1. Infant and Toddler Care: Improving Quality Through Health and Safety Practices
Danette Swanson Glassy, MD, FAAP
CA Head Start Association
2015 Health Institute
Los Angeles, CA
April 29, 2015

2. Danette Swanson Glassy, MD, FAAP
Mercer Island Pediatrics
Advisory Committee, Head Start National Center on Health
Co-Editor, Caring For Our Children, National Health and Safety Performance Standards; Guidelines for Early Care and Education Programs, 3rd Edition

3. Agenda National Center on Health
Best-Practice/Standards/Regulations Oh My!
Infant/Toddler Care-a few highlights
Medical Home
Infection Control
Immunizations: children and adults
Safe Sleep
Developmental Screening
Feeding solids (anemia/allergy issues)
Nutrition/Physical Activity
Others?
Resources
Measure Your Quality

4. What is Health?
“Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” 
World Health Organization, 1948
The World Health Organization (WHO) adopted this definition of “health” in 1946 and has been used officially by all associated groups since WHO is the directing and coordinating authority for health within the United Nations system. It is responsible for providing leadership on global health matters, shaping the health research agenda, setting norms and standards, articulating evidence-based policy options, providing technical support to countries and monitoring and assessing health trends.
Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, June, 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April 1948.
The Definition has not been amended since 1948.

5. Office of Head Start National Centers
NCPMFO
Program Management and Fiscal Operations
NCQTL
Quality Teaching and Learning
NCPFCE
Parent, Family, and Community Engagement
NCCLR
Cultural and Linguistic Responsiveness
EHSNRC
Early Head Start
NCH
Health

6. Head Start National Center on Health
Our Goal:
Fostering a culture of health and wellness for children, families, staff, and communities
Our Foundation:
School readiness begins with health!

7. Sound Management Systems Staff, Parent, and Community Engagement
Culturally & Linguistically Appropriate
Positively Associated with Improvement in Learning
Applicable to Home Visits & Child Care Settings
Safety & Injury Prevention
Oral Health
Mental Health
Nutrition & Physical Activity
Health
Literacy
The NCH supports Head Start programs in a variety of health areas, including safety & injury prevention, oral health, mental health, and nutrition and physical activity. Health literacy is at the core of these issues, because the more we know about our health and our children’s health, the more we (staff, families, and children) can use preventive and appropriate strategies. We also incorporate the essential areas seen in the outer ring on this display:
sound management systems to support health services and children’s safety
Staff, parent, and community engagement,
Cultural and linguistic responsiveness and appropriate approaches
Understanding the link between a child’s health and his or her ability to learn
And assuring our information is relevant to home visiting programs and center-based care, both in HS/EHS and child care programs.

8. National Center on Health Partners
American Academy of Pediatrics
Education Development Center, Inc.
Center for Child and Human Development at Georgetown University
National Maternal and Child Oral Health Resource Center at Georgetown University
UCLA Health Care Institute at the UCLA Anderson School of Management
AAP holds the cooperative agreement w/ OHS. AAP is the lead organization for the NCH and we work with the following partners…
Working as a team, as one National Center on Health
Each partner brings an area of expertise to the effort:
EDC – the lead on Safety and Injury prevention
Center for Child and Human Development at GT- lead on mental health
National Maternal and Child OHRC at GT- (in partnership with you all at ASTDD) - lead on oral health
UCLA – lead on health literacy
University of North Carolina at Chapel Hill – lead on health consultation
AAP – lead on Healthy Active Living and Asthma/Tobacco Exposure

9. NCH Resources Newsletters Online courses Webinars Fact sheets
Newsletters
Online courses
Webinars
Fact sheets
T/TA tools

10. OHS Priority Health Issues
Healthy active living
Mental health
Safety and injury prevention
Health literacy
Oral health and dental homes
Asthma prevention with special emphasis on tobacco exposure prevention
I mentioned these 6 priority areas earlier…
One of the first products we’ve produced is a series of Fact Sheets on these 6 priorities (one targeting staff, the other set targeting families). The Fact Sheets provide basic info these topics… (a “10 Things you Need to Know” format). One packet was just sent to each of the 1600 Health Managers across the country, as a way to introduce the Center to them and provide info.
The fact sheets will soon be available on ECLKC (early childhood Learning and Knowledge Center)

11. Emerging Issues Emergency preparedness and response
Connecting children with medical and dental homes
Health manager networks
Health and home visiting
Toxic stress and trauma in early childhood
Orientation for new health managers
Staff wellness
After the initial directives from OHS to address the 6 priority areas – there are other areas/topics that the NCH is addressing.
These came about as a result of the listening sessions, more collaboration with the other national centers, and networking with national partners/organizations….

12. Who’s Here Today? Health Managers? Family Services Managers?
Other Area Managers?
Classroom Staff, Home Visiting Staff, or Family Child Care Providers?
Parents or Family Members?
Directors or Administrators?
Governing Boards/Tribal Council/Policy Council?
Community Partners?
TA Staff?
Federal Staff?
Other?
From California or Other States?
Use this opportunity in the beginning of the session to gauge the experience level of the audience and the relevance of your material and examples to their work.

13. Quality Evidence-based, expert informed *
Head Start Program Performance Standards
Accreditation Requirements
State Child Care Regulations
Evaluator Interpretation

14. Medical Home Overall better health with true Medical Home accessible,
continuous,
comprehensive,
family-centered,
coordinated,
compassionate, and
culturally effective

15. Medical Home Access-Use local outreach advocates: Communication
Covered California Outreach and Education Grant Partners
Promote
Communication
Call, really, I mean it!

16. Infection Control Infants and Toddlers more vulnerable
Infants with fever hospitalized if under 2-3 months
With flu hospitalized at the same rate as senior citizens
Diarrheal illness significantly reduced with proper hand hygiene, sanitizing/disinfecting

17. Infection Control Cleaning, Sanitizing, Disinfecting Written policy
Which-for-What: CFOC Appendices J and K
Alameda County Green Child Care:
Coalition for Safety and Health in Early Learning:

18. Infection Control
Hand Hygiene

19. Infection Control Diapering
Use posters:
Policy for parents using the diapering area
Hand washing nowhere near food and bottle prep sink/area

20. Infection Control Inclusion/Exclusion
Written policy shared with parents-Plan B
Help from health professional-
Child Care Health Consultant
Health Services Advisory Member (Weaving Connections)
Specific child’s Health Care Provider (call, really)

21. Immunizations Timing critical for Infants and Toddlers Trusted Advisor
Parent Friendly resources
Staff Immunizations a must
Parent Immunizations

22. Immunizations Resources
CA DOH:
AAP:
Measles Simulation:

23. Developmental Screening
Critical Elements-
Evidenced based tool
Easy to understand and use
Practice communicating results
Know how to refer
Always share results with health care provider

24. Developmental Screening
EHS tip sheet No. 6
Learn the Signs, Act Early
Home page-
Free online training for Early Education and Child Care Providers-

25. Safe Sleep
More than SIDS, think SUIDS—Sudden Unexplained Infant Deaths
Positioning AND Environment-cribs, blankets, temperature, cords, bumpers
Resources and Free online training-

26. Safe Sleep http://www.healthychildcare.org/sids.html
A Parents' Guide to Safe Sleep ( Also available in Spanish) This brochure includes information for parents about infant sleep positioning and practices as well as describes how parents can work with child care providers to ensure that safe sleep practices are used in all child care settings as well as at home. (Updated April 2012)
A Child Care Provider's Guide to Safe Sleep (Also available in Spanish) This easy-to-read brochure provides child care providers with information about ways to promote safe sleep practices and reduce the risk of SIDS. (Updated April 2012)
Tummy Time This brochure provides information about the importance of supervised tummy time and how it promotes healthy development. (Revised 2011)
It’s important to think about guidance for FCC homes. What are their sleep arrangements? Do they use cribs or playpens? Do they have access to the ground floor of a building in case of evacuation?
For infants and toddlers, it’s important to plan to allow children to sleep on demand, not necessarily at a defined “nap time.” How will you plan for that?

27. Safe Sleep Online learning module: www.healthychildcare.org/sids
More information about the new play yard standards. Links to keeping babies safe in their sleeping environments is at the Crib Information Center on CPSC’s website.
Online learning module:
Safe Sleep Practices and SIDS/Suffocation Risk Reduction This spinoff includes safe sleep practice standards from Caring for Our Children, 3rd Edition.

28. Feeding Solids “Cue feed”, just like feeding bottles
New recommendations:
Promote iron-rich foods early on
Introduce allergy-prone foods before 12 months

29. Nutrition/Physical Activity
Remember NCH website:

30. Little Voices for Healthy Choices
Little Voices for Healthy Choices provides additional resources on nutrition and physical activity specific to infants and toddlers.
Click the image to link to the page on ECLKC

31. Nutrition/Physical Activity
Containers 
Resources to keep infants and toddlers moving:
Motion Moments-
Bright Futures-

32. Others

33. Resources
Caring For Our Children: National Health and Safety Performance Standards; Guidelines for Early Care and Education, 3rd Edition
Available in print or online

34. Resources CFOC Spinoffs:
Caring for Infants and Toddlers in Early Care and Education
Stepping Stones*
Preventing Childhood Obesity in ECE Programs*
Safe Sleep Practices and SIDS/Suffocation Risk Reduction
Oral Health in Child Care and Early Education
Environmental Health in ECE
Coming Soon: Caring for Children with Special Health Care Needs in ECE

35. Resources Healthy Child Care America www.healthychildcare.org AAP
Information, resources, trainings
Sign up for newsletter

36. Resources
National Resource Center for Health and Safety in Child Care and Early Education
Houses CFOC and Spin Offs
Search state child care regulations
Child Care Health and Policy information
Sign up for E-Resources Newsletters

37. Resources
AAP books
Managing Infectious Diseases in Child Care and Schools, 3rd Edition
Easy to use guide with specific diseases and conditions
Easy to copy information about inclusion and exclusion

38. Resources
AAP Books
Managing Chronic Health Conditions in Child Care and Schools
Easy to use format, specific conditions addressed, easy to reproduce forms and handouts

39. Resources AAP Books Model Child Care Health Policies, 5th edition
Also available online at

40. Resources
AAP Books
PedFACTs-Pediatric First Aid for Caregivers and Teachers, 2nd edition
Manual and a training program

41. Resources Health Consultation Websites
California Child Care Health:
Disinfecting/Sanitizing Worksheets
Integrated Pest Management Toolkit
Health and Safety Checklist

42. Resources Health Consultation Websites
Early Childhood Education Linkage System
Professional Development, Training, Tools
Public Health Seattle King County Child Care Health Program
Trainings, Tools, Model Policy recently updated

43. Measure Your Quality Head Start Health and Safety Checklist
Stepping Stones to Caring for Our Children, 3rd Edition Compliance/Comparison Checklist
CCCH Health and Safety Checklist

44. National Center on Health Contact Information
Toll-free:
Website: system/health/center