Module 2: A Safe Environment. You have achieved this module’s learning objectives if you can: Identify processes to plan for, establish, and maintain a safe child care environment Identify procedures for reporting accidents and incidents Explain methods used to prevent potential safety and fire hazards Explain procedures used in case of emergency Explain procedures for using car seats and other methods of restraining a child in a vehicle Health, Safety, and Nutrition PG – 49

Module 3: Children and Nutrition Approximate time required for this module: 115 minutes Materials: Flipchart and Markers, VCR/TV, Video: Nutrition for Infants and Children, One Week Menu, and Sticky Notes. Welcome to Module 3: Children and Nutrition. This module will highlight the nutritional needs of children, and explain how caregivers should address those needs through proper meal and snack planning, as well as how to identify foods that are hazardous to children. It explains how caregivers should interact with children during mealtimes and demonstrates appropriate actions to take to help a choking child. The module also includes activities and other opportunities to practice skills that lead to serving safe, nutritious meals and snacks in a child care program. Health, Safety, and Nutrition

Participants will identify the need for and understand guidelines related to proper nutrition for all children. Learning Objectives After successfully completing this module, you will be able to: Identify the nutritional needs of all children Describe how to plan nutritious meals and snacks Explain the proper role of the caregiver during mealtimes Identify foods that are potentially dangerous for young children Describe procedures for helping a choking child Goal Participants will identify the need for and understand guidelines related to proper nutrition for all children. Learning Objectives After successfully completing this module, you will be able to: Identify the nutritional needs of all children Describe how to plan nutritious meals and snacks Explain the proper role of the caregiver during mealtimes Identify foods that are potentially dangerous for young children Describe procedures for helping a choking child Health, Safety, and Nutrition PG – 50

Physical Development and Nutrition
Module 3 Physical Development and Nutrition Nutrition is the process of nourishing or being nourished by the foods we eat and how our bodies use them. The food needs of infants, babies and children are essential for their growth and development. Food experiences also have an impact on: Social skills or behaviors during meal times Motor skills or dexterity in handling utensils and foods And more, as we will see in this module. Approximate time required for this lesson: 15 minutes Take a moment to familiarize yourself with some terms that will be used throughout this module. Locate the Glossary in the appendix as you review the following terms. Appetite: A desire to eat. Hunger: A craving or urgent need for food. Meal: A portion of food eaten to satisfy appetite. Nutrient: A nourishing substance or ingredient. Nutrition: The processes by which an animal or plant takes in and utilizes food substances. Snack: A light meal, or food eaten between regular meals. Thirst: A desire or need to drink. Nutrition is the process of nourishing or being nourished by the foods we eat and how our bodies use them. The food needs of infants, babies and children are essential for their growth and development. Food experiences also have an impact on: Social skills or behaviors during meal times. Motor skills or dexterity in handling utensils and foods. And more, as we will see in this module. Developmental readiness of a child determines the types and textures of the food that should be served and what feeding style to use. Children develop at their own rates, and all children do better when they are allowed to do this and are not rushed into the next stage of development. A caregiver should pay very close attention to the mouth, hand, and body skill development in the infants they feed. Health, Safety, and Nutrition PG – 51

Module 3 Key Point Each age group has specific nutritional needs that must be met in order to supply essential resources their bodies must have to grow and develop. Key Point: Each age group has specific nutritional needs that must be met in order to supply essential resources their bodies must have to grow and develop. Health, Safety, and Nutrition PG – 51

Physical Development and Nutrition
Module 3 Physical Development and Nutrition When we discuss children’s developmental skills related to eating, we consider three things: Mouth patterns Hand and body skills Feeding skills or abilities In your experience, is feeding an infant more or less difficult than feeding an older baby? Why or why not? When we discuss the developmental skills related to eating for children, we consider three things: Mouth Patterns Hand and Body Skills Feeding Skills or Abilities These three developmental skills related to eating vary based on the age of the child. Take a moment to think about the three developmental skills that we just discussed as they relate to different age ranges, by reviewing the chart in your participant’s guide. It is important for you to be knowledgeable about age-appropriate developmental skills to ensure proper feeding practices. NEVER Prop a bottle. It is important to hold infants during feeding as well as interact with them. Health, Safety, and Nutrition PG – 51

Breast Milk and Feeding Infants and Toddlers
Module 3 Breast Milk and Feeding Infants and Toddlers Breast Milk Feeding Infants and Toddlers Approximate time required for this lesson: 10 minutes Breast Milk Caregivers play an important role in supporting a mother’s decision to breastfeed her infant. It takes some coordination between the mother and the caregiver, but the results are well worth the effort. Caregivers can help by providing nursing mothers with a place to nurse their babies at drop-off, pick-up and other times, and by understanding how to integrate breast milk feeding into feeding procedures. The American Academy of Pediatrics recommends that mothers breastfeed their babies for at least one year. The optimal food for any infant is its own mother’s milk; in fact, it is the only food an infant needs in the first 4 to 6 months of life. Breastfeeding helps develop a secure, nurturing and loving relationship between a mother and her child. Breast milk is ready-to-feed and needs no additives. Breast milk does not cost anything. Breast-fed infants do not get as sick as often as formula-fed infants. Breast-fed infants do not have constipation or diarrhea as often as formula-fed babies. Milk should be slightly bluish in color and should look thinner than cow’s milk. Breast milk is more easily digested than cow’s milk, so the infant should be fed more often, usually every 1 ½ to 3 hours. Caregivers should ask each mother how often their child needs to be fed; you should write this information down and keep it handy. Feeding Infants and Toddlers Breast milk, formula and food must be handled in a sanitary manner at all times. All formulas and food brought from home must be labeled with the child’s first and last name. The provider is responsible for the label; therefore if the label is not completed by the parent, the child care program must complete the label upon receipt of the formula or food. Prepared bottles must be refrigerated immediately and used within 48 hrs. Before use, for optimum digestion, breast milk and infant formula should to be warmed to body temperature. Remember, heated bottles or food must be tested before feeding to ensure heat is evenly distributed and to prevent injury to children. And, NEVER warm a bottle in a microwave oven, as overheating can occur. A bottle may be warmed only once; a warmed bottle may not be returned to the refrigerator or re-warmed. All breast milk and infant formula remaining in bottles after feeding shall be discarded within one hour after serving an infant. If the wrong breast milk or infant formula is provided to an infant in care, the provider must immediately inform the child’s parent. It is also important to take safety precautions into consideration when feeding solid foods to toddlers. Previously opened baby food jars shall not be accepted by a child care program. If food is fed directly from the jar by the caregiver, the jar shall be used for only one feeding and the remainder discarded. Solid foods—including cereal—shall not be given in bottles or with infant feeders to children with normal eating abilities, unless authorized by a physician. Solid foods must not be fed to an infant younger than four months of age, unless directed by a physician. Lastly, solid foods must always be of a safe consistency, and be developmentally appropriate for the age and developmental ability of the infant. Health, Safety, and Nutrition PG – 53

Module 3 Key Point A very important feeding practice is to always hold and interact with infants while you feed them—you should NEVER prop a bottle. Key Point: A very important feeding practice is to always hold and interact with infants while you feed them—you should NEVER prop a bottle. Health, Safety, and Nutrition PG – 53

Module 3 Key Point When the right foods are introduced at the right time, nutritional needs are met, and skills develop properly. Approximate time required for this lesson: 15 minutes Good nutrition is based on good eating habits, and these habits should be established during infancy. Now that we have discussed how a child should eat, we will take a look at what a child typically eats. Remember that these are general guidelines, and individual children may be on different or special diets prescribed by their pediatrician. Turn to the appendix and study the chart titled, Good Eating Habits for the First Year of Life. It is your responsibility to become familiar with this chart because the information in it is important in providing good nutritional experiences for children in your care. Based on the knowledge you have gained by studying the chart Good Eating Habits for the First Year of Life, think about the answers to the following questions. When should you burp an infant during feeding? (You burp the child during the middle and at the end of the feeding.) When is it appropriate to prop a bottle against a child’s mouth? (You should never prop a bottle against a child or use an automatic feeder. Propped bottles can be a choking hazard to infants. Feeding time is an optimum time to talk and sing with an infant.) Where should you place the spoon when you feed a child solid food? (Place the spoon on the middle of the child’s tongue.) When the right foods are introduced at the right times, nutritional needs are met and skills develop properly. Fulfilling a child’s nutritional needs is one of the base level necessities identified in Maslow’s hierarchy of needs. For more information about Abraham Maslow and the Hierarchy of Needs, as well as a few other important child development theories, take the Department of Children and Families’ course Child Growth and Development. Remember, the Good Eating Habits for the First Year of Life chart is critically important to you as a child care professional and you need to be familiar with its contents. Key Point: When the right foods are introduced at the right time, nutritional needs are met, and skills develop properly. Health, Safety, and Nutrition PG – 54

Module 3 MyPlate Approximate time required for this lesson: 50 minutes Introduction to MyPlate The United States Department of Agriculture, or USDA, studies nutrition and publishes their findings about how to maintain a healthy lifestyle by making responsible choices regarding your nutritional intake. The USDA has a campaign called MyPlate, which is used to illustrate healthy foods and proper portions at mealtime and snack time. The USDA formerly published the Food Guide Pyramid, as well as the MyPyramid campaigns; both of which have been retired and replaced with the MyPlate campaign. The MyPlate campaign identifies the five major food groups as: Fruits (apples, pineapples, pears, oranges, raisins, fruit juice) Vegetables (carrots, broccoli, spinach, onions, celery, zucchini) Grains (cereals, oatmeal, bread, rice, pasta, crackers) Protein foods (beef, chicken, fish, eggs, beans, tofu, nuts and seeds) Dairy (milk, yogurt, cheese) The USDA describes the purpose of the campaign on their webpage, ChooseMyPlate.gov. “MyPlate illustrates the five food groups that are the building blocks for a healthy diet using a familiar image – a place setting for a meal. Before you eat, think about what goes on your plate, in your cup, or in your bowl.” It is important to note that the MyPlate campaign treats oils differently than the previous campaigns did. While oils play an important part of a balanced diet, they are no longer considered to be part of a food group. The USDA explains this decision on their website: “Oils are NOT a food group, but they provide essential nutrients. Therefore, oils are included in the USDA patterns.” MyPlate illustrates the five food groups as a place setting for a meal, which is a familiar image. All of the food groups are the building blocks for a healthy diet. “Choose MyPlate.” Choose MyPlate. United States Department of Agriculture, n.d. Web. 09 Oct MyPlate – Vegetables As you can see in the graphic representing appropriate portion sizes of each food group, MyPlate suggests that one of the two largest portions featured on the plate should be vegetables. Vegetables that count as a member of this group and may be raw or cooked; fresh, frozen, canned, or dried/dehydrated; may be whole, cut-up, or mashed; or served as a juice, as long as it is 100% natural juice. Vegetables are organized into five subgroups: dark-green vegetables, starchy vegetables, red and orange vegetables, beans and peas, and other vegetables. According to the USDA, “Eating vegetables provides health benefits – people who eat more vegetables and fruits as part of an overall healthy diet are likely to have a reduced risk of some chronic diseases.” The health benefits of eating vegetables are as wide and varied as the selection of vegetables themselves. Health benefits of eating vegetables: “Eating a diet rich in vegetables and fruits as part of an overall healthy diet may reduce risk for heart disease, including heart attack and stroke. Eating a diet rich in some vegetables and fruits as part of an overall healthy diet may protect against certain types of cancers. Diets rich in foods containing fiber, such as some vegetables and fruits, may reduce the risk of heart disease, obesity, and type 2 diabetes. Eating vegetables and fruits rich in potassium as part of an overall healthy diet may lower blood pressure, and may also reduce the risk of developing kidney stones and help to decrease bone loss. Eating foods such as vegetables that are lower in calories per cup instead of some other higher-calorie food may be useful in helping to lower calorie intake.” The serving size of vegetables for children, according to MyPlate, is generally between one and three cups per day. Refer to the Daily Vegetable Chart for more specific information about appropriate daily serving sizes. MyPlate – Grains According to the MyPlate portion-size graphic, in addition to vegetables, grains should take up the other largest portion of your plate. Grains are composed of a wide variety of types of foods. The USDA provides the following examples, “Any food made from wheat, rice, oats, cornmeal, barley or another cereal grain is a grain product. Bread, pasta, oatmeal, breakfast cereals, tortillas, and grits are examples of grain products.” When a child eats a sandwich, the two slices of bread used in the sandwich belong to the grain group; while the contents of the sandwich probably do not. Similarly, when a child eats spaghetti and meatballs, the pasta itself is part of the grain group; while the meatballs belong to the protein group. When analyzed very closely, a sandwich could possibly contain all of the food groups, if you consider the bread, vegetables, protein, dairy, and fruit. For example, the bread is from the grain group, the lettuce is from the vegetable group, meat is from the protein group, cheese is from the dairy group, and tomatoes are from the fruit group. When considering how much grain a person needs per day, remember that nutritional needs tend to vary from person to person. The MyPlate campaign points out that, “The amount of grains you need to eat depends on your age, sex, and level of physical activity.” Though it also makes the recommendation that, “At least half of all the grains eaten should be whole grains.” So what are whole grains, and how do they differ from grains in general? There are two types of grains, Whole Grains and Refined Grains. “Whole grains contain the entire kernel — the bran, germ, and endosperm. Examples of whole grains include whole-wheat flour, bulgur, oatmeal, whole cornmeal, and brown rice.” “Choose MyPlate.” Choose MyPlate. United States Department of Agriculture, 17 Feb Web. 13 Oct Think about the types of foods you eat on a daily basis, and the types of grains that are included in the foods served in your child care program. What types of grains are they, whole or refined? Talk to your program director and fellow child care professionals to discuss ways you can include more whole grains in the types of foods that are served in your program. The serving size of grains for children, according to MyPlate, is generally between three and eight ounces per day. Refer to the Daily Grain Table for more specific information about appropriate daily serving sizes. MyPlate – Fruits Fruits take up a smaller portion size represented on the plate, according to the MyPlate graphic. This certainly does not mean that they are not important; they are just as important as the other food groups, but the amount eaten at each meal is just slightly smaller than grains or vegetables. So, what are fruits? Some common examples of fruits that you probably already know and enjoy include: Apples Oranges Bananas Strawberries Pears Watermelon Children tend to enjoy fruit, so it is not surprising that most candy that is readily available to children is fruit flavored. Is fruit-flavored candy considered a part of the fruit group? (No, it is not.) What kinds of foods are appropriate to include in the fruit group portion of the MyPlate suggested serving? (The answer is, “Any fruit or 100% fruit juice counts as part of the Fruit Group. Fruits may be fresh, canned, frozen, or dried, and may be whole, cut-up, or pureed.” Even if the juice is 100% fruit juice, it should be limited because of the sugar. Eating fruit is a healthier option. "Choose MyPlate." Choose MyPlate. United States Department of Agriculture, 11 Feb Web. 13 Oct ) The serving size of fruits for children, according to MyPlate, is generally between one and two cups per day. Refer to the Daily Fruit Chart for more specific information about appropriate daily serving sizes. MyPlate – Protein The protein group is represented as a portion size comparable to the portion size of fruit on the MyPlate graphic. You may notice that children tend to enjoy the protein served at mealtime and snack time more than they may enjoy the vegetables or grains. There is a wide variety of protein sources available, so it should be no trouble to keep mealtime and snack time interesting, as well as to provide a variety of protein sources that children enjoy. According to the USDA, examples of protein include, “All foods made from meat, poultry, seafood, beans and peas, eggs, processed soy products, nuts, and seeds…” The protein group can become a little bit complicated when including beans and peas; therefore, MyPlate has provided more specific information. MyPlate also recommends, “including at least 8 ounces of cooked seafood per week.” "Choose MyPlate." Choose MyPlate. United States Department of Agriculture, 11 Feb Web. 13 Oct The serving size of protein, according to MyPlate, is generally between two and six ounces per day. Refer to the Daily Protein Foods Table for more specific information about appropriate daily serving sizes. MyPlate – Dairy Since dairy, in most of its forms, could be messy to serve on a plate with the other food groups, it is represented as a side item next to the plate in the MyPlate graphic. Do not mistake the circular representation in the graphic to be a drink, since it could also represent a number of other dairy products included as part of a healthy meal. The Dairy Group includes a wide variety of foods. The USDA states, “All fluid milk products and many foods made from milk are considered part of this food group. Most Dairy Group choices should be fat-free or low-fat. Foods made from milk that retain their calcium content are part of the group. Foods made from milk that have little to no calcium, such as cream cheese, cream, and butter, are not.” “Choose MyPlate." Choose MyPlate. United States Department of Agriculture, 23 Feb Web. 13 Oct The serving size of dairy, according to MyPlate, is generally between two and three cups per day. Refer to the Daily Dairy Table for more specific information about appropriate daily serving sizes. MyPlate – Oils Since oils are not considered a food group of their own, they are not represented in the MyPlate graphic. When we talk about oils in relation to nutrition, we are talking about oils such as vegetable oil; olive oil; and the oils contained in certain foods, such as plants and fish. According to the MyPlate campaign, “Oils are fats that are liquid at room temperature, like the vegetable oils used in cooking. Oils come from many different plants and from fish. Oils are NOT a food group, but they provide essential nutrients. Therefore, oils are included in USDA food patterns.” What kinds of foods are we talking about when we discuss oils? (“Canola oil, corn oil, cottonseed oil, olive oil, safflower oil, and sunflower oil.”) What kinds of foods contain these essential oils? (“Nuts, olives, some fish, and avocados.”) What kinds of foods use these oils mainly as added flavorings? (“Mayonnaise, certain salad dressings, and soft margarine with no trans fat.”) Considering appropriate oil intake should be part of establishing a healthy diet. Be sure to check the nutritional labels provided on the foods you eat to discover what kinds of oils, if any, are contained in the foods. Be sure to include this information when planning appropriate nutritious meals for the children in care. “Choose MyPlate." Choose MyPlate. United States Department of Agriculture, 24 Feb Web. 13 Oct The serving size of oils, according to MyPlate, is generally between three and six teaspoons per day. Refer to the Daily Allowance Table for more specific information about appropriate daily serving sizes. Health, Safety, and Nutrition PG – 55

Meal and Snack Planning
Module 3 Meal and Snack Planning Offer different foods from day to day, and encourage children to choose from a variety of foods. Serve food in small portions during scheduled meals and snacks. Choose healthy snacks. This will help children get the nutrients they need as part of their daily requirements. Make smart beverage choices. Water, fat-free or low-fat milk, and small amounts of 100% fruit juices are good examples. Planning meals and snacks throughout the day should adhere to the standards defined by the American Academy of Pediatrics in their publication Caring for Our Children. Their recommendations for the number of meals and snacks served throughout the day state, “The facility should ensure that the following meal and snack pattern occurs: Children in care for eight and fewer hours in one day should be offered at least one meal and two snacks or two meals and one snack. Children in care more than eight hours in one day should be offered at least two meals and two snacks or three snacks and one meal. A nutritious snack should be offered to all children in midmorning (if they are not offered a breakfast on-site that is provided within three hours of lunch) and in the middle of the afternoon. Children should be offered food at intervals at least two hours apart and not more than three hours apart unless the child is asleep. Some very young infants may need to be fed at shorter intervals than every two hours to meet their nutritional needs, especially breastfed infants being fed expressed human milk. Lunch service may need to be served to toddlers earlier than the preschool-aged children due to their need for an earlier nap schedule. Children must be awake prior to being offered a meal/snack. Children should be allowed time to eat their food and not be rushed during the meal or snack service. They should not be allowed to play during these times. Caregivers/teachers should discuss the breastfed infant’s feeding patterns with the parents/guardians because the frequency of breastfeeding at home can vary. For example, some infants may still be feeding frequently at night, while others may do the bulk of their feeding during the day. Knowledge about the infant’s feeding patterns over twenty-four hours will help caregivers/teachers assess the infant’s feeding during his/her time with the caregiver/teacher.” American Academy of Pediatrics, American Public Health Association, National Resource Center for Health and Safety in Child Care and Early Education Caring for our children: National health and safety performance standards; Guidelines for early care and education programs. 3rd Edition. Standard : Meal and Snack Patterns. Elk Grove Village, IL: American Academy of Pediatrics; Washington, DC: American Public Health Association. Here are some additional considerations to help you when planning meals and snacks in your child care program: Offer different foods from day to day, and encourage children to choose from a variety of foods. Serve food in small portions during scheduled meals and snacks. Use smaller bowls, plates, and utensils. Do not insist that children finish all of the food on their plates, instead let them know that it is okay to only eat as much as he or she wants to eat at that time. Choose healthy snacks. This will help children get the nutrients they need as part of their daily requirements. Make smart beverage choices. Water, fat-free or low-fat milk, and small amounts of 100% fruit juices are good examples. Additional Resource For more information, visit the USDA’s MyPlate website. Health, Safety, and Nutrition PG – 56

Daily Food Plan for Preschoolers
Module 3 Daily Food Plan for Preschoolers Nutritional snacks and meals should be planned around guidelines established by the United States Department of Agriculture. Calories are a measure of the energy a food or beverage provides. USDA Sample Meal Patterns SuperTracker Nutritional snacks and meals should be planned around guidelines established by the United States Department of Agriculture. When planning a healthy diet, child care programs must also ensure they serve the proper amounts of each food group to provide the proper caloric intake. Remember, not all meals are consumed in a child care program so it is important to communicate with families about meals while in care. Calories are a measure of the energy a food or beverage provides. Calories are the fuel you need to work and play. You even need calories to rest and sleep. Foods and beverages vary in how many calories and nutrients they contain. When choosing what to eat and drink, it is important to get the right mix—enough nutrients, but not too many calories. The USDA provides guidance on daily requirements for each food group that is based on age, gender, and physical activity levels. These daily requirements need to be translated into a daily food plan that includes foods children will eat. There are many ways to divide the recommended amounts from each food group into daily meals and snacks. The USDA provides sample meal and snack patterns that can help child care providers create daily food plans that are healthy and provide the right amount of calories. Turn to the appendix and review the USDA sample meal patterns for preschoolers. Understanding the USDA Sample Meal Patterns First, determine the amount of calories required. Say your child care program provides 90 minutes of outdoor play activity each day for three 5 year old boys and four 5 year old girls that are enrolled. Starting with the boys, select the “More than 60 minutes a day” column and go down to the 5-years-of-age row. It shows that 1600 calories are needed; doing the same for the girls results in the same calories needed. The appendix shows the 1600-calorie daily requirement: Five ounces of grain Two cups of vegetables One and a half cups of the fruit food group Two and a half cups from the dairy group Five ounces of protein If you add up the portions for each food group in Pattern A and Pattern B, they are the same. Only the way they are distributed throughout the day is different. For example, Pattern A provides half a cup of fruit for breakfast, half a cup at morning snack, half a cup at lunch, and none for the afternoon snack or dinner. Pattern B provides no fruit for breakfast, half a cup at morning snack, half a cup at lunch, half a cup for afternoon snack, and none for dinner. Although the patterns provide the requirements in different ways during the day, both patterns provide the same total amount for each food group. Child care providers can create other patterns to plan meals and snacks. The key is to ensure the total amounts of each food group are provided during the day. In most cases, not all of children’s meals are provided at a child care program, so owners or directors should communicate meal and snack menus with parents to ensure children are getting the right amounts and types of foods. USDA Daily Recommendations The USDA provides daily recommendations based on a person’s age, sex, and level of physical activity. Use the MyPlate website to find a chart describing daily recommendations for each food group, as well as oils. Be sure to take note of the special consideration described below each chart. It describes allowances for individuals who are more physically active and for people who get less than 30 minutes of exercise per day. SuperTracker The USDA has created a useful tool to help keep track of a person’s daily nutritional needs. “SuperTracker can help you plan, analyze, and track your diet and physical activity. Find out what and how much to eat; track foods, physical activities, and weight; and personalize with goal setting, virtual coaching, and journaling.” You can use SuperTracker to plan healthy meals and snacks for the children in your care, as well as to ensure that they are receiving an appropriate amount of exercise to offset the calories in their diets. United States Department of Agriculture. "Choose MyPlate." Choose MyPlate. April 03, Accessed October 30, It is important to ensure children have opportunities to be physically active each day in order to be healthy. Physical activity can take place indoors or outdoors. It can be in a large group, small group, or by themselves. There are many resources available to help you plan activities for children that will encourage them to be active. For more information about the importance of physical activity and children, take the Department of Children and Families’ course Obesity Prevention and Healthy Lifestyles. Health, Safety, and Nutrition PG – 56

Key Point The amount of exercise an individual gets per day has an effect on the amount of calories recommended by the USDA. Individuals who are more physically active should be allowed a higher caloric intake, as described by the USDA’s MyPlate charts. Key Point: The amount of exercise an individual gets per day has an effect on the amount of calories recommended by the USDA. Individuals who are more physically active should be allowed a higher caloric intake, as described by the USDA’s MyPlate charts. Additional Resources What is MyPlate – MyPlate Food Groups The United States Department of Agriculture’s SuperTracker Let’s Move Trying Different Foods Maintaining variety in the foods you serve, as well as periodically introducing new foods, encourages children to experience a wide array of textures and flavors in the foods they eat. This will help children learn to maintain variety in their diets, and to prevent food aversions that may be introduced by serving the same meals and snacks on a constant rotation. You can also help children learn about different cultures by introducing them to meals and snacks planned around the theme of other cultures and people. Holidays such as St. Patrick’s Day, Thanksgiving, Cinco de Mayo, Hanukkah, and Chinese New Year are great opportunities to introduce children to traditional dishes from other cultures, as well as to teach information about the culture itself. The USDA has recommendations for introducing preschoolers to new foods that may seem unusual or different to them. “Here are some tips on how to get your preschooler to try new foods: Sometimes, new foods take time. Kids don’t always take to new foods right away. Offer new foods many times. It may take up to a dozen tries for a child to accept a new food. Small portions, big benefits. Let your kids try small portions of new foods that you enjoy. Give them a small taste at first and be patient with them. When they develop a taste for many types of foods, it’s easier to plan family meals. Be a good role model by trying new foods yourself. Describe its taste, texture, and smell. Offer only one new food at a time. Serve something that you know your child likes along with the new food. Offering too many new foods all at once could be overwhelming. Offer new foods first, at the beginning of a meal, when your child is the most hungry. Serve food plain if that is important to your preschooler. For example, instead of a macaroni casserole, try meatballs, pasta, and a vegetable. Also, to keep the different foods separate, try plates with sections. For some kids the opposite works and serving a new food mixed in with a familiar item is helpful.” United States Department of Agriculture. "Help Them Try New Foods." Help Them Try New Foods. Accessed October 30, Health, Safety, and Nutrition

Written Menus and Food Sensitivities
Module 3 Written Menus and Food Sensitivities Creating a written menu well in advance of preparing and serving meals and snacks provides several benefits for caregivers. By communicating with parents about the foods they are serving at home and the new types of foods they are introducing, caregivers can ensure that children are receiving foods they enjoy, as well as avoiding any complications from potential food allergies. Creating a written menu well in advance of preparing and serving meals and snacks provides several benefits for caregivers. It allows parents and caregivers to review the meals and snacks to make sure they are nutritionally balanced. The menu can also serve as a shopping list to make obtaining the foods easier, and helps ensure that all of the planned foods are available at the child care program. According to the American Academy of Pediatrics, “Facilities should develop, at least one month in advance, written menus showing all foods to be served during that month and should make the menus available to parents/guardians. To avoid problems of food sensitivity in very young children under eighteen months of age, caregivers/teachers should obtain from the child’s parents/guardians a list of foods that have already been introduced (without any reaction), and then serve some of these foods to the child.” American Academy of Pediatrics, American Public Health Association, National Resource Center for Health and Safety in Child Care and Early Education Caring for our children: National health and safety performance standards; Guidelines for early care and education programs. 3rd Edition. Standard Written Menus and Introduction of New Foods. Elk Grove Village, IL: American Academy of Pediatrics; Washington, DC: American Public Health Association. By communicating with parents about the foods they are serving at home and the new types of foods they are introducing, caregivers can ensure that children are receiving foods they enjoy, as well as avoiding any complications from potential food allergies. Open communication with parents also helps parents plan meals and snacks at home that complement the foods they are served while in care. Without knowing which of the MyPlate nutritional recommendations have been met for a particular day, parents may have difficulty ensuring that their child is receiving a balanced diet. Health, Safety, and Nutrition PG – 56

Food Allergies Food allergies affect 4-6% of children in the United States. A food allergy occurs when the body has a physical reaction to a specific food. Reactions to these foods can range from minor to severe. Over 90% of food allergies are associated with eight types of food. It is also important to educate all of the staff, children, and families about food allergies As part of the emergency plans, the child care program should have a plan to handle food allergies. Food Allergies Food allergies affect 4-6% of children in the United States. A food allergy occurs when the body has a physical reaction to a specific food. Reactions to these foods can range from minor to severe. Minor reactions may include tingling on the tongue, a scratchy throat, or hives. Severe reactions include anaphylaxis, which may involve an itchy rash, throat swelling, weak pulse, nausea, vomiting, and low blood pressure or can lead to death. Over 90% of food allergies are associated with eight types of food: milk, eggs, peanuts, tree nuts, fish, shellfish, soy, and wheat. Tree nuts include walnuts, almonds, cashews, pistachios, and pecans. Branum AM, Lukacs SL. Food allergy among U.S. children: trends in prevalence and hospitalizations. NCHS Data Brief. 2008;10:1-8. It is important for the child care program to be aware of any food allergies a child may have. This information should be shared with all individuals who are responsible for caring for the child, this includes the cook, child care director, and substitute teachers. When serving children food, it is important to know the ingredients and ensure the food does not contain anything the child with food allergies is allergic too. Because of the prevalence of food allergies, it is also important to educate all of the staff, children, and families about food allergies so everyone knows what to look for and how to handle any emergencies. As part of the emergency plans, the child care program should have a plan to handle food allergies, regardless of whether or not there is a child currently enrolled. While it is critical for families to share food allergy information with the child care program, there may be times when a child has not been diagnosed with a food allergy but has an allergic reaction for the first time while they are in care. Health, Safety, and Nutrition

Module 3 Key Point A written menu, especially when provided to parents well in advance, offers many benefits for children, caregivers, and parents. Key Point: A written menu, especially when provided to parents well in advance, offers many benefits for children, caregivers, and parents. Health, Safety, and Nutrition PG – 57

Module 3 Key Point Knowing the foods that children like and dislike allows you to ensure that they will enjoy a diet that is healthy and balanced while under your care. Key Point: Knowing the foods that children like and dislike allows you to ensure that they will enjoy a diet that is healthy and balanced while under your care. Health, Safety, and Nutrition PG – 57

Module 3 Key Point It is critical for child care programs to be prepared to handle food allergies. Key Point: It is critical for child care programs to be prepared to handle food allergies. Additional Resources: Food Allergy Research & Education Food Allergies in Schools Kids Health from Nemours Health, Safety, and Nutrition PG – 57

Module 3 Activity: Icky! Yummy! Think about your experiences with children and create a list of foods that they typically enjoy or dislike. Write these foods in your participant’s guide. Think about ways to introduce healthy foods to children that they may think they dislike in order to encourage healthy eating practices. Approximate time required for this activity: 5 minutes Ask the participants to name foods children hate and love. Record these on flip charts labeled “Icky!” and “MMM!” The MyPlate serves as a guideline to serving nutritious snacks and meals. The appendix of your participant’s guide contains a wealth of information on this topic. Since we won’t be able to cover all of it today, you are encouraged to read this information on your own. Health, Safety, and Nutrition PG – 57

Activity: Menu Evaluation
Module 3 Activity: Menu Evaluation Using the information you just learned about meal planning, you will be asked to evaluate a menu for a typical child. Approximate time required for this activity: 5 minutes Ask participants to review a weekly meal plan that was recently used at a child care program. Provide them one used at your own program, or make one up in advance. Have them discuss the strengths and the weaknesses of the menu according to the Menu Evaluation Chart. Give one full menu for evaluation and a blank menu they could then create. Alternative Activity: Menu Planning. Divide the participants into 4 groups. Direct the groups to work together to prepare a day-long menu using guidelines established in class. Each group should be assigned a different age group. When they finish, have each group share their menus for each meal and snack time. Have the class select the best one from each, and record the best meals and snacks on flip chart pages labeled with the time the food is consumed. When you’re finished, the class will have created one day of great meals and snacks. Using the information you just learned about meal planning, you will be asked to evaluate a menu for a typical child. Take a moment to review the MyPlate information in the appendix of your participant’s guide to assist in your evaluation. Health, Safety, and Nutrition PG – 57-58

The Roles of the Adults and Children at Mealtime
Module 3 The Roles of the Adults and Children at Mealtime It is the adults’ responsibility to make certain that mealtimes are enjoyable, stress-free occasions, during which children can learn and practice important social skills. Based on your own experience, can you think of any other equipment that is used for children with special needs at mealtime? Children also have the opportunity to learn important responsibilities at mealtimes. Approximate time required for this lesson: 10 minutes Adults do much more at mealtimes and snack times than simply planning, preparing, and serving food. It is the adults’ responsibility to make certain that mealtimes are enjoyable, stress-free occasions, during which children can learn and practice important social skills. During mealtime adults are responsible for: Planning, preparing, and serving nutritious foods at appropriate times Helping children serve themselves Allowing children to decide how much they will eat at any given meal, and providing them with information that will help them make good choices Making conversation with the children to allow them to develop social and language skills Modeling proper eating behaviors and table manners Teaching the children about specific foods by pointing out color, size, shape, texture, temperature, flavor (sweet, salty, sour), numbers, and food-related words Teaching the children about food groups and which foods belong in each group Teaching the children about the importance of foods as they relate to specific cultures Helping children with special needs manage mealtimes, with the understanding that they might need foods and equipment other children do not need Based on your own experience, what kinds of equipment might children with special needs use? (Examples may include: 2-handled cup; sippy cups for older children; feeding tube; wrap-around spoon; non-slip plate; chair with tray.) Children also have the opportunity to learn important responsibilities at mealtimes. Children should be encouraged to: Understand what they are eating and how much they are eating Observe what an appropriate portion size looks like Have a sense of when they are full and when to stop eating Join the social interactions and conversations at the table Learn table manners, eating behaviors, and healthy eating habits Show respect for others during mealtime and snack time Learn about foods and the ways they relate to culture Learn about nutrition and its importance For more information about the importance of mealtime interactions, take the Department of Children and Families’ course Understanding Developmentally Appropriate Practices and Obesity Prevention and Healthy Lifestyles. Health, Safety, and Nutrition PG – 59

Module 3 Key Point Remember, since tooth brushing has the potential to expose caregivers to bodily fluids, Universal Precautions should be used during tooth brushing activities. The end of a meal provides an opportunity to reinforce proper dental hygiene by reminding children about tooth brushing. Talk to children about tooth brushing as a way to prevent tooth decay and other problems with the mouth, teeth, and gums. Discuss the importance of tooth brushing and dental hygiene as parts of a healthy lifestyle. According to the American Academy of Pediatrics, “All children with teeth should brush or have their teeth brushed at least once during the hours the child is in care.” There is an exemption noted for children who brush frequently at home, “Children whose teeth are brushed at home twice a day may be exempted since additional brushing has little additive benefit and may expose a child to excess fluoride toothpaste.” You may also seek the assistance of a local dental health professional. The AAP recommends, “Local dental health professionals can facilitate compliance with these activities by offering education and training for the child care staff and providing oral health presentations for the children and parents/guardians.” Consider contacting a dentist, doctor, hospital, or other local health resource in your area to request their help in educating children about the importance of maintaining proper oral hygiene. American Academy of Pediatrics, American Public Health Association, National Resource Center for Health and Safety in Child Care and Early Education Caring for our children: National health and safety performance standards; Guidelines for early care and education programs. 3rd Edition. Standard : Routine Oral Hygiene. Elk Grove Village, IL: American Academy of Pediatrics; Washington, DC: American Public Health Association. Health, Safety, and Nutrition PG – 60

Module 3 Key Point Remind children not to swallow toothpaste. Call the Florida Poison Control Center immediately if they swallow an excessive amount. When tooth brushing is practiced with children in a child care program, there must be care taken to ensure that children do not improperly ingest any toothpaste or choke on their toothbrush. Caregivers must also ensure that children do not come into contact with the bodily fluids of others, and that their toothbrushes and toothpaste remain separate from others, in a sanitary fashion. The American Academy of Pediatrics provides the following guidelines, “In facilities where tooth brushing is an activity, each child should have a personally labeled, age-appropriate toothbrush. No sharing or borrowing should be allowed. After use, toothbrushes should be stored on a clean surface with the bristle end of the toothbrush up to air dry in such a way that the toothbrushes cannot contact or drop on each other and the bristles are not in contact with any surface.” Regarding the appropriate use and storage of toothpaste, “If toothpaste is used, each child should have his/her own labeled toothpaste tube. If toothpaste from a single tube is shared among the children, it should be dispensed onto a clean piece of paper or paper cup for each child rather than directly on the toothbrush. A pea-sized amount should be used for each brushing. Toothpaste should be stored out of children’s reach. ” American Academy of Pediatrics, American Public Health Association, National Resource Center for Health and Safety in Child Care and Early Education Caring for our children: National health and safety performance standards; Guidelines for early care and education programs. 3rd Edition. Standard : Toothbrushes and Toothpaste. Elk Grove Village, IL: American Academy of Pediatrics; Washington, DC: American Public Health Association. Key Point: Remind children not to swallow toothpaste. Call the Florida Poison Control Center immediately if they swallow an excessive amount. Health, Safety, and Nutrition PG – 60

Module 3 Inappropriate Foods There are some foods that are inappropriate for children due to their size, shape, and/or texture. Have you ever seen a situation when a parent put a dangerous food in a child’s lunch? How did you handle the situation? Approximate time required for this lesson: 10 minutes There are foods that are inappropriate for children due to their size, shape, texture and nutritional value. Foods that are very firm, smooth, or slippery may slide down a child’s throat before they are chewed. Some examples of these foods are hot dogs, hard candy, peanuts, and grapes. Small, dry, hard foods are difficult to chew properly, which may cause the child to swallow them whole. These include popcorn, corn chips, nuts, seeds, and small pieces of raw carrot. Sticky foods may be hard to remove from an airway. Some examples are peanut butter, raisins, and dried fruit. Tough foods do not break apart easily. Some examples are meat and hard candy. Have you ever seen a parent put a dangerous food in a child’s lunch? What did you do? (If there is no answer, ask them how they’d react to that situation if it happened. Answers may include: remove the food from the child’s presence; tell the parent why this food is inappropriate.) What are the dangers of feeding a child, or letting a child eat, inappropriate food? (Choking.) One of the biggest dangers of foods—even appropriate ones—is choking. Let’s discuss some of the ways to avoid choking, and steps to take to help a choking child. Health, Safety, and Nutrition PG – 61

Module 3 Key Point When helping a choking child, it is as important to know what not to do as it is to know what to do. Approximate time required for this lesson: 5 minutes Choking is when food is inhaled directly into the airway. This occurs most often in infants and young children because the airway is not always blocked off properly when swallowing. This allows food to enter the airway and prevent breathing. The American Academy of Pediatrics states, “Children in mid-infancy who are learning to feed themselves should be supervised by an adult seated within arm’s reach of them at all times while they are being fed. Children over twelve months of age who can feed themselves should be supervised by an adult who is seated at the same table or within arm’s reach of the child’s highchair or feeding table.” There are several critical things to be alert for while supervising children during mealtime and snack time. “Squirreling” is when a child shoves several pieces of food in their mouth at a time, which can increase the chance of choking. It is important to be close to children who are eating and to be alert until all children are finished, because a choking child will often not make any noise and may be unable to call for help. Paying close attention to children who are eating also provides an opportunity to deter bad eating habits that can lead to choking. American Academy of Pediatrics, American Public Health Association, National Resource Center for Health and Safety in Child Care and Early Education Caring for our children: National health and safety performance standards; Guidelines for early care and education programs. 3rd Edition. Standard : Adult Supervision of Children Who Are Learning to Feed Themselves. Elk Grove Village, IL: American Academy of Pediatrics; Washington, DC: American Public Health Association. If a child is choking on a food or an object, watch them closely. Allow them to cough, as they may dislodge the object themselves. If a child is turning blue, is unable to speak or cry, or is losing consciousness, call out: “Help! Call 9-1-1!” If you are certified to do so, perform the Heimlich Maneuver. If you are not certified, keep calling loudly for someone to help you. If the object does not dislodge, wait for medical help to arrive. Continue the Heimlich Maneuver. Never leave a choking child alone, or permit them to leave you. What not to do when a child is choking: Do not hit the child on their back, unless it is part of the first aid you are administering. Do not attempt first aid unless you are trained to perform it. Do not perform the Heimlich Maneuver, unless you are trained to do it. Do not finger-sweep the child’s mouth—you could push the object further inside his/her mouth. Do not shake the child, or try to put the child’s head between their knees. Do not panic in front of the child. Key Point: When helping a choking child, it is as important to know what not to do as it is to know what to do. Health, Safety, and Nutrition PG – 62

Module 3 Choking Prevention Make sure children eat slowly. Provide a calm, relaxed eating environment. Encourage them to sit quietly in their places. Remind them to chew food well before swallowing and to eat small bites. Teach them not to talk with their mouth full, because they could inhale it into their “airway” that way. The biggest potential danger from food is choking. Choking is when food becomes lodged in the throat and prevents the passage of air into the lungs, causing suffocation. Using prevention techniques is the best method to use to avoid choking and prevent unnecessary injury in a child care program. There are several ways to prevent choking: Monitor and supervise mealtimes and snack times. Make sure children eat slowly Provide a calm, relaxed eating environment Encourage children to sit quietly in their places Remind them to chew food well before swallowing and to eat small bites Teach children not to talk with their mouths full, because they could inhale food into their “airways” Health, Safety, and Nutrition PG – 63

Module 3 Choking Prevention Grind up tough foods. Cut food into small pieces or thin strips. Cut round foods, such as hot dogs, into strips rather than slice them into round pieces. Remove all bones from fish, chicken, and meat. Cook food until it is soft. Take out seeds and pits from fruits. Prepare foods so they are easy to swallow. Grind up tough foods Cut food into small pieces or thin strips Cut round foods, such as hot dogs, into strips, rather than slicing them into round pieces Remove all bones from fish, chicken, and meat Cook food until it is soft Remove seeds and pits from fruits Health, Safety, and Nutrition PG – 63

Key Point Never serve foods that could potentially pose a choking hazard. Key Point: Never serve foods that could potentially pose a choking hazard. Additional Resources In addition to the Department of Children and Families’ website, there are many other websites that provide valuable information about health, safety, and nutrition. Explore each resource to find useful information to contribute to your professional development, and information that you can share with others to promote children’s health and safety. MyPlate Federal Food/Nutrition Programs Florida Health Child Care Program National Resource Center for Health and Safety in Child Care and Early Education Health, Safety, and Nutrition

Module 3 Conclusion You have achieved this module’s learning objectives if you can: Identify the nutritional needs of all children Describe how to plan nutritious meals and snacks Explain the proper role of the caregiver during mealtimes Identify foods that are potentially dangerous for young children Describe procedures for helping a choking child Module 3 Summary Here is a summary of key points for Module 3: Children and Nutrition. Each age group has specific nutritional needs that must be met in order to supply essential resources their bodies must have to grow and develop. A very important feeding practice is to always hold and interact with infants while you feed them—you should NEVER prop a bottle. When the right foods are introduced at the right time, nutritional needs are met and skills develop properly. The amount of exercise an individual gets per day has an effect on the amount of calories recommended by the USDA. Individuals who are more physically active should be allowed a higher caloric intake, as described by the USDA’s MyPlate charts. A written menu, especially when provided to parents well in advance, offers many benefits for children, caregivers, and parents. Knowing the foods that children like and dislike allows you to ensure that they will enjoy a diet that is healthy and balanced while under your care. Remember, since tooth brushing has the potential to expose caregivers to bodily fluids, Universal Precautions should be used during tooth brushing activities. Remind children not to swallow toothpaste. Call the Florida Poison Control Center immediately if they swallow an excessive amount. When helping a choking child, it is as important to know what not to do as it is to know what to do. Never serve foods that could potentially pose a choking hazard. Conclusion Congratulations! You have completed Module 3: Children and Nutrition. You have achieved this module’s learning objectives if you can: Identify the nutritional needs of all children Describe how to plan nutritious meals and snacks Explain the proper role of the caregiver during mealtimes Identify foods that are potentially dangerous for young children Describe procedures for helping a choking child Health, Safety, and Nutrition PG – 64

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