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

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

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

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

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

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

7. 10A NCAC 09 .0903 REQUIREMENTS FOR CHILDREN AGED 24 MONTHS AND OLDER
Meals and snacks shall be planned according to the number of hours a child is in the center. These rules apply in all situations except during sleeping hours and nighttime care:
(1) For preschool-aged children in the center at least two hours but less than four hours, and for all school-aged children, one snack shall be provided unless the child is present during the time the center is serving a meal, in which case, a meal shall be provided.
(2) For children in the center at least four hours, but less than six hours, one meal shall be provided equal to at least one-third of the child's daily food needs.

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

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

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

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

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

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

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

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

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

17. 10A NCAC 09 .0902 GENERAL NUTRITION REQUIREMENTS FOR INFANTS
The parent or health care provider of each child under 15 months of age shall provide the center an individual written feeding schedule for the child. This schedule must be followed at the center. This schedule must include the child's name, be signed by the parent or health care provider, and be dated when received by the center. Each infant's schedule shall be modified in consultation, with the child's parent and/or health care provider, to reflect changes in the child's needs as he or she develops. The feeding instructions for each infant shall be posted for quick reference by the caregivers, except in centers licensed for three to 12 children located in a residence.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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