Health and Safety of Staff and Children 2011 Margaret Poppe RN, MSN

Health and Safety of Staff and Children

2011

Margaret Poppe RN, MSN

Child Care Worker’s Health

Working in Child Care settings can be associated with:

• Increased exposure to infectious Diseases • Muscle and Skeletal Injuries • Falls • Environmental Hazard Exposure • Stress

Developmental Injury Risks for Children

Preventing Injuries in Child Care Settings

What types of injuries:• Minor (cuts, scrapes, bruises)• Severe( head injuries and broken bones, internal injuries,

dental injuries) How:

– Falls– Collisions– Drowning

Why:• Physical ability• Hazards• Lack of supervision

04/11/23The National Training Institute for

Child Care Health Consultants5

Site Specific Safety Assessment Checklist

• Every child care facility should have daily and monthly safety checklists in place that are specific to their own facilities and environments.

• Create injury prevention and response policies and assure that all staff are aware.

Adapted from :

04/11/23The National Training Institute for


Supervision• Be alert and attentive• Be aware of age-appropriate equipment• Evaluate and inspect hazards• Know and apply safe playground rules • Teach children correct use of equipment• Be consistent with adult-child ratio• Intervene for inappropriate behavior• Ensure safe clothing for children • Assign staff to a “zone” and rotateAdapted from :

What is Sudden Infant Death Syndrome (SIDS)?

• SIDS is the unexpected death of seemingly healthy babies 12 months or younger.

• No cause of death is determined by – Death scene investigation and autopsy.– Review of baby’s medical history.

• Experts cannot predict which babies will die from SIDS.

Reducing the Risk of SIDS in Child Care Speaker's Kit http://www.healthychildcare.org/sids.htmlWillinger M, James LS, Catz C. Defining the sudden infant death syndrome (SIDS):

deliberations of an expert panel convened by the National Institute of Child Health and Human Development. Pediatr Pathol. 1991;11:677–684

Revised – 12/08

Triple Risk Model

SIDS

Critical development period

External stressors

Vulnerable infant

Revised – 12/08

Reducing the Risk of SIDS in Child Care Speaker's Kit http://www.healthychildcare.org/sids.html

Rebreathing Theory

• Infants in certain sleep environments are more likely to trap exhaled CO2 around the face– Lie prone and near-face-down/face-down– Soft bedding– Tobacco smoke exposure

• Infants rebreathe exhaled CO2 : CO2 ↑ & O2 ↓

• Infants die if they cannot arouse/ respond appropriatelySIDS and Sleep-related Deaths: Current Statistics, Accomplishments & ChallengesFern R. Hauck, MD, MS, Department of Family Medicine ,University of Virginia

Reasons that people place babies on their tummies

• They think that babies are more likely to choke or aspirate if they vomit or spit up

• They are worried that babies won’t sleep as well

• Parental requests


Revised – 12/08

Anatomy when sleeping on stomach

Revised - 0408


Anatomy when supine

Revised – 12/08


Tummy to Play and Back to Sleep

• Supervised tummy time when babies are awake– Promotes healthy physical and brain development– Strengthens neck, arm, and shoulder muscles– Decreases risk of head flattening and balding– Encourages bonding and play between the supervising

adult and the baby• Back to sleep

– Reduces the risk of SIDS– Comfortable and safe

Revised – 12/08

Tummy Time

• Tummy time is for babies who are awake and being observed.

• It is needed to develop strong muscles.

• Have tummy time 2 to 3 times a day and increase the amount of tummy time per day as the baby gets stronger.

• There are lots of ways for babies to enjoy tummy time!

Revised – 12/08


Safe Sleep Practices

• Always put healthy babies to sleep on their backs for naps and at bedtime.

Revised – 12/08


Safe Sleep Practices

• Avoid overheating.– Do not overdress baby.– Never cover baby’s head with a blanket.– Room temperature should be comfortable for a

lightly clothed adult.

Revised – 12/08


Safe Sleep Practices• Pacifiers may be offered to babies to reduce

the risk of SIDS– If breastfed, wait until breastfeeding is well

established (approximately 3 - 4 weeks of age), before offering a pacifier.

– If the baby refuses the pacifier, don’t force it.– If the pacifier falls out while the baby is asleep,

you do not have to re-insert it.

Revised – 12/08


Safe Sleep Environment

• Safe crib, firm mattress.• Avoid chairs, sofas, air mattresses, water

beds, and adult beds.

Revised – 12/08


19

Emergencies in Child Care Facilities

• General emergencies• Missing children• Disgruntled or impaired parents/guardians or their authorized

representatives• Medical emergencies• Natural disasters, including hurricanes, tornados, and severe

storms• Fire/smoke emergencies• Bioterrorism/war emergencies (such as bomb threats)• Nuclear or radiation emergencies• Utility disruption• Hazardous materials• Chemical leaks

The National Training Institute for Child Care Health Consultants, 2009

20

Grab and Go Kit• List of emergency phone numbers, including parent contact

information • A charged cell phone or calling card or “walkie talkies”• Water • Non-perishable food, manual can opener• First aid kit• Blankets• Radio, flashlights, extra batteries• Handwashing solution that does not require running water• Extra clothing/shoes• Diapers, baby food and formula• Prescription medicines for children and staff• Other items as needed for safety and comfort• Child records and attendance sheets

The National Training Institute for Child Care Health Consultants, 2009

Musculoskeletal Injuries and Falls

Risk Factors• Heavy lifting and

carrying• Sitting on the floor or

in child sized chairs with little back support

• Kneeling and squatting

• Reaching

Use “Good Body Mechanics”to Prevent Injury

• Use adult size furniture• When rising from child size furniture ( use squat

position, back straight, pelvis level, thighs tight • Set up storage so you can reach from normal

standing• To get to child level squat or kneel keep spine

straight

Lifting Children

• Feet apart , one foot along side of child one slightly back.

• Squat, bend at knees . Tighten stomach keep back straight

• Use leg strength • Avoid twisting • Putting child down same process, back

straight

Other Ways to Prevent Injury

• Wear supportive non skid footwear

• Regular exercise & stretching

• Maintain proper body weight

• Floor sitting use the wall for support

• Use or request carts for moving heavy objects

OSHA Hazard Communication Standard 1910.1200

Requires that all employees be informed of the identities and hazards of the chemicals they are exposed to when working

• Warning labels should be visible on containers • Products including sanitizing agents should have

an MSDS (Material Safety Data Sheets)• Training on proper handling, storage, usage

should be provided for staff

Environmental Safety for Staff and Children

• Avoid use of high solvent cleaners especially carpets • Store cleaning products in their original containers • Pest management should choose the lowest number

Health Hazard Rating(0-4)

• Only certified professionals should be employed for pest management or mold or mildew treatment

Environmental Safety

• Art Materials : ASTM-D-4236 or ACMI• Staff should avoid personal use of adult art

supplies such as rubber cement and aerosols or turpentine based materials

Infectious Disease Concerns ?

Why do Young Children Spread Illnesses so Easily ?

• Immature immune system & frequent illness

• Children need a lot of intimate hands on care

• Hand to mouth activity • Children are in close contact• Great number of unrelated

children• Age group mixing• Children and staff bring mild

illness to school

Chain of Infection

Source of Germs Route of

Transmission Host

Attack the source of infection or the “first link” by identification, treatment and, if necessary, isolation of the sick person

Attack the route of transmission or the “second link” by personal and general hygiene: Handwashing

Protect the vulnerable person or the “third link” through immunization, balanced nutrition, and healthy practices.

California Child Care Health Project

Modes of Transmission

• Droplets• Fecal Oral Route• Skin• Blood or Body Fluids

Droplets

Stool or Fecal/Oral transmission

Skin Contact

Blood or Other Body Fluids

Group Activity

Break the Chain by Enforcing Exclusion Guidelines

• http://www.healthychildcare.org/PDF/InfDiseases/Videos/Module3Video2.wmv

Break the Chain by Enforcing Exclusion Guidelines Key Points

• The ill child is unable to take part comfortably in regular activities

• The ill child needs care that significantly interferes with provider’s ability to provide appropriate care for other children

• The child has signs or symptoms of a possible serious condition

• Signs or symptoms that indicate a contagious illness or condition or has a diagnosed contagious illness

Caring for Our Children http://nrckids.org/SPINOFF/IE/IncExc.pdf

Exclusion Cont.

• Diarrhea that can’t be explained by diet change, is watery , and can’t be contained in the diaper or managed by regular toileting

• 2 or more episodes of vomiting in 24 hours• Others See VT licensing regulations

VT Exclusion Guidelines

• Axillary (armpit) temperature of 100°F or greater and behavior change

• Rectal (anus) temperature of 102°F or greater and behavior change

• Under 2 months old with temperature 100.4°F or higher rectal contact parent or EMS if not reachable

http://dcf.vermont.gov/sites/dcf/files/pdf/cdd/care/ECP_Appendix_B.pdf

Break the Chain : Morning Health Check and Exclusion

Break the Chain : Immunizations

Concept of Herd Immunity

If enough of the “herd “ is immunized the whole “herd” is protected . ( 95%) Goal : Aim to get as many children and staff immunized as possible to protect the whole group.

Break the Chain :Hand Washing and Sanitizing

Handwashing Activity

Policy Considerations

• What should be Done • Why• Who is responsible • When will it be done • How will it be done • How will it be communicated and enforced

© The National Training Institute for Child Care Health Consultants, UNC-CH, 2007

46

What Should a Policy Include?

1. Title2. Belief Statement3. Intent Statement4. Background5. Procedure/Practice6. Application


47

What Should a Policy Include?

7. Communication 8. References9. Review10. Effective Date11. Review Date

Policy Activity

Sanitizing Surfaces Breaks the Chain

• 1/4 cup household bleach to one gallon of cool water

• One tablespoon household bleach to one quart cool water

• Spray don’t dip • Contact time 2

minutes • Mix ever day• Safety issues

Safe Diapering Breaks the Chain

Evaluate This Diapering Set-up

Courtesy of Cheryl Frank and Andrea Miller

OSHA Blood borne Pathogen Standard 1910.1030

• Requires that any workplace that exposes employees to blood borne pathogens should have a written exposure plan. Staff should be oriented to the plan.– All body fluids should be considered potential

sources of infection and precautions should be taken including

• Gloves and protective equipment as appropriate • Hand washing • Sanitizing• Reporting exposure and following the exposure

plan is program specific

Infectious Disease Policy & Procedures

• Checking children’s immunization status and informing parents of gaps

• Universal precautions • Hand washing • Diapering• Cleaning & disinfecting• Identifying an ill child or child care provider• Informing parents that their child is ill• Routinely informing all families about highly infectious

condition or disease

Pregnant Employees

• Contact your physician for advice• Risk for CMV • Get tested for CMV antibody• Work with 2 year olds and older during

pregnancy • Good hand washing• Avoid saliva, toys, and utensils contaminated

with saliva

OBESITY RISK : Organizational & Institutional: Childcare

• Attending childcare associated with obesity• Need to Address Healthy Eating Standards

Regulations, Quality Stars, NAPSACC– Meal pattern– Limit Juice, ban SSB’s– Reduce energy density– Portion size

Gubbels, et al: Int J Obesity 2010 May; Khan, et al; MMWR 2009;58:1-26; Rolls: Poc Nutr Soci, December 2009; Lehahy, et al: JADA 2008;108:41-48.

Barbara A. Dennison, MD, Early Childhood Obesity Role of Barbara A. Dennison, MD, Early Childhood Obesity Role of nutrition Factors Powerpoint presentation, 2010.New York nutrition Factors Powerpoint presentation, 2010.New York State Department of Health School of Public Health, SUNY State Department of Health School of Public Health, SUNY AlbanyAlbany

Why are young children getting fatter?They are eating too many calories.

FITS, JADA, 2004;IOM, 2002; USDA, ERS, 2004

Barbara A. Dennison, MD, Early Childhood Obesity Role Barbara A. Dennison, MD, Early Childhood Obesity Role of nutrition Factors PowerPoint presentation, 2010.New of nutrition Factors PowerPoint presentation, 2010.New York State Department of Health School of Public York State Department of Health School of Public Health, SUNY AlbanyHealth, SUNY Albany

Socio-ecologic Model: A Framework to Socio-ecologic Model: A Framework to Identify Levels of InfluenceIdentify Levels of Influence

Barbara A. Dennison, MD, Early Childhood Obesity Role Barbara A. Dennison, MD, Early Childhood Obesity Role of nutrition Factors PowerPoint presentation, 2010.New of nutrition Factors PowerPoint presentation, 2010.New York State Department of Health School of Public Health, York State Department of Health School of Public Health, SUNY AlbanySUNY Albany

Frieden TR: Am J Public Health 2010;100:590-595

High Resource

Low Resource

Barbara A. Dennison, MD, Early Childhood Obesity Role of Barbara A. Dennison, MD, Early Childhood Obesity Role of nutrition Factors PowerPoint presentation, 2010.New York nutrition Factors PowerPoint presentation, 2010.New York State Department of Health School of Public Health, SUNY State Department of Health School of Public Health, SUNY AlbanyAlbany

Licensing Regulations, Standards, Stars

• What is the minimum required?• Is it enough? • What is the role of child care in promoting

healthy eating and physical activity?• What are the challenges?

New Standards on Nutrition, Physical Activity, and Screen Time

Recently released 2010 standards provide guidance beyond what we currently have in our licensing regulations.

• Preventing Childhood Obesity in Early Care and Education Programs http://nrckids.org/CFOC3/PDFVersion/preventing_obesity.pdf

Highlights of New Guidelines • General: Use USDA CACFP guidelines , meal pattern, menu, water,

100%juice• Infants: Encourage breastfeeding, Consistent caregiver feeding, cue

based, storage of human milk, bottle feeding techniques, introduction of age appropriate foods, soy based products

• Toddlers: Meal and snack pattern, serving size, self feeding• Food brought from home: Quality and selection and preparation• Nutrition education: Provide nutrition learning experiences for children,

parents/guardians, including health, nutrition , and physical activity • Policies: Infant feeding, food and nutrition, • Physical activity : Active indoor and outdoor play, policies and practices ,

role modeling • Limit screen time http://nrckids.org/CFOC3/PDFVersion/preventing_obesity.pdf Preventing Childhood Obesity in Early Care and Education Programs :

http://nrckids.org/CFOC3/PDFVersion/preventing_obesity.pdf

Nutrition Key Points

• The Child Care program must promote a Healthy Eating Environment

• Food Must Meet the Children’s Nutritional Needs ( USDA Child and Adult Care Food Program )

• Meal or snack provided every 3 hours • Fruit juice recommendation • Food Served Must Be Safe

Eating Environment Recommendation

• Family style• Separate serving utensil• Encourage but do not force eating ( ideas?)• Adults role model food choices that meet nutritional

standards • Socialize, talk about food, days events, color etc.• Don’t rush slow eaters • Accommodate special diets• Hold Infants for Bottle feeding


65

Harms, Clifford and Cryer Environment Rating Scales


66

Scale Characteristics: Items

Each scale has items to evaluate:• Physical environment• Basic care • Curriculum• Caregiver/child interaction• Schedule/program structure• Provisions for parent/staffECKERS Video Clip meals and snacks

USDA Child and Adult Program Recommendations

Meal Pattern Recommendations :http://www.fns.usda.gov/cnd/care/

ProgramBasics/Meals/Meal_Patterns.htm

Activity

Food Policy

04/11/2304/18/07The National Training Institute for


Requirements for Food Safety

• All children must be served food that is stored, prepared, and presented in a safe and sanitary environment.

• All child care facilities must follow the steps for safe food handling.

Storage Containers and Heating

Bottles made of plastics containing BPA or phthalates should be avoided (labeled with #3, #6, or #7). Glass bottles or plastic bottles labeled BPA Free or with a #1, #2, #4, or #5 are acceptable.

Food Safety • Hand washing before food preparation • Formula storage and labeling ( prepared for 24 hours ) • Warming Bottles • Choking prevention Cut foods into pieces no larger than ½

inch. Teach children how to chew their food well.• Food storage and labeling ( clearly labeled and dated ) • Food Allergies posted • Cleaning surfaces • Refrigerator temperatures ( <40 degrees) • Washing fresh fruits and vegetables VT Early Childhood Program Licensing Regulations:http://dcf.vermont.gov/cdd/child_care_licensing ( Early Childhood Programs

pg. 30-33 and Regulations for Family Day Care Homes pg. 13 )



Nutritional Needs - Infants• Exclusive breastfeeding is

recommended for the first six months of life.

• Research shows breastfeeding has strong benefits for both mother and baby

Support for Breast Feeding • Establish a supportive breastfeeding policy • Train Staff In proper handling/storage of human milk. • Provide positive breastfeeding promotion messages • Provide a place to breastfeed or pump in privacy • Assure all know that mothers may breastfeed

her child wherever she and her child have a legal right to be (Vermont Act 117) • Encourage expectant mothers to breastfeed • Connect new mothers with others who have

successfully combined breastfeeding and working.http://healthvermont.gov/wic/food-feeding/breastfeeding/

childcare.aspx



Storing Breast Milk• Store in firm plastic containers, either poly propylene

(cloudy and a little flexible) or polycarbonate (clear and rigid), or glass.

• Store in the refrigerator no longer than 48 hours, and in the freezer for no longer than two weeks.

• All containers must be labeled with the child’s name and serving date.



Serving Breast Milk

• Bottles of breast milk should be warmed by placing them in a pan of hot (not boiling) water for 5 minutes or until it reaches the desired temperature.

• Milk should never be heated in a microwave. • The temperature of the milk should always be tested

to reduce the risk of burns upon feeding.



Nutritional Needs - Infants• Feed infants whenever they are hungry.

• Juice is not necessary for infants and may be detrimental.

• Hold infants when feeding.



Nutritional Needs - Infants• Solid Foods

May be introduced at 6 months of age, depending on the individual child’s development.

Finger feeding may be introduced at 8-10 months of age.



Nutritional Needs – Toddlers and Preschoolers

• Eating CharacteristicsSmall frequent meals.

Child chooses how much food they eat• Portion Sizes

Refer to CACFP and the Food Guide Pyramid for age appropriate portion sizes.



Nutritional Needs – Toddlers and Preschoolers

• Nutritional RequirementsVariety needed for growth and health

– CACFP and the Food Guide PyramidUse as a guide for meals and snacks.

Check for updates.

Limit sweets, fat, and juice.



Special Needs and Allergies• Special requirements obtained in

writing

• Individualized adaptations

• Monitoring and rapid response plan



Menu Planning• Plan menus in advance and work with a

nutrition specialist.• Snacks make up 20% of children’s daily

energy and nutrient needs, so all foods need to be nutritious.

• Avoid high sugar, high fat or sticky foods.

Juice Recommendation 2010

• Only 100% Juice or diluted full strength • No more than 4-6 oz. per day from age 1-3• Infants to 12 months : No fruit juice • No sweeteners • At meal and snack time • Conversations with Parents • Why : teeth and obesity research

Menu Planning Checklist Meets the CACFP requirementsIncludes a good source of vitamin CIncludes a good source of ironIncludes a good source of vitamin A Includes foods with different texturesIncludes foods with different colorsIncludes new foods and favorite foodsRepresents cultural foods of the childrenFood safety standards are followedIncludes a variety of fruits and vegetables?

Food Allergies

• All children with food allergies should have a plan which includes which foods need to be eliminated and actions to take in an emergency

• Allergies should be prominently posted • Staff should receive training

http://nrckids.org/CFOC3/PDFVersion/preventing_obesity.pdf

Nutrition ScenariosCommunicating with Parents

Physical Activity Physical Activity Guidelines• Promote active play everyday

– 2-3 time outdoors weather permitting( toddlers 60-90 minutes, preschoolers 90-120 minutes)

– 2+ structured adult led activities or games that promote movement

– Opportunities to practice age appropriate gross motor and movement

Activity

Creative Opportunities for Active Play

Examples/Resources

http://www.aahperd.org/headstartbodystart/news/takeItOutsideWeek/upload/movingwithbeac-ball.pdf

http://www.aahperd.org/headstartbodystart/

• Motion Moments videos http://nrckids.org/Motion_Moments/index.htm

Too Much TV

The American Academy of Pediatrics (AAP) recommends that children two years old and under should

• not be exposed to television• children over age two should limit daily media

exposure to only 1-2 hours of quality programming

Resources

• Head Start Body Start Lead Structured Activities http://www.aahperd.org/headstartbodystart/news/takeItOutsideWeek/structuredactivities.cfm

• Eat Well Play Hard in Child Care Settings Curriculum http://www.health.state.ny.us/prevention/nutrition/cacfp/ewphccs_curriculum/

• Color me Healthy Preschoolers Eating and Moving http://www.colormehealthy.com

Curriculum and Other Ideas?

Eat Well Play Hard : Choose Your Fun: http://www.health.state.ny.us/prevention/nutrition/cacfp/ewphccs_curriculum/docs/choose_your_fun.pdf

Licensing Regulations , Standards, Stars

• What is the minimum required?• Is it enough? • What is the role of child care in promoting

healthy eating and physical activity?• What are the challenges?

What causes you to feel stress at work ?

What is Work Related Stress ?

• The harmful physical and emotional responses that occur when the requirements of the job do not match capabilities, resources and needs of the worker “ ( NIOSH, 2002)

• “Job challenge is a positive experience that energizes us psychologically and motivates us to learn new skills and master our jobs “ ( NIOSH 2002)

Program Strategies that Help Decrease Stressors

• Staff are responsible for one group of children in one room

• Written job descriptions and personnel policies ( family friendly)

• Regular staff meetings • Staff involved in decision making• Trained volunteers or parents for

breaks • Emergency relief

How Do You Manage Stress ?

Documents

Health and Safety of Staff and Children 2011 Margaret Poppe RN, MSN