PA-ECE 4: Health and Safety
The agency promotes and protects the health and safety of children and staff.
identifies health promotion as a key indicator
and a strong predictor of positive outcomes.
A health record is maintained for each child that includes:
- verification of up-to-date, preventative screenings;
- evidence of up-to-date immunizations as required by applicable law or regulation;
- emergency contact information that is kept current and updated at least once a year;
- written parental authorization for emergency care; and
- an acknowledgment form, signed by the program director or a designee, which states that information has been received about the child’s health needs and allergies, and specifies the agency’s role in carrying out any related care or treatment.
Emergency contact information includes the names of the family physician, clinic, or hospital to be used in emergencies. When a child has allergies or health issues, the acknowledgment form must include specific information regarding the allergy such as which foods or materials the child cannot eat or come in contact with, and any activities in which the child cannot participate.
All parents receive a written health policy and procedures that address:
- the process for determining whether or not the agency can handle a child’s specific health needs;
- attendance guidelines for sick children, including separation from other children; and
- procedures for notifying parents that their child may have been exposed to an infectious disease.
Child health problems and accidents, including changes in appearance or behavior, are promptly recorded and reported to parents and administration, and follow-up is conducted as needed.
Procedures for regularly cleaning and sanitizing the classroom limit the spread of infection and include:
- daily cleaning of the facility;
- disinfecting bedding, beds, cots, cribs, and mats at least once a week and between use by different children;
- disinfecting toys and other materials at least weekly and immediately after use if items are placed in the child’s mouth; and
- the availability of properly labeled disinfectants, which are securely stored away from children at all times.
To limit the spread of infection, diaper changing areas:
- are separate from food preparation areas;
- have a posted copy of diaper changing procedures;
- utilize changing tables made of non-porous material; and
- include covered, plastic-lined, hands-free cans for the disposal of used diapers.
Diapering procedures meet nationally recognized guidelines for sanitary diapering practices, and include:
- that children are never to be left unattended on changing tables and that one hand must be on the child at all times;
- proper disposal of diapers and other contaminated items;
- proper use of gloves when they are offered to teaching staff;
- steps for gathering materials ahead of time;
- relevant hand-washing requirements; and
- steps for disinfecting the area after each use.
Research Note: The 2nd Edition of Caring for Our Children, which is a joint partnership of the American Academy of Pediatrics, the American Public Health Association, and the National Resource Center for Health and Safety in Child Care, offers detailed diaper changing procedures that agencies may find useful when developing their own diapering practices.
Hand washing areas are designed to promote safety and limit the spread of infection including:
- separating hand-washing sinks from food preparation sinks;
- installing shatter-proof mirrors;
- making hand washing sinks easily accessible to all children; and
- having liquid soap and sanitary methods for drying off hands available.
Sanitary methods for drying off hands include disposable paper towels or electric dryers that turn on and off automatically.
Hand washing policies and procedures meet nationally recognized guidelines for hand washing and include:
- under what situations hands must be washed;
- requirements for water temperature, soap use, and time spent scrubbing and rinsing; and
- procedures for turning off water that reduce the risk of recontamination.
Research Note: The 2nd Edition of Caring for Our Children, which is a joint partnership of the American Academy of Pediatrics, the American Public Health Association, and the National Resource Center for Health and Safety in Child Care, has hand washing procedures that agencies may find useful when developing their own hand washing practices.
Teaching staff promote good health habits by:
- modeling and providing developmentally-appropriate instruction on health and hygiene practices;
- serving nutritious meals and snacks; and
- providing opportunities for active play.
Active play for infants may include “tummy time,” allowing infants to develop the muscles of their back and neck.
Interpretation: Examples of health and hygiene practices include, but are not limited to:
- washing hands before and after eating;
- washing hands after using the bathroom;
- covering the nose and mouth when sneezing or coughing; and
- regular tooth brushing.
Research Note: Research has shown that healthy eating habits and active lifestyles are established in infancy.
Children are protected from injuries, accidents, and illnesses through practices that ensure teaching staff:
- follow universal precautions as well as diapering, hand washing, and sanitation procedures;
- notify parents in case of emergencies or when safety issues arise;
- are trained on emergency response procedures;
- identify and report suspected child abuse and neglect to prescribed authorities;
- have access to a telephone, emergency transportation, emergency numbers and first aid supplies both on- and off-site;
- are informed about children in their care with special medical needs or allergies; and
- are healthy and capable of performing the essential functions of the job with reasonable accommodation.
While an annual physical examination is preferred, teaching staff may receive a general health screening performed by a qualified medical practitioner, provided the screening addresses communicable diseases, including tuberculosis when required by relevant health authorities.
The agency ensures that staff are available to respond in a medical emergency by guaranteeing:
- each classroom has at least one person present with current pediatric First Aid certification;
- one person with current Cardiopulmonary Resuscitation (CPR) certification is on site at all times the program is in operation; and
- individuals with First Aid and CPR certification are present on field trips away from the facility.
First Aid and CPR certification must be kept up-to-date according to the guidelines established by the certification body.
A health facility or qualified medical professional is available to provide:
- medical consultation to the agency and parents;
- a review of children’s health needs; and
- a review of the agency’s health and safety practices.
The intent of this standard is not to require that agencies pay for this service, but to ensure they have access to medical professionals as needed. Some agencies, particularly those that serve a higher risk population, might have medical professionals on staff; others will develop formal or informal relationships with medical professionals outside the agency to receive assistance when special health needs arise.
Research Note: The literature identifies physical health as one predictor of future academic success. As such, agencies should consider each child’s physical health and well-being when making program decisions.
Bottles of breast milk and formula are:
- labeled with the child’s full name and the date that it was brought in;
- brought in daily and stored in a refrigerator upon arrival;
- discarded if the bottle is not finished in one feeding; and
- warmed in water and never in a microwave oven.
Breast milk or formula should not stored overnight by the child care center. Bottles that are unused at the end of the day should be sent home with the parent.
Teaching staff take necessary precautions to reduce the risk of Sudden Infant Death Syndrome (SIDS), including:
- placing infants on their backs to sleep unless otherwise instructed by the child’s doctor;
- placing infants on a firm sleep surface such as a safety-approved crib mattress with fitted sheet;
- removing soft, fluffy bedding, pillows, objects, or toys from sleep areas;
- keeping the room at a comfortable temperature and dressing infants in light sleep clothing to prevent overheating; and
- tucking blankets into the bottom and sides of crib to prevent them from rising above the infant’s chest.
Research Note: The Back to Sleep Campaign promotes infant back sleeping to help reduce the risk of Sudden Infant Death Syndrome (SIDS) and is a good resource for agencies looking for more information on SIDS prevention. Campaign sponsors include the National Institute of Child Health and Human Development, the Maternal and Child Health Bureau, the American Academy of Pediatrics, the First Candle/SIDS Alliance, and the Association of SIDS and Infant Mortality Programs.
A safe environment is maintained through proper selection and maintenance of play equipment, including:
- indoor and outdoor playground equipment that meets national safety standards;
- installing equipment on an appropriate amount of impact absorbing surfaces;
- conducting daily inspections of playground equipment and the surrounding area;
- monthly maintenance inspections of playground equipment according to manufacturer’s instructions; and
- annual inspections of the play equipment by a Certified Playground Safety Inspector.
The amount of the impact absorbing surface will vary given the material used and the height of the playground equipment. Agencies should refer to industry standards and the manufacturer’s instructions for more detailed guidance on the proper depth of impact absorbing surfaces.
The daily inspection of the playground should focus on the immediate identification of potentially hazardous conditions such as standing water, broken glass, or damage to the play equipment. Monthly maintenance inspections should check for worn or damaged wood, bolts, chains, anchors, etc. The agency should use a standardized checklist for monthly inspections and observations should be documented. While routine checks of playground equipment can be performed by trained staff, the inspection, and maintenance of playground equipment is highly technical and best performed annually by an industry professional.
Stairwells have railings and are closed off from child care classrooms.
The facility provides an optimal care and learning environment that is:
- well lit, with natural light where possible and emergency lighting throughout;
- maintained at a safe, comfortable temperature;
- odor free; and
- adequately ventilated.
Smoking is prohibited anywhere on the premises, including outside entrances, outdoor play areas and program vehicles.
Toys and other materials are child-proof, non-toxic, and maintained in good repair.