1. Safe Return of Children to Daycares Impacted by Flooding, Storms or Hurricanes Maida P. Galvez, MD, MPH, FAAP Region 2 PEHSU Director AAP District 2 Chapter 3 Vice President Associate Professor, Dept of Preventive Medicine Mount Sinai School of Medicine, New York

2. Children are uniquely vulnerable to environmental hazards. Children breathe and eat more per pound of body weight than adults. Common hand to mouth behaviors places them in contact with materials. Children are rapidly growing and these unique windows of development may make them more vulnerable to exposures.

3. Children’s Health Concerns Exposure to the water and the flooded environment put children at risk for: – drowning, injuries from debris, chemical contamination, and hypothermia. – infectious diseases, stress, mental health issues, poor access to care and medications, and poor nutrition.

4. Major Concerns after Superstorm Sandy: Injuries can occur during the flood or with return to an unstable building. Electrical hazards from water close to electrical lines, circuits, or equipment. Hypothermia from flood waters or due to power outage. Breathing problems due to dust, debris, outdoor exhaust or mold. Carbon monoxide poisoning due to unventilated gas powered electrical generators, pressure washers, cooking tanks, and house fires. Mental health problems are common after disasters, especially in children.

5. Ensure the safety of daycares BEFORE children’s return. Daycares should have access to: Safe drinking water supply Functioning wastewater treatment sites Electrical Power Communications system Medical care Safe travel routes

6. Ensure the safety of daycares BEFORE children’s return. Daycares are cleaned before return: Solid waste and debris has been removed Replacement or remediation of flood damaged building materials Proper cleaning and maintenance of building and supplies – http://www.nyc.gov/html/doh/downloads/pdf/dc/sandy- reopening-guideline.pdf http://www.nyc.gov/html/doh/downloads/pdf/dc/sandy- reopening-guideline.pdf

7. General Precautions Be aware of the potential for air quality issues due to temporary measures typically found in areas impacted by flooding/storms – generators and construction vehicles Ensure carbon monoxide detectors and smoke alarms are functional. Use caution in selecting materials brought in for cleaning.

8. Safe Play Spaces Parks, playgrounds, yards where children play should be clear of debris and free from environmental hazards to children – Safety matting, sandboxes, play materials Routes to and from living, learning, and playing places have been cleaned and made free of safety and environmental hazards. Areas not-cleaned or with ongoing environmental issues (e.g., air quality issues) should be closed to children.

9. KEY TAKE HOME MESSAGE Children and, whenever possible, teens should not be involved in cleanup efforts and only return after the area is cleaned. In short, children should be the last group to return to areas impacted by flooding and/or hurricanes.

10. Resources Fact Sheets – http://www.nyc.gov/html/doh/downloads/pdf/dc/sandy- reopening-guideline.pdf http://www.nyc.gov/html/doh/downloads/pdf/dc/sandy- reopening-guideline.pdf – http://www.mssm.edu/static_files/MSSM/Files/Research/Progr ams/Pediatric%20Environmental%20Health%20Specialty%20Uni t/Preparedness%20and%20Recovery%20Recommendations_11 2812_Final.pdf http://www.mssm.edu/static_files/MSSM/Files/Research/Progr ams/Pediatric%20Environmental%20Health%20Specialty%20Uni t/Preparedness%20and%20Recovery%20Recommendations_11 2812_Final.pdf To speak with an Environmental Pediatrician: – Nationwide: http://aoec.org/PEHSU/searchbystate.html – In NY, NJ, Puerto Rico or USVI: http://www.mssm.edu/research/programs/pediatric-environmental- health-specialty-unit http://www.mssm.edu/research/programs/pediatric-environmental- health-specialty-unit

11. Acknowledgements National PEHSU Network NYSDOH Bureau of Toxic Substance Assessment US EPA Region 2 Office Health and Human Services Office of Childcare American Academy of Pediatrics – District 2 Chapters 2 & 3

12. This material was supported by Association of Occupational and Environmental Clinics and funded under cooperative agreement award 1U61TS000118-03 from the Agency for Toxic Substances and Disease Registry (ATSDR). The US Environmental Protection Agency (EPA) supports the PEHSU by providing funds to ATSDR under Inter-Agency Agreement number DW-75-92301301-0. Neither EPA nor ATSDR endorse the purchase of commercial products/services mentioned.