Taking Care of Taking Care of Caregivers: Wellness Caregivers: Wellness

for Everybodyfor Everybody

Susan S. Aronson, MD, FAAPSusan S. Aronson, MD, FAAP

Objectives – Identify how to:Objectives – Identify how to:

Promote adult healthPromote adult health Prevent work-related injuries & Prevent work-related injuries &

illnessillness Address caregiver mental healthAddress caregiver mental health Use modeling to teach children Use modeling to teach children

healthy behaviors and attitudes healthy behaviors and attitudes Use publications, OSHA, NRC, AAP as Use publications, OSHA, NRC, AAP as

sources of helpsources of help

The health status of adults who work in the child care setting is a critical component of quality. Quality child care requires consistently supportive human relationships. When caregivers and supervisors are ill, relationships and performance suffer.

Caregivers/Teachers Matter!Caregivers/Teachers Matter! Caregivers work in a physically demanding and Caregivers work in a physically demanding and

stressful work environment every day.stressful work environment every day. Caregivers lift, bend, stoop, crawl, climb, reach, Caregivers lift, bend, stoop, crawl, climb, reach,

pull, and pushpull, and push Caregivers have limited control over the Caregivers have limited control over the

demands for interaction from young, energetic demands for interaction from young, energetic children and their families children and their families

Practice of healthy behaviors has personal and Practice of healthy behaviors has personal and professional benefitsprofessional benefits

– Feel goodFeel good– Improve/maintain your health and your family’s healthImprove/maintain your health and your family’s health– Do a better job in child careDo a better job in child care

Occupational Health Issues for Occupational Health Issues for Teachers/CaregiversTeachers/Caregivers

Infectious diseases Infectious diseases Musculoskeletal injuriesMusculoskeletal injuries FallsFalls Environmental hazardsEnvironmental hazards Pregnancy risks - 97% of providers are Pregnancy risks - 97% of providers are

women in childbearing yearswomen in childbearing years StressStress NutritionNutrition Physical conditioning and fitnessPhysical conditioning and fitness Development & implementation of staff Development & implementation of staff

health policieshealth policies

Documented Increased RiskDocumented Increased Risk Increased exposure to Increased exposure to

infectious diseases infectious diseases (Reves and Pickering, (Reves and Pickering, 1992; Churchill and 1992; Churchill and Pickering, 1997)Pickering, 1997)

Musculoskeletal injuries Musculoskeletal injuries of back, neck, and of back, neck, and limbs (Owen, 1994; U. limbs (Owen, 1994; U. S. National Institute of S. National Institute of Occupational Safety Occupational Safety and Health [NIOSH], and Health [NIOSH], 1997).1997).

http://nrc.uchsc.edu National Resource Center for Health and Safety in Child Care

www.aap.org

American Academy of Pediatrics

Lifting children, toys, supplies

Avoid lifting. Have children climb steps with help.

To lift, pull child or object to be lifted as close as possible directly in front of you; squat and wrap your arms around whatever you are lifting, then tighten stomach muscles and use thigh muscles to raise yourself and your load.

Slide objects and children down your body to a level where you can squat or kneel to lower whatever you are putting down to its destination.

Wise Moves

Alicia M. Wortman, MPT (EXCHANGE - July 2001)

Inadequate work heights

Store frequently used objects where you can reach them easily.

Store heavy objects at waist height

Adjust diapering and other work surfaces to waist height

Use adult-sized chairs whenever you can

Squat or kneel on a kneepad if you can’t sit next to children when helping them

Use step stools to reach high places.

Wise Moves

Lifting infants in and out of cribs

Do not use cribs with floor level mattresses or those that do not have a side you can drop when putting children in or out.

Get you and the child as close to the crib side as possible before you lift.

Wise Moves

Frequent sitting on the floor without back support

Sit against a wall or furniture that supports your back

Sit with a little pillow in the small of your back when you can

Stretch when you get up

Wise Moves

Carrying heavy objects or children

Use carts and strollers

Let children climb up with a step stool

Divide heavy loads into several smaller loads; use carts that can be slid under the load, and then tilt the load onto the cart

Wise Moves

Awkward posture to open windows or adjust objects

Move objects away from the window to get as close as possible to it

Put one foot on a step stool for better leverage

Lubricate the window mechanism to make opening it easier

Ask for help from a co-worker when the job is hard

Wise Moves

Picking up crumbs and small toys from the floor

Use a long-handled dustpan and broom to pick up small objects

Keep a separate dustpan and broom for toys (clean) and for things going into the trash

Caring for children with special needs

Get specific training from the child’s physical therapist about how to move and carry the child

Wise Moves

Caring for children during active play when sudden moves may be needed

Avoid twisting

Practice turning and bending to intercept a running or falling child so the move becomes natural

Bend knees when pushing children in swings

Use good body mechanics to help children on and off equipment

Wise Moves

Staff Health AssessmentStaff Health Assessment

NAEYC Accreditation requirementNAEYC Accreditation requirement

Caring For Our Children Caring For Our Children standards standards provide expectation and rationale for provide expectation and rationale for job-related health screeningjob-related health screening

Model Child Care Health PoliciesModel Child Care Health Policies – – appendix has staff health assessment appendix has staff health assessment formform

Mental HealthMental Health Tune in to stress Tune in to stress

behaviorsbehaviors– Trouble Trouble

concentratingconcentrating– Inexplicable sadnessInexplicable sadness– Trouble sleepingTrouble sleeping– Fatigue even with 8Fatigue even with 8 hours of sleephours of sleep– IrritabilityIrritability– Loss of appetiteLoss of appetite– Self-medicating withSelf-medicating with alcohol & other drugsalcohol & other drugs

Monitor for Monitor for physical symptoms physical symptoms of stressof stress– HeadachesHeadaches– Neck painNeck pain– BackachesBackaches– StomachachesStomachaches

Mental Health ExercisesMental Health Exercises Provide mutual Provide mutual

supportsupport– Be alert to the needsBe alert to the needs of others (“on call”)of others (“on call”)– Share cause ofShare cause of personal stress whenpersonal stress when signs of stress aresigns of stress are obvious & it is obvious & it is appropriateappropriate– Offer sources of Offer sources of

professional helpprofessional help

Promote PleasurePromote Pleasure– Have fun Have fun – Physical activityPhysical activity– StretchingStretching– Imaging Imaging – Relaxation Relaxation

exercisesexercises– Enjoy the value ofEnjoy the value of your workyour work

Promote WellnessPromote Wellness Rest Rest

– Go to bed on time, without TVGo to bed on time, without TV– Avoid late nights on weekendsAvoid late nights on weekends– Plan some mini-rest & stretch breaks Plan some mini-rest & stretch breaks – Take off time to get well when illness occursTake off time to get well when illness occurs

ExerciseExercise Control sound pollution Control sound pollution Plan healthful meals & snacks – use Plan healthful meals & snacks – use

MyPyramidMyPyramid– Breakfast, lunch, dinner (eat your colors)Breakfast, lunch, dinner (eat your colors)– Mid-AM, mid-PM protein snacksMid-AM, mid-PM protein snacks

Promote WellnessPromote Wellness

Manage temperature and humidityManage temperature and humidity Dress for comfort and body careDress for comfort and body care

– Layer when it is coldLayer when it is cold– Sun-protective clothing outsideSun-protective clothing outside– Well-fitted, low-heeled shoesWell-fitted, low-heeled shoes

Limit exposure to chemicalsLimit exposure to chemicals– Indoors and outdoors (cleaning Indoors and outdoors (cleaning

products, art supplies, mold, pesticides)products, art supplies, mold, pesticides)– Outside and inside your bodyOutside and inside your body

Promote WellnessPromote Wellness

Daily health maintenanceDaily health maintenance– Oral healthOral health– Bowel routinesBowel routines

Motor vehicle and pedestrian safetyMotor vehicle and pedestrian safety Hand hygieneHand hygiene Routine preventive health careRoutine preventive health care

– CheckupsCheckups– VaccinesVaccines

Health Insurance for well and sick careHealth Insurance for well and sick care

Preventive Health CarePreventive Health Care

American College of Preventive Medicine and American College of Preventive Medicine and the U.S. Preventive Services Task Force the U.S. Preventive Services Task Force (USPSTF), based at the Agency for Healthcare (USPSTF), based at the Agency for Healthcare Research and Quality, have each developed Research and Quality, have each developed evidence-based recommendations regarding evidence-based recommendations regarding the delivery of clinical preventive services the delivery of clinical preventive services

At www.acpm.org, look up recommendations for At www.acpm.org, look up recommendations for ScreeningScreening CounselingCounseling Chemoprevention (vaccines, aspirin, Chemoprevention (vaccines, aspirin,

hormones)hormones)

Adult Immunization Adult Immunization www.cdc.gov/nip

Special Risks for Pregnant Special Risks for Pregnant WomenWomen

• ChickenpoxChickenpox• CytomegalovirusCytomegalovirus• Fifth Disease Fifth Disease • RubellaRubella

Staff Health PoliciesStaff Health Policies

Pre-employment job-related health Pre-employment job-related health assessmentassessment

BenefitsBenefits BreaksBreaks Ongoing health requirementsOngoing health requirements

– Daily health check (visual, verbal)Daily health check (visual, verbal)– Emergency contactsEmergency contacts– Modeling healthful behavior monitored Modeling healthful behavior monitored

in performance evaluationin performance evaluation

PublicationsPublications

Caring for Our Children: National Caring for Our Children: National Performance Standards, Performance Standards, 2002 – 2002 – AAP/APHA/NRCAAP/APHA/NRC

Stepping Stones (to CFOC) -Stepping Stones (to CFOC) - NRC NRC Health in Child Care Manual for Health Health in Child Care Manual for Health

Professionals Professionals – AAP– AAP Healthy Young ChildrenHealthy Young Children – NAEYC – NAEYC

PublicationsPublications Model Child Care Health Policies Model Child Care Health Policies – hard copy – hard copy

from NAEYC; electronic copy at www.ecels-from NAEYC; electronic copy at www.ecels-healthychildcarepa.org healthychildcarepa.org

Managing Infectious Diseases in Child Care and Managing Infectious Diseases in Child Care and Schools Schools - AAP at www.aap.org - AAP at www.aap.org

Posters www.globalhealthychildcare.org Posters www.globalhealthychildcare.org DVD/Videos DVD/Videos Health and Safety Consultation in Health and Safety Consultation in

Child Care Child Care includes staff health observation includes staff health observation segment, electronic segment, electronic CFOC, MCCHP CFOC, MCCHP www.ecels-www.ecels-healthychildcarepa.org or www.aap.org healthychildcarepa.org or www.aap.org

OSHA – www.osha.govOSHA – www.osha.govDescription for 8351: Child Day Care ServicesDescription for 8351: Child Day Care Services

Division I: Services Major Group 83: Social ServicesDivision I: Services Major Group 83: Social ServicesIndustry Group 835: Child Day Care Services Industry Group 835: Child Day Care Services

Establishments primarily engaged in the care of infants or children, Establishments primarily engaged in the care of infants or children, or in providing prekindergarten education, where medical care or or in providing prekindergarten education, where medical care or delinquency correction is not a major element. These delinquency correction is not a major element. These establishments may or may not have substantial educational establishments may or may not have substantial educational programs. These establishments generally care for prekindergarten programs. These establishments generally care for prekindergarten or preschool children, but may care for older children when they are or preschool children, but may care for older children when they are not in school. Establishments providing babysitting services are not in school. Establishments providing babysitting services are classified in Industry 7299. Head Start centers operating in classified in Industry 7299. Head Start centers operating in conjunction with elementary schools are classified in Industry 8211. conjunction with elementary schools are classified in Industry 8211. – Child care centers Child care centers – Day care centers, child Day care centers, child – Group day care centers, child Group day care centers, child – Head Start centers, except in conjunction with schools Head Start centers, except in conjunction with schools – Nursery schools Nursery schools – Preschool centers Preschool centers

OSHA requires: Communication about hazards & OSHA requires: Communication about hazards & safety + Controls for blood-borne pathogenssafety + Controls for blood-borne pathogens

Sources of SupportSources of Support

National Resource Center for Health and National Resource Center for Health and Safety in Child CareSafety in Child Care http://nrc.uchsc.edu http://nrc.uchsc.edu

(University of Colorado Health Sciences Center)(University of Colorado Health Sciences Center)

Health and Child Care Partnership Program –Health and Child Care Partnership Program –Healthy Child Care America Healthy Child Care America www.healthychildcare.org www.healthychildcare.org

(American Academy of Pediatrics)(American Academy of Pediatrics)

Summary – Identified How Summary – Identified How To:To:

Promote adult healthPromote adult health Prevent work-related injuries & Prevent work-related injuries &

illnessillness Address caregiver mental healthAddress caregiver mental health Use modeling to teach children Use modeling to teach children

healthy behaviors and attitudes healthy behaviors and attitudes Use publications, OSHA, NRC, AAP as Use publications, OSHA, NRC, AAP as

sources of helpsources of help