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Caring for Our Children: National Health and Safety Performance Standards; Guidelines for Early Care and Education Programs, Third Edition A Joint Collaborative Project of American Academy of Pediatrics 141 Northwest Point Boulevard Elk Grove Village, IL 60007-1019 American Public Health Association 800 I Street, NW Washington, DC 20001-3710 National Resource Center for Health and Safety in Child Care and Early Education University of Colorado, College of Nursing 13120 E 19th Avenue Aurora, CO 80045 Support for this project was provided by the Maternal and Child Health Bureau, Health Resources and Services Administration, U.S Department of Health and Human Services (Cooperative Agreement #U46MC09810) Copyright © 2011 by American Academy of Pediatrics American Public Health Association National Resource Center for Health and Safety in Child Care and Early Education Second printing with minor corrections noted by asterisks, August 2011 Go to http://nrckids.org for future changes/additions to this publication All rights reserved This book is protected by copyright No part of this book may be reproduced in any form or by any means, including photocopying, or utilized by any information storage and retrieval system without prior written permission from the publisher To request permission to reproduce material from this book, please contact the Permissions Editor at the American Academy of Pediatrics by fax (847/434-8780), mail (PO Box 927, Elk Grove Village, IL 600071019), or email (marketing@aap.org) Suggested Citation: American Academy of Pediatrics, American Public Health Association, National Resource Center for Health and Safety in Child Care and Early Education 2011 Caring for our children: National health and safety performance standards; Guidelines for early care and education programs 3rd Edition Elk Grove Village, IL: American Academy of Pediatrics; Washington, DC: American Public Health Association Also available at http://nrckids.org The National Standards are for reference purposes only and shall not be used as a substitute for medical or legal consultation, nor be used to authorize actions beyond a person’s licensing, training, or ability ISBN 978-1-58110-483-7 (American Academy of Pediatrics) MA0552 (American Academy of Pediatrics) Printed and bound in the United States of America Design & Typesetting: Lorie Bircher, Betty Geer, Susan Paige Lehtola, Garrett T Risley 10 Caring for Our Children: National Health and Safety Performance Standards Table of Contents Introduction xvii Guiding Principles xix Advice to the User .xxi New and Significant Changes in Caring for Our Children (CFOC) Standards Since the 2nd Edition xxiv Chapter 1: Staffing 1.1 Child:Staff Ratio, Group Size, and Minimum Age 1.1.1 Child:Staff Ratio and Group Size 1.1.2 Minimum Age 1.2 Recruitment and Background Screening 1.3 Pre-service Qualifications 10 1.3.1 Director’s Qualifications 10 1.3.2 Caregiver’s/Teacher’s and Other Staff Qualifications 12 1.3.3 Family Child Care Home Caregiver/Teacher Qualifications 18 1.4 Professional Development/Training 19 1.4.1 Pre-service Training 19 1.4.2 Orientation Training 21 1.4.3 First Aid and CPR Training 24 1.4.4 Continuing Education/Professional Development 26 1.4.5 Specialized Training/Education 29 1.4.6 Educational Leave/Compensation 31 1.5 Substitutes 32 1.6 Consultants 33 1.7 Staff Health 39 1.8 Human Resource Management 43 1.8.1 Benefits 43 1.8.2 Evaluation 43 Chapter 2: Program Activities for Healthy Development 47 2.1 Program of Developmental Activities 49 2.1.1 General Program Activities 49 2.1.2 Program Activities for Infants and Toddlers from Three Months to Less Than Thirty-Six Months 57 2.1.3 Program Activities for Three- to Five-Year-Olds 61 2.1.4 Program Activities for School-Age Children 63 2.2 Supervision and Discipline 64 2.3 Parent/Guardian Relationships 77 2.3.1 General 77 2.3.2 Regular Communication 78 2.3.3 Health Information Sharing 80 2.4 Health Education 81 2.4.1 Health Education for Children 81 2.4.2 Health Education for Staff 83 2.4.3 Health Education for Parents/Guardians 84 Chapter 3: Health Promotion and Protection 87 3.1 Health Promotion in Child Care 89 3.1.1 Daily Health Check 89 iii Table of Contents Caring for Our Children: National Health and Safety Performance Standards 3.1.2 Routine Health Supervision 89 3.1.3 Physical Activity and Limiting Screen Time 90 3.1.4 Safe Sleep 96 3.1.5 Oral Health 101 3.2 Hygiene 104 3.2.1 Diapering and Changing Soiled Clothing 104 3.2.2 Hand Hygiene 110 3.2.3 Exposure to Body Fluids 114 3.3 Cleaning, Sanitizing, and Disinfecting 116 3.4 Health Protection in Child Care 118 3.4.1 Tobacco and Drug Use 118 3.4.2 Animals 119 3.4.3 Emergency Procedures 122 3.4.4 Child Abuse and Neglect 123 3.4.5 Sun Safety and Insect Repellent 126 3.4.6 Strangulation 129 3.5 Care Plans and Adaptations 129 3.6 Management of Illness 131 3.6.1 Inclusion/Exclusion Due to Illness 131 3.6.2 Caring for Children Who Are Ill 137 3.6.3 Medications 141 3.6.4 Reporting Illness and Death 144 Chapter 4: Nutrition and Food Service 149 4.1 Introduction 151 4.2 General Requirements 152 4.3 Requirements for Special Groups or Ages of Children 162 4.3.1 Nutrition for Infants 162 4.3.2 Nutrition for Toddlers and Preschoolers 174 4.3.3 Nutrition for School-Age Children 175 4.4 Staffing 176 4.5 Meal Service, Seating, and Supervision 177 4.6 Food Brought From Home 182 4.7 Nutrition Learning Experiences for Children and Nutrition Education for Parents/Guardians 183 4.8 Kitchen and Equipment 185 4.9 Food Safety 188 4.10 Meals from Outside Vendors or Central Kitchens 195 Chapter 5: Facilities, Supplies, Equipment, and Environmental Health 197 5.1 Overall Requirements 199 5.1.1 General Location, Layout, and Construction of the Facility 199 5.1.2 Space per Child 203 5.1.3 Openings 204 5.1.4 Exits 206 5.1.5 Steps and Stairs 208 5.1.6 Exterior Areas 209 5.2 Quality of the Outdoor and Indoor Environment 211 5.2.1 Ventilation, Heating, Cooling, and Hot Water 211 5.2.2 Lighting 217 5.2.3 Noise 218 5.2.4 Electrical Fixtures and Outlets 219 Table of Contents iv Caring for Our Children: National Health and Safety Performance Standards 5.2.5 Fire Warning Systems 221 5.2.6 Water Supply and Plumbing 221 5.2.7 Sewage and Garbage 225 5.2.8 Integrated Pest Management 226 5.2.9 Prevention and Management of Toxic Substances 228 5.3 General Furnishings and Equipment 237 5.3.1 General Furnishings and Equipment Requirements 237 5.3.2 Additional Equipment Requirements for Facilities Serving Children with Special Health Care Needs 244 5.4 Space and Equipment in Designated Areas 245 5.4.1 Toilet and Handwashing Areas 245 5.4.2 Diaper Changing Areas 248 5.4.3 Bathtubs and Showers 250 5.4.4 Laundry Area 251 5.4.5 Sleep and Rest Areas 251 5.4.6 Space for Children Who Are Ill, Injured, or Need Special Therapies 255 5.5 Storage Areas 256 5.6 Supplies 257 5.7 Maintenance 259 Chapter 6: Play Areas/Playgrounds and Transportation 263 6.1 Play Area/Playground Size and Location 265 6.2 Play Area/Playground Equipment 269 6.2.1 General Requirements 269 6.2.2 Use Zones and Clearance Requirements 272 6.2.3 Play Area and Playground Surfacing 273 6.2.4 Specific Play Equipment 274 6.2.5 Inspection of Play Areas/Playgrounds and Equipment 277 6.3 Water Play Areas (Pools, Etc.) 278 6.3.1 Access to and Safety Around Bodies of Water 278 6.3.2 Pool Equipment 280 6.3.3 Pool Maintenance 281 6.3.4 Water Quality of Pools 282 6.3.5 Other Water Play Areas 283 6.4 Toys 283 6.4.1 Selected Toys 283 6.4.2 Riding Toys and Helmets 286 6.5 Transportation 287 6.5.1 Transportation Staff 287 6.5.2 Transportation Safety 289 6.5.3 Vehicles 293 Chapter 7: Infectious Diseases 295 7.1 How Infections Spread 297 7.2 Immunizations 297 7.3 Respiratory Tract Infections 300 7.3.1 Group A Streptococcal (GAS) Infections 300 7.3.2 Haemophilus Influenzae Type B (HIB) 301 7.3.3 Influenza 303 7.3.4 Mumps 304 7.3.5 Neisseria Meningitidis (Meningococcus) 305 v Table of Contents Caring for Our Children: National Health and Safety Performance Standards 7.3.6 Parvovirus B19 306 7.3.7 Pertussis 306 7.3.8 Respiratory Syncytial Virus (RSV) 307 7.3.9 Streptococcus Pneumoniae 308 7.3.10 Tuberculosis 309 7.3.11 Unspecified Respiratory Tract Infection 311 7.4 Enteric (Diarrheal) Infections and Hepatitis A Virus (HAV) 311 7.5 Skin and Mucous Membrane Infections 315 7.5.1 Conjunctivitis 315 7.5.2 Enteroviruses 316 7.5.3 Human Papillomaviruses (Warts) 316 7.5.4 Impetigo 317 7.5.5 Lymphadenitis 317 7.5.6 Measles 318 7.5.7 Molluscum Contagiosum 318 7.5.8 Pediculosis Capitis (Head Lice) 319 7.5.9 Tinea Capitis and Tinea Cruris (Ringworm) 319 7.5.10 Staphylococcus Aureus Skin Infections Including MRSA 320 7.5.11 Scabies 321 7.5.12 Thrush 321 7.6 Bloodborne Infections 321 7.6.1 Hepatitis B Virus (HBV) 321 7.6.2 Hepatitis C Virus (HCV) 324 7.6.3 Human Immunodeficiency Virus (HIV) 324 7.7 Herpes Viruses 326 7.7.1 Cytomegalovirus (CMV) 326 7.7.2 Herpes Simplex 327 7.7.3 Herpes Virus and (Roseola) 327 7.7.4 Varicella-Zoster (Chickenpox) Virus 328 7.8 Interaction with State or Local Health Departments 329 7.9 Note to Reader on Judicious Use of Antibiotics 329 Chapter 8: Children with Special Health Care Needs and Disabilities 331 8.1 Guiding Principles for This Chapter and Introduction 333 8.2 Inclusion of Children with Special Needs in the Child Care Setting 335 8.3 Process Prior to Enrolling at a Facility 336 8.4 Developing a Service Plan for a Child with a Disability or a Child with Special Health Care Needs 337 8.5 Coordination and Documentation 340 8.6 Periodic Reevaluation 341 8.7 Assessment of Facilities for Children with Special Needs 341 8.8 Additional Standards for Providers Caring for Children with Special Health Care Needs 342 Chapter 9: Policies 345 9.1 Governance 347 9.2 Policies 348 9.2.1 Overview 348 9.2.2 Transitions 351 9.2.3 Health Policies 353 9.2.4 Emergency/Security Policies and Plans 364 9.2.5 Transportation Policies 373 Table of Contents vi Caring for Our Children: National Health and Safety Performance Standards 9.2.6 Play Area Policies 374 9.3 Human Resource Management 375 9.4 Records 377 9.4.1 Facility Records/Reports 377 9.4.2 Child Records 386 9.4.3 Staff Records 392 Chapter 10: Licensing and Community Action 395 10.1 Introduction 397 10.2 Regulatory Policy 397 10.3 Licensing Agency 398 10.3.1 The Regulation Setting Process 398 10.3.2 Advisory Groups 399 10.3.3 Licensing Role with Staff Credentials, Child Abuse Prevention, and ADA Compliance 400 10.3.4 Technical Assistance from the Licensing Agency 402 10.3.5 Licensing Staff Training 406 10.4 Facility Licensing 407 10.4.1 Initial Considerations for Licensing 407 10.4.2 Facility Inspections and Monitoring 409 10.4.3 Procedures for Complaints, Reporting, and Data Collecting 410 10.5 Health Department Responsibilities and Role 411 10.6 Caregiver/Teacher Support 415 10.6.1 Caregiver/Teacher Training 415 10.6.2 Caregiver/Teacher Networking and Collaboration 416 10.7 Public Policy Issues and Resource Development 417 Appendices 419 Appendix A: Signs and Symptoms Chart 421 Appendix B: Major Occupational Health Hazards 426 Appendix C: Nutrition Specialist, Registered Dietitian, Licensed Nutritionist, Consultant, and Food Service Staff Qualifications 427 Appendix D: Gloving 428 Appendix E: Child Care Staff Health Assessment 429 Appendix F: Enrollment/Attendance/Symptom Record 430 Appendix G: Recommended Childhood Immunization Schedule 431 Appendix H: Recommended Adult Immunization Schedule 434 Appendix I: Recommendations for Preventive Pediatric Health Care 439 Appendix J: Selecting an Appropriate Sanitizer or Disinfectant 440 Appendix K: Routine Schedule for Cleaning, Sanitizing, and Disinfecting 442 Appendix L: Cleaning Up Body Fluids 444 Appendix M: Clues to Child Abuse and Neglect 445 Appendix N: Protective Factors Regarding Child Abuse and Neglect 449 Appendix O: Care Plan for Children with Special Health Care Needs 451 Appendix P: Situations that Require Medical Attention Right Away 458 Appendix Q: Getting Started with MyPlate 459 Appendix R: Choose MyPlate: 10 Tips to a Great Plate 460 Appendix S: Physical Activity: How Much Is Needed? 461 Appendix T: Foster Care 462 Appendix U: Recommended Safe Minimum Internal Cooking Temperatures 464 Appendix V: Food Storage Chart 465 Appendix W: Sample Food Service Cleaning Schedule 467 vii Table of Contents Caring for Our Children: National Health and Safety Performance Standards Appendix X: Adaptive Equipment for Children with Special Health Care Needs 468 Appendix Y: Non-Poisonous and Poisonous Plants 470 Appendix Z: Depth Required for Shock-Absorbing Surfacing Materials for Use Under Play Equipment 472 Appendix AA: Medication Administration Packet 474 Appendix BB: Emergency Information Form for Children with Special Health Care Needs 479 Appendix CC: Incident Report Form 481 Appendix DD: Injury Report Form for Indoor and Outdoor Injuries 482 Appendix EE: America’s Playgrounds Safety Report Card 484 Appendix FF: Child Health Assessment 487 Appendix GG: Licensing and Public Regulation of Early Childhood Programs 488 Appendix HH: Use Zones and Clearance Dimensions for Single-and Multi-Axis Swings 496 Appendix II: Bicycle Helmets Quick-Fit Check 499 Appendix JJ: Our Child Care Center Supports Breastfeeding 501 Appendix KK: Authorization for Emergency Medical Care 502 Appendix LL: Conversion Table CFOC 2nd Edition to 3rd Edition 503 Appendix MM: Coinversion Table CFOC 3rd Edition to 2nd Edition 523 Glossary .541 Acronyms 555 Index 558 Table of Contents viii Caring for Our Children: National Health and Safety Performance Standards ACKNOWLEDGMENTS field We are pleased to build upon their foundational work in this Third Edition with new science and research The National Resource Center for Health and Safety in Child Care would like to acknowledge the outstanding contributions of all persons and organizations involved in the revision of Caring for Our Children: National Health and Safety Performance Standards: Guidelines for Out-of-Home Child Care Programs, Third Edition. The collaboration of the American Academy of Pediatrics, the American Public Health Association, and the Maternal and Child Health Bureau provided a wide scope of technical expertise from their constituents in the creation of this project The subjectspecific Technical Panels as listed provided the majority of the content and resources Over 180 organizations and individuals were asked to review and validate the accuracy of the content and contribute additional expertise where applicable The individuals representing these organizations are listed in Stakeholder Reviewers/Additional Contributors (see below) This broad collaboration and review from the best minds in the field has led to a more comprehensive and useful tool Technical Panel Chairs and Members Child Abuse Anne B Keith, DrPH, RN, C-PNP, Chair; New Gloucester, ME Melissa Brodowski, MSW, MPH; Washington, DC Gilbert Handal, MD, FAAP; El Paso, TX Carole Jenny, MD, MBA, FAAP; Providence, RI Salwa Khan, MD, MHS; Baltimore, MD Ashley Lucas, MD, FAAP; Baton Rouge, LA Hannah Pressler, MHS, PNP-BC; Portland, ME Sara E Schuh, MD, FAAP; Charleston, SC Child Development Angela Crowley, PhD, APRN, CS, PNP-BC, Chair; New Haven, CT George J Cohen, MD, FAAP; Rockville, MD Christine Garvey, PhD, RN; Chicago, IL Walter S Gilliam, PhD; New Haven, CT Peter A Gorski, MD, MPA; Tampa, FL Mary Louise Hemmeter, PhD; Nashville, TN Michael Kaplan, MD; New Haven, CT Cynthia Olson, MS; New Haven, CT Deborah F Perry, PhD; Baltimore, MD June Solnit Sale, MSW; Los Angeles, CA In a project of such scope, many individuals provide valuable input to the end product We would like to acknowledge those individuals whose names may have been omitted Steering Committee Danette Swanson Glassy, MD, FAAP Co-Chair, American Academy of Pediatrics; Mercer Island, WA Children with Special Health Care Needs Herbert J Cohen, MD, FAAP, Chair; Bronx, NY Elaine Donoghue, MD, FAAP; Neptune, NJ Lillian Kornhaber, PT, MPH; Bronx, NY Jack M Levine, MD, FAAP; New Hyde Park, NY Cordelia Robinson Rosenberg, PhD, RN; Aurora, CO Sarah Schoen, PhD, OTR; Greenwood Village, CO Nancy Tarshis, MA, CCC/SP; Bronx, NY Melanie Tyner-Wilson, MS; Lexington, KY Jonathan B Kotch, MD, MPH, FAAP Co-Chair, American Public Health Association; Chapel Hill, NC Barbara U Hamilton, MA Project Officer, U.S Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau; Rockville, MD Marilyn J Krajicek, EdD, RN, FAAN Director, National Resource Center for Health and Safety in Child Care and Early Education; Aurora, CO Environmental Quality Steven B Eng, MPH, CIPHI(C), Chair; Port Moody, BC Darlene Dinkins; Washington, DC Hester Dooley, MS; Portland, OR Bettina Fletcher; Washington, DC C Eve J Kimball, MD, FAAP; West Reading, PA Kathy Seikel, MBA; Washington, DC Richard Snaman, REHS/RS; Arlington, VA Brooke Stebbins, BSN; Concord, NH Nsedu Obot Witherspoon, MPH; Washington, DC Phyllis Stubbs-Wynn, MD, MPH Former Project Officer, U.S Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau; Rockville, MD The Caring for Our Children, 3rd Ed Steering Committee would like to express special gratitude to the Co-Chairs of the First and/or Second Editions: Dr Susan Aronson, MD, FAAP; Dr Albert Chang, MD, MPH, FAAP; and Dr George Sterne, MD, FAAP General Health CAPT Timothy R Shope, MD, MPH, FAAP, Chair; Portsmouth, VA Abbey Alkon, RN, PNP, PhD; San Francisco, CA Paul Casamassimo, DDS, MS; Columbus, OH Sandra Cianciolo, MPH, RN; Chapel Hill, NC Beth A DelConte, MD, FAAP; Broomall, PA Karen Leamer, MD, FAAP; Denver, CO Judy Romano, MD, FAAP; Martins Ferry, OH Their leadership and dedication in setting the bar high for quality health and safety standards in early care and education ensured that children experienced healthier and safer lives and environments in child care and provided a valuable and nationally recognized resource for all in the ix Acknowledgments Caring for Our Children: National Health and Safety Performance Standards Lead Organizations’ Reviewers Linda Satkowiak, ND, RN, CNS; Denver, CO Karen Sokal-Gutierrez, MD, MPH, FAAP; Berkeley, CA American Academy of Pediatrics Sandra G Hassink, MD, MPH, FAAP Infectious Diseases American Public Health Association Elizabeth L M Miller, BSN, RN, BC; Newtown Square, PA Barbara Schwartz, PhD; New York, NY Larry Pickering, MD, FAAP, Chair; Atlanta, GA Ralph L Cordell, PhD; Atlanta, GA Dennis L Murray, MD; Augusta, GA Thomas J Sandora, MD, MPH; Boston, MA Andi L Shane, MD, MPH; Atlanta, GA U.S Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau R Lorraine Brown, RN, BS, CPHP; Rockville, MD CAPT Stephanie Bryn, MPH; Rockville, MD Denise Sofka, MPH, RD; Rockville, MD Injury Prevention Seth Scholer, MD, MPH, Chair; Nashville, TN Laura Aird, MS; Elk Grove Village, IL Sally Fogerty, BSN, Med; Newton, MA Paula Deaun Jackson, MSN, CRNP, LNC; Philadelphia, PA Rhonda Laird; Nashville, TN Sarah L Myers, RN; Moorhead, MN Susan H Pollack, MD, FAAP; Lexington, KY Ellen R Schmidt, MS, OTR; Washington, DC Alexander W (Sandy) Sinclair; Washington, DC Donna Thompson, PhD; Cedar Falls, IA National Resource Center for Health and Safety in Child Care and Early Education Project Team Marilyn J Krajicek, EdD, RN, FAAN; Director Jean M Cimino, MPH; Professional Research Assistant Betty Geer, MSN, RN, CPNP; Research Assistant Barbara U Hamilton, MA; Former Assistant Director Susan Paige Lehtola, BBA, BS; Research Assistant David Merten, BS; Former Research Assistant Garrett T Risley, MBA-HA; Research Assistant Linda Satkowiak, ND, RN, CNS; Nurse Consultant Gerri Steinke, PhD; Evaluator Ginny Torrey, BA; Program Specialist Nutrition Catherine Cowell, PhD, Chair; New York, NY Sara Benjamin Neelon, PhD, MPH, RD; Durham, NC Donna Blum-Kemelor, MS, RD, LD; Alexandria, VA Robin Brocato, MHS; Washington, DC Kristen Copeland, MD, FAAP; Cincinnati, OH Suzanne Haydu, MPH, RD; Sacramento, CA Janet Hill, MS, RD, IBCLC; Sacramento, CA Susan L Johnson, PhD; Aurora, CO Ruby Natale, PhD, PsyD; Miami, FL Shana Patterson, RD; Denver, CO Barbara Polhamus, PhD, MPH, RD; Atlanta, GA Susan Schlosser, MS, RD; Chappaqua, NY Denise Sofka, MPH, RD; Rockville, MD Jamie Stang, PhD, MPH, RD; Minneapolis, MN Stakeholder Reviewers/Additional Contributors Kenneth C Akwuole, PhD U.S Administration for Children and Families, Office of Child Care, DC Duane Alexander, MD, FAAP National Institute of Child Health and Human Development, MD Abbey Alkon, RN, PNP, MPH, PhD American Academy of Pediatrics, Section on Early Education and Child Care, IL University of California San Francisco, California Childcare Health Program, CA Organization and Administration Christopher A Kus, MD, MPH, Chair; Albany, NY Christine Ross–Baze; Topeka, KS Janet Carter; Dover, DE Sally Clausen, ARNP, BSN; Des Moines, IA Judy Collins; Norman, OK Pauline Koch; Newark, DE Jackie Quirk; Raleigh, NC Krista Allison, RN, BSN Parent, CO Jamie Anderson, RNC, IBCLC New Jersey Department of Health and Senior Services, Division of Family Health Services, NJ Staff Health Amy C Cory, PhD, RN, CPNP, PCNS, BC, Chair; Valparaiso, IN Patricia S Cole; Indianapolis, IN Susan Eckelt, CDA; Tulsa, OK Bethany Geldmaker, PNP, PhD; Richmond, VA Stephanie Olmore, MA; Washington, DC Barbara Sawyer; Arvada, CO Acknowledgments Kristie Applegren, MD American Academy of Pediatrics, Council on Communication and Media, IL Lois D W Arnold, PhD, MPH National Commission on Donor Milk Banking, American Breastfeeding Institute, MA x Caring for Our Children: National Health and Safety Performance Standards Facilities (cont.) collection of data on illness or harm to children in, 411 compliance with fire prevention code, 199 designating role of person responsible for coordinating care in child care, 338 development of list of providers of services to, 405 diaper changing areas, 248 handwashing sinks for in centers, 248–249 in homes, 249 maintenance of tables, 249–250 requirements for tables, 249–250 use, location, and setup of, 249 electrical service, 219 electrical cords, 220 extension cords, 220 ground fault circuit interrupters (GFCIs) for outlets near water, 220 location of electrical devices near water, 220 safety covers and shock protection devices for, 219 exits access to, 208 alternate, and emergency shelter, 206 closet door latches, 208 evacuation of children with special health care needs and children with disabilities, 206–207 labeled emergency, 208 locks, 207–208 path of egress, 207 exterior areas areas used by children for wheeled vehicles, 210 construction and maintenance of walkways, 209–210 designated walkways, bike routes, and drop-off and pick-up points, 209 drainage of paved surfaces, 210 guardrails and protective barriers, 210–211 location of satellite dishes, 211 walking surfaces, 210 fire warning systems, 221 cross-connections, 224 drinking fountains, 224 emergency safe drinking water and bottled water, 223 handwashing sink using portable water supply, 224 installation of pipes and plumbing fixtures, 224 portable fire extinguishers, 221 testing for lead and copper levels in drinking water, 222–223 testing of drinking water not from public system, 222 water handling and treatment equipment, 223–224 water supply, 221–222 water test results, 223 floor space beneath low ceiling heights, 204 general furnishings and equipment, 237–244 arrangements to minimize back injuries, 241 availability and use of telephone or wireless communication device, 243 carriage, stroller, gate, enclosure, and play yard requirements, 242 ceilings, 240–241 exercise, 243 floors, 240–241 high chair requirements, 241–242 orthotic and prosthetic devices, 244 placement of equipment and furnishings, 240 product recall monitoring, 238 restrictive infant equipment requirements, 242–243 safety of equipment, materials, and furnishings, 237–238 size of furniture, 238–239 special adaptive, 244 storage for adaptive, 244 surfaces of equipment, furniture, toys, and play materials, 239–240 therapeutic and recreational, 244 walls, 240–241 governing body of, 347 inclusion and exclusion of children from, that serve children who are ill, 141 inspection of, 199, 409–410 insurance coverage for, 377 integrated pest management, 226–228 insect breeding hazard, 228 laundry area location of equipment and water temperature for laundering, 251 service and equipment, 251 layout to reduce risk of child abuse and neglect, 125–126 licensing, 407–411 alternative means of compliance, 408-409 procedure prior to issuing a license, 408–409 quality rating and improvement systems, 408 that care for children who are ill, 140 uniform categories and definitions, 407–408 lighting emergency, 218 fixtures including halogen lamps, 217–218 high intensity discharge lamps, 218 levels of illumination, 217–218 565 mercury lamps, 218 multi-vapor lamps, 218 maintenance cleaning of humidifiers, 261 cleaning schedule for exterior areas, 260 electrical fixtures and outlets, 261 of exterior surfaces, 259 inaccessibility of hazardous equipment, 260 plumbing and gas, 261 removal of allergen triggering materials from outdoor areas, 260 removal of hazards from outdoor areas, 259–260 storage area ventilation and, 260 structure, 261 monitoring of, 409–410 multiple use of rooms, 202–203 noise, levels of, 218–219 notification of, about infectious disease or other problems by parents, 145 office space, 202 on-site sewage systems, 225 containment of garbage, 225 containment of soiled diapers, 226 labeling, cleaning, and disposal of waste and diaper containers, 226 removal of garbage, 225 storage and disposal of infectious and toxic wastes, 226 openings directional swing of indoor doors, 206 finger-pinch protection devices, 205–206 possibility of exit from windows, 204–205 safety guards for glass windows/ doors, 205 screens for ventilation, 205 weather-tightness and water-tightness, 204 plan for responding to death of child, 146–147 prevention and management of toxic substances, 228–229 carbon monoxide detectors, 230–231 chemicals used to control odors, 234 construction and remodeling during hours of operation, 237 exposure to asbestos or other friable materials, 231 informing staff regarding presence of toxic substances, 229–230 plastic containers and toys, 232–234 prohibition of poisonous plants, 234 proper use of art and craft materials, 231–232 radon concentrations, 230 shoes in infant play areas, 236–237 testing for lead, 235–236 Index Caring for Our Children: National Health and Safety Performance Standards Facilities (cont.) treatment of chromated copper arsenate (CCA) pressure-treated wood, 234–235 use and storage of toxic substances, 228 use of play dough and other manipulative art of sensory materials, 232 use of poison center, 229 process prior to enrolling at, for children with special health care needs and disabilities, 336 program requirements for, that care for children who are ill, 138 in promoting active opportunities for physical activity, 90–93 provision of training to, by health agencies, 415-416 quality of outdoor and indoor environment, 211–237 ventilation, heating, cooling, and hot water, 211–217 record of valid license, certificate or registration of, 384 records of access to, 379 availability of records to licensing agency, 380 maintenance of, 378 proper installation and maintenance of equipment of, 375 written policy on confidentiality of, 378–379 requirements for, to report to health department, 413-414 Safe Sleep Policy at, 100–101 safe sleep practices for, 96–99 scheduled rest periods and sleep arrangements, 100–101 separation of operations from child care areas, 202 sleep and rest areas bunk beds, 255 cribs, 253–254 equipment and supplies, 251–253 futons, 255 stackable cribs, 254–255 space for children who are ill, injured, or need special therapies for ill children, 255 for therapy services, 255–256 space per child, 203–204 steps and stairs, 208–209 balusters, 208 guards at stairway access opening, 209 handrails, 208–209 landings, 209 storage areas coat hooks/cubicles, 256 firearms, 257 of flammable materials, 256–257 inaccessibility to matches, candles, and lighters, 257 of plastic bags, 257 Index of play and teaching equipment and supplies, 256 for soiled and clean linens, 256 storage and labeling of personal articles, 256 structurally sound, 201 supplies for bathrooms and handwashing sinks, 258–259 first aid and emergency, 257–258 microfiber cloths, rags, and disposable towels and mops used for cleaning, 259 single service cups, 258 support for consultants to provide technical assistance to facilities, 403–405 technical assistance to, to address diversity in community, 406 toilet and handwashing areas ability to open toilet room doors, 245 chemical toilets, 245–246 cleaning and disinfection, 247 general requirements for, 245 handwashing sinks, 247–248 learning/training equipment, 246–247 location of toilets and privacy issues, 245 mop sinks, 248 preventing entry to toilet rooms by infants and toddlers, 245 prohibited uses of handwashing sinks, 248 ratios of toilets, urinals, and hand sinks to children, 246 waste receptacles in child care facility and in child care facility toilet rooms, 247 toothbrushes and toothpaste in, 102–103 types of, xxii unrelated business in child care area, 201–202 unscheduled access to rest areas, 101 window size, 205 Facilities serving children with disabilities, specialized consultation for, 39 Facilities that care for children who are ill See also Ill children child care health consultants for, 139–140 child-staff ratios for, 139 Facility health log, contents of, for each child, 391–392 Facility records/reports, 377–386 Fact sheets, use of, on common illnesses associated with child care, 414 Families coordination of public and private resources to ensure, access to quality child care, 417 helping cope with separation, 53–54 information sharing on health of, 358 meal service, benefits of meal service style, 179 Family and Medical Leave Act (1993) (FMLA), parental leave and, Family child care homes 566 alcoholic beverages in, 118-119 caregivers/teachers qualifications, 18–19 child-staff ratios, continuing education for directors of, 31 defined, 407 support networks for, 19 Family Educational Rights and Privacy Act (FERPA), 38 care plan for children with special health care needs, 129-130 confidentiality of, 130-131 Fans, electric, 214 Feeding infants on cue by consistent caregivers/teachers, 164–165 Fever defined, 141 temporary exclusion of children and, 132 Finger-pinch protection devices, 205–206 Fire, response to, 123 Firearms, 257 policy prohibiting, 363–364 Fire extinguishers portable, 221 use of, 123 Fireplaces, 215–216 inserts in, 215–216 Fire prevention code, compliance with, 199 Fire protection devices, availability of reports on inspections of, 385 Fire warning systems, 221 cross-connections, 224 drinking fountains, 224 emergency safe drinking water and bottled water, 223 handwashing sink using portable water supply, 224 installation of pipes and plumbing fixtures, 224 portable fire extinguishers, 221 testing for lead and copper levels in drinking water, 222–223 testing of drinking water not from public system, 222 water handling and treatment equipment, 223–224 water supply, 221–222 water test results, 223 Firearms, 257 policy prohibiting, 363–364 Fireplaces, 215-216 inserts in, 215-216 First aid child-staff ratio and, emergency supplies and, 257–258 topics covered in training, 25 training for staff in, 24–25 Flammable materials, storage of, 256–257 Floors, 240–241 Flu See influenza Fluoride toothpaste, regular tooth brushing with, 101 Fluoride varnish, reduction in decay rates and, 102 Food allergies care for children with, 160–161 dietary modifications and, 159 Caring for Our Children: National Health and Safety Performance Standards Food and nutrition service policies and plans, 361 Food areas and equipment, cleaning, 193 Food avoidance, successful, 160–161 Food-borne illness See also Infectious diseases food brought from home and, 182 outbreaks of, 361 restriction of staff from food preparation and handling, 188–189 Food brought from home nutritional quality of, 183 selection and preparation of, 182 Food poisoning, food brought from home and, 182 Food preparation area, 185–186 Foods burns from hot liquids and, 181 categories of, 155–156 experience with familiar and new, 181 feeding age-appropriate solid, to infants, 173–174 introduction of age-appropriate solid to infants, 172–173 introduction of new, 159–160 maintaining safe temperatures, 187 nutritional quality of, when brought from home, 183 prohibited uses of, 182 selection and preparation of, brought from home, 182 storage of dry bulk, 192 supply of, for disaster, 192–193 that are choking hazards, 181 training of stall with responsibilities for handling, 29–30 Food safety cleaning food areas and equipment, 193 compliance with Food and Drug Administration, U S (FDA) sanitation standards, state and local, 188 cutting boards, 193 dishwashing in centers, 193–194 in small and large family child care homes, 194 leftovers, 191 precautions for safe food supply, 189–191 preparation for and storage of food in refrigerator, 191–192 staff restricted from food preparation and handling, 188–189 storage of dry bulk foods, 192 of foods not requiring refrigeration, 192 supply of food and water for disasters, 192–193 during transport, 195 washing dishes by hand, 194–195 Food sensitivity, problems of, 159 Food service See Nutrition and Food Service Food service facilities, holding of food prepared at off-site, 195 Food Stamp Programs, soy-based formula and soy milk, 169 Formula concentrated, 168 elements, 168 powdered, 168 preparation, 167-169 soy-based, 169 storage, 168 Fountains, drinking, 224 Friable materials, preventing exposure to, 231 Frostbite, 94 Fruit, whole as more nutritious than juice, 157–158 Fruit juice, 157–158 Funding, adequacy of staff and, for regulatory enforcement, 397 Furnishings arrangements to minimize back injuries, 241 availability and use of telephone or wireless communication device, 243 carriage, stroller, gate, enclosure, and play yard requirements, 242 ceilings, 240–241 exercise, 243 floors, 240–241 general, 237–244 high chair requirements, 241–242 orthotic and prosthetic devices, 244 placement of, 240 product recall monitoring, 238 requirements for safety of equipment, materials, and furnishing, 237–238 restrictive infant equipment requirements, 242–243 safety of equipment, materials, and furnishings, 237–238 size of furniture, 238–239 special adaptive, 244 storage for adaptive, 244 surfaces of equipment, furniture, toys, and play materials, 239–240 therapeutic and recreational, 244 walls, 240–241 Furniture, size of, 238–239 Futons, 255 G Garbage containment of, 225 removal of, 225 Gas grills, 214–215 Gas heaters, 214–215 Gas maintenance, 261 Gas stoves, portable, 214–215 Gastrointestinal (GI) tract disease diaper hygiene and, 104 notification of parents/guardians, 145 Gate requirements, 242 Gender awareness, 83 Generators, 214–215 Glass windows/doors, safety guards for, 205 Gloves body fluids exposure and, 114 for changing children’s soiled underwear/ pull-ups and clothing, 109 for diaper changing, 107 567 hypoallergenic latex, 116 preventing transmission of infectious diseases, 115, 116 G-max scale, 274 Governance, 347–348 governing body of facility, 347 written delegation of administrative authority, 347–348 Governing body of facility, 347 Ground fault circuit interrupters (GFCIs), 219 for outlets near water, 220 Group A streptococcal (GAS) infections exclusion for, 300–301 informing caregivers/teachers of, 301 Group size defined, floor space and, 203 recommended, and child-staff ratio for, for small family child care homes, 3–4 Growth charts, basis for, 90 Guardians See Parents/guardians Guardrails for elevated play areas, 266–267 protective barriers and, 210–211 Guards at doors, 205 at heaters, 216 at stairway access openings, 209 at windows, 204-205 splash, 187 Guideline, xxi H Haemophilus influenzae type B (HIB) immunization for, 301–303 informing parents/guardians of, 302 notification of parents/guardians, 145 staff exclusion and, 135 Halogen lamps, light fixtures including, 217–218 Hand hygiene, 110–113 after applying insect repellent, 127 assisting children with, 112 hand sanitizers, 113 handwashing procedure, 111–112 situations that require, 110–111 training and monitoring for, 112–113 washing, 194–195 Handrails, 208–209 Hand sanitizers, 111, 113 Hand sinks, ratios of, to children, 246 Handwashing procedure in child care centers, 111–112 Handwashing sinks, 247–248 for diaper changing areas in centers, 248–249 for diaper changing areas in homes, 249 portable water supply for, 224 prohibited uses of, 248 separate from food zones, 187 supplies for, 258–259 Harm, collection of data on, or illness to children in facilities, 411 Hazardous equipment, inaccessibility of, 260 Hazards, removal of, from outdoor areas, 259–260 Index Caring for Our Children: National Health and Safety Performance Standards Head count, caregivers/teachers’ of children during transportation, Head-impact injuries, 274 Head injury criterion (HIC) scale, 274 Head lice attendance of children with, 319 spread of, from sharing helmets, 286 staff exclusion and, 135 temporary exclusion of children and, 133 Head Start Act, section 645A of, 352 Health, nutrition, physical activity, and safety awareness, 50 Health advocates, qualifications and responsibilities for, 16–18 Health agencies, provision of training to facilities by, 415-416 Health care for animals, 121 Health department requirements for facilities to report to, 413-414 responsibilities and role of, 411–414 written plans for role of, 413 written policy reporting notifiable diseases, 355 Health education for caregivers/teachers, 83–84 for parents/guardians, 84–85 staff modeling of healthy and safe behavior and activities, 82–83 topics for children, 81–82 Health history, 390 Health information sharing, parents/guardians provision of information on their child’s health and behavior, 80–81 Health insurance, caregivers/teachers need for, 376 Health Insurance Portability and Accountability Act (1996) (HIPAA) care plan for children with special health care needs, 130 confidentiality of, 131 Health limitations of staff, 41 Health policies, 353–364 child care health consultant’s review of, 364 content and development of plan for care of children and staff who are ill, 354 documentation of exemptions and exclusion of children who lack immunizations, 356 food and nutrition service, and plans, 361 identification of child’s medical home and parental consent for information exchange, 356–357 infant feeding, 361–362 information sharing on family health, 358 on therapies and treatments needed, 357–358 oral, 362–363 plans for evening and nighttime child care, 362 policies and practices that promote physical activity, 353–364 prohibiting Index firearms, 363–364 smoking, tobacco, alcohol, illegal drugs, and toxic substances, 363 for reporting notifiable diseases to health department, 355 sanitation, and procedures, 360–361 on use of medications, 358–360 written, for obtaining preventive health service information, 355–356 Health protection in child care, 125 animals and, 119–122 care for children who have been abused/ neglected, 125 child abuse and neglect, 123–126 for children who have been abused/neglected, 125 daily health check, 89 emergency procedures and, 122–123 facility layout to reduce risk of child abuse and neglect, 125–126 fire extinguishers, 123 insect repellent and protection from vector-borne diseases, 127–128 preventing and identifying shaken baby syndrome/abusive head trauma, 125 to reduce risk of child abuse and neglect, 125–126 response to fire and burns, 123 routine health supervision and, 89–90 sun safety including sunscreen, 126–127 tobacco and drug use, 118–119 Heat-induced illness, preventing, 93 Heating, 211–217 Heating, ventilation, air conditioning (HVAC) systems, 211–217 inspection and maintenance, 212–213 Helmets, 286–287 Hepatitis A virus (HAV) infections control of, 311–313 disease surveillance of, 314 staff education and policies on, 313–314 staff exclusion and, 135 temporary exclusion of children and, 133 Hepatitis B virus (HBV) infections disease recognition and control of, 321–322 handling injuries to carrier, 323–324 observation and follow-up of child who is, 322–323 risk of transmission in feeding human milk to another mother’s child, 167 Hepatitis C virus (HCV) infections control measures with, 324 risk of transmission in feeding human milk to another mother’s child, 167 Herpes simplex virus (HSV) disease recognition and control of, 327 Herpes virus and (roseola), 327–328 Herpes viruses, 326 cytomegalovirus (CMV), 326–327 herpes simplex, 327 herpes virus and 7, 327–328 varicella-zoster (chickenpox), 328–329 High chair limiting infant/toddler time in, 66 requirements for, 241–242 washing, rinsing, and sanitizing trays, 178 568 High intensity discharge lamps, 218 Hip dysplasia, swaddling and, 99 History, health, 390 Hitting, handling, 72–73 HIV See Human immunodeficiency virus (HIV) infection Home room for school-age children, Homes handwashing sinks for diaper changing areas in, 249 nutritional quality of food when brought from, 183 selection and preparation of food brought from, 182 Hospitalizations from food allergy, 160 Hot water, 211–217, 216 Hours of operation construction and, 237 remodeling during, 237 Humane care for animals, 121 Human immunodeficiency virus (HIV) infection, 324–326 attendance of children with, 324 risk of transmission in feeding human milk to another mother’s child, 167 staff education about preventing transmission of, 325 Human milk See also Breastfeeding as developmentally appropriate for infants, 151 feeding to another mother’s child, 167 iron-fortified infant formula as alternative to, 163 preparing, feeding, and storing, 165–166 Human papillomaviruses (warts), 316 Human resource management, 375–377 benefits, 43 written for centers and large family child care homes, 375–376 for small family child care homes, 376–377 Human temperatures, thermometers for taking, 135–136 Humidifiers cleaning of, 261 maintenance of, 216–217 Hygiene checking for need to change diapers, 105 cough and sneeze etiquette, 114 diaper changing procedure, 106–108 exposure to body fluids, 114–116 hand, 110–113 handling cloth diapers, 105 procedure for changing children’s soiled underwear/pull-ups and clothing, 108–110 type of diapers worn, 104–105 Hyperthermia, 99, 291-292, 373 Hypoallergenic latex gloves, 116 Hypothermia, 94, 292 Caring for Our Children: National Health and Safety Performance Standards I Illegal drugs, policies prohibiting, 363 Illness See also Food-borne illness; Infectious diseases collaborative development of child care requirements for children with, 400 collection of data on, or harm to children in facilities, 411 content and development of plan for children and staff who have, 354 documentation of parents/guardians notification of, 383 records of, 381–382 reporting, 144–147 review and accessibility of reports on, 383–384 use of fact sheets on common, associated with child care, 414 Immunity for reporters of child abuse and neglect, 124 Immunizations autism and, 299 of caregivers/teachers, 299–300 documentation, 297–298 of exemptions and exclusion of children who lack, 356 against Haemophilus influenzae type B (HIB), 301–303 importance of, in child care, 297–298 against infectious diseases, 297–300 against influenza, 303 against measles-mumps-rubella, 304, 318 parent/guardian concerns over safety of, 298–299 PCV7, 308 PCV13, 308 against Streptococcus pneumoniae, 308–309 Impetigo, 317 temporary exclusion of children and, 133 Inborn errors of metabolism, dietary modifications and, 159 Inclusion, planning for, 335–336 Inclusion/exclusion dismissal of children, 131–135 Individualized Education Programs (IEPs) children with chronic health conditions and, 360 for children with special health care needs and disabilities, 337, 338, 340, 341 compensation for participation in multidisciplinary assessments for children with special health care or education needs and, 405-406 written reports on Individualized Family Service Plan (IFSP), 341 Individualized Family Service Plan (IFSP) children with chronic health conditions and, 360 for children with special health care needs and disabilities, 334, 337, 338, 341 compensation for participation in multidisciplinary assessments for children with special health care or education needs and, 405-406 Individuals with Disabilities Education Act (IDEA) (1991) (PL 102-119) for children with special health care needs and disabilities, 333–335, 338, 340, 342 compensation for participation in multidisciplinary assessments for children with special health care or education needs and, 405-406 Part B Section 619 of, 334–335 Part C of, 333–334, 351 Indoor learning/play environments, transitioning within programs, 54–55 Indoor play areas inspection of, 277 size and requirements of, 265–266 Indoor temperature, 212 Infant equipment requirements, restrictive, 242–243 Infant feeding policy, 361–362 Infant foods, temperature in serving, 171–173 Infant formula preparing, feeding, and storing, 167–169 as supplement for breastfed infant, 151 Infant play areas, shoes in, 236–237 Infants brain development of, 14 caregivers/teachers qualifications for, 14–16 child safety seats for, 290 child-staff ratio for, encouraging self-feeding by older, 175 enrollment in child care settings, 7–8 feeding age-appropriate solid foods to, 173–174 guardrails and protective barriers for, 210 housing of child care units for, 201 human milk as developmentally appropriate for, 151 importance of low child-staff ratios for, interactions with caregivers/teachers, 57–58 limiting time in crib, high chair, car seat, etc., 66 nutrition for, 162–174 cleaning and sanitizing equipment used for bottle feeding, 172 feeding age-appropriate solid foods to, 173–174 feeding cow’s milk, 169–170 feeding human milk to another mother’s child, 167 feeding on cue by consistent caregivers/teachers, 164–165 general plan for feeding, 162–164 introduction of age-appropriate solid foods to, 172–173 preparing, feeding and storing formula, 167–169 preparing, feeding and storing human milk, 165–166 techniques for bottle feeding, 170–171 569 use of soy-based formula and soy milk, 169 warming bottles and foods, 171–172 outdoor play of, 90, 91 personal caregivers/teachers relationships for, 57 preventing entry to toilet rooms by, 245 risk of sudden infant death syndrome (SIDS), 32, 33, 35 safe sleep procedures for, 96 separation of, from older children, 59 space and activity to support learning of, 58–59 tummy time of, 91 Infectious diseases, 297–330, 306 See also Food-borne illness bloodborne infections hepatitis B virus, 321–324 hepatitis C virus, 324 human immunodeficiency virus (HIV), 324–326 daily health check and, 89 enteric (diarrheal) infections and hepatitis A, 311–315 exposure of children to, 144 gloves in preventing, 115 health check in reducing transmission of, 89 herpes viruses cytomegalovirus (CMV), 326–327 herpes simplex, 327 herpes virus and 7, 327–328 varicella-zoster (chickenpox), 328–329 immunizations against, 297–300 of caregivers/teachers, 299–300 documentation, 297–300 unimmunized children, 298–299 interactions with state or local health departments, 329 judicious use of antibiotics, 329–330 as major concern of parents/guardians and staff, 354 measures with Hepatitis C virus (HCV) and control, 324 notification of facility about, or other problems by parents/guardians, 145 for parents/guardians notification about exposure of children to, 144 in preventing transmission of infectious diseases, 115 prevention with sanitation policies, 360 of transmission by handwashing, 247 procedure for parents/guardians notification about exposure of children to, 144 requiring parents/guardians notification, 145 respiratory tract infections group A streptococcal infections, 300–301 Haemophilus influenzae type B, 301–303 influenza, 303–304 Index Caring for Our Children: National Health and Safety Performance Standards Infectious diseases (cont.) mumps, 304–305 Neisseria meningitides, 305–306 parvovirus B19, 306 pertussis, 306–307 respiratory syncytial virus, 307–308 Streptococcus pneumoniae, 308–309 tuberculosis, 309–311 unspecified, 311 sick leave in minimizing, 377 skin and mucous membrane infections conjunctivitis, 315 enteroviruses, 316 human papillomaviruses, 316 impetigo, 317 lymphadenitis, 317–318 measles, 318 molluscum contagiosum, 318–319 Pediculosis capitis (head lice), 319 scabies, 321 Staphylococcus aureus skin infections including MRSA, 320–321 thrush, 321 tinea capitis and tinea cruris, 319–320 spread of, 297 transmission of, 137 written policy for reporting, to the health department, 355 Influenza, 303–304 control of, 303 prevention education, 303–304 written plan for seasonal and pandemic, 368–370 Information community resource, 386 exchange of at transition, 352–353 upon enrollment, 350 obtaining health check from parents/ guardians, 89 parental consent for exchange of, 356–357 pre-admission enrollment, for each child, 387–388 sharing, on family health, 358 sharing, on therapies and treatments needed, 357–358 written policy for obtaining preventive health service, 355–356 Informing staff regarding presence of toxic substances, 229–230 Ingestion of substances that not provide nutrition, 161–162 Injuries documentation of parents/guardians notification of, 383 head-impact, 274 records of, 382 review and accessibility of reports on, 383–384 Insect breeding hazard, 228 Insect repellent, 127–128 Inspections Index Inspections building, 199, 202 electrical, 219 fire safety, 199, 202 for lead, 200, 222, 235-236 frequency, 409 of equipment, 186 of facility, 409 of food, 188-189 of heating systems, 212 of pools, 281 of records, 384 of vehicles, 288, 289 playground safety, 269, 277, 374 reports, 223, 384-385 sanitation,188, 225 unannounced, water quality, 223 Installation of play equipment, 270 Insurance caregivers/teachers need for health, 376 facility coverage, 377 vehicle, 377 Integrated pest management, 226–228 insect breeding hazard, 228 Interferon-gamma release assay (IGRA) blood test, 310 Introduction of age-appropriate solid foods See Age-appropriate solid foods Introduction of new foods, 59, 173, 181, 183 Invasive infections, notification of parents/ guardians, 145 Iron-fortified infant formula as alternative to human milk, 163 J Juice See fruit juice K Kerosene heaters, 214–215 Kitchen and equipment design of food service equipment, 186 food preparation area, 185–186 food preparation sinks, 187 handwashing sink separate from food zones, 187 maintaining safe food temperatures, 187 maintenance of food service surfaces and equipment, 186–187 microwave ovens, 188 ventilation over cooking surfaces, 187–188 L Lactose intolerance See Soy-based formula and soy milk Landings, 209 Language development, fostering, in three-tofive-year olds, 62 Large family child care homes, xxii child-staff ratio for, 4–6 continuing education for directors and caregivers/teachers in, 26 defined, 407 dishwashing in, 194 570 food service staff at, 176 frequency of inspections for, 409 locks in, 207 transportation policy for, 373–374 written daily activity plan and statement of principles, 49–50 written human resource management policies for, 375–376 Latchkey children, 416 Latex, ongoing exposures to, 116 Latex gloves, hypoallergenic, 116 Laundry area location of equipment and water temperature for laundering, 251 service and equipment, 251 Laundry equipment, location of, 251 Laundry service and equipment, 251 Lawn care treatments, chemicals used in, 228 Lead effects of toxicity, 161 in paint, 162, 237–238, 259, 260 in plastic, 232–233, 284 and poison center as a resource, 229 in soil, 93, 200, 236 in tableware and feeding utensils, 178 test results for, 378, 380, 384 testing for, 235–236 testing for levels of, in drinking water, 222–223 Lead teachers, qualifications of, 12–13 Learning, space and activity to support in infants and toddlers, 58–59 Learning experiences for children, 183–185 Learning/play environments, transitioning within programs and indoor and outdoor, 54–55 Leftovers, 191 Lice See Head lice Licenses licensing agency procedures prior to issuing, 408 record of valid, 384 Licensing agency, 398–407 availability of records to, 380 collaborative development of child care requirements and guidelines for children who are ill, 400 community participation in development of rules, 398–399 licensing staff training, 406–407 operation permits, 398 procedures prior to issuing a license, 408 provision of child abuse prevention materials, 402 public-private collaboration on care of children who are ill, 400 rational basis of regulations, 398 role in communicating importance of compliance with Americans with Disabilities Act, 402 role with staff credentials, child abuse prevention, and Americans with Disabilities Act, 399–400, 400–402 technical assistance from, 402-406 training of personnel, about child abuse, 407 Caring for Our Children: National Health and Safety Performance Standards Licensing and community action, 397–418 caregivers/teachers support, 414-416 facility licensing, 407–411 health department responsibilities and role, 411–415 licensing agency, 398–407 public policy issues, 397–418 regulatory policy, 397 Licensing inspectors education, experience and training of, 406–407 performance monitoring of, 406-407 Licensing of facilities that care for children who are ill, 140 Licensing rules, community participation in development of, 398–399 Licensing staff training, 406–407 Lighters, inaccessibility to, 257 Lighting, 217–218 emergency, 218 fixtures including, 217–218 high intensity discharge lamps, 218 levels of illumination, 217–218 mercury lamps, 218 multi-vapor lamps, 218 natural, 217 Limiting time in equipment (cribs, high chairs, etc), 66 screen, 66-68 Linens, storage for soiled and clean, 256 Local health department interaction with, concerning infectious diseases, 329 role of, 411–414 Lock down drills, record of, 385 Locks, 207–208 Lost child, 364 Lyme disease, 128 Lymphadenitis, 317–318 M Maintenance of air filters, 214 of changing tables, 250 cleaning of humidifiers, 261 cleaning schedule for exterior areas, 260 of dehumidifiers, 216–217 electrical fixtures and outlets, 261 of exterior surfaces, 259 gas, 261 of humidifiers, 216–217 inaccessibility of hazardous equipment, 260 plumbing, 261 plumbing and gas, 261 removal of allergen triggering materials from outdoor areas, 260 removal of hazards from outdoor areas, 259–260 storage area ventilation and, 260 structure, 261 Management of illness inclusion/exclusion due to illness, 131–136 infectious disease outbreak control, 136 sharing of personal articles prohibited, 136 staff exclusion for, 135 thermometers for taking human temperatures, 135–136 Manipulative art or sensory materials, use of, 232 Matches, inaccessibility to, 257 Material Safety Data Sheets (MSDS), 213–214, 228 Maternal and Child Health programs, nutrition training and, 27 Mattresses, 118, 252 McKinney-Vento Homeless Assistance Act, 356 Meal and snack patterns, 156–157 for infants, 361-362 for school-age children, 175–176 for toddlers and preschoolers, 174–175 Meals, socialization during, 179–180 Meal service, seating, and supervision, 177–182 activities that are incompatible with eating, 178–179 adult supervision of children who are learning to feed themselves, 180 developmentally appropriate seating and utensils for meals, 177–178 experience with familiar and new foods, 181 foods that are choking hazards, 181 hot liquids and foods, 181 numbers of children fed simultaneously by one adult, 180 participation of older children and staff in mealtime activities, 180 prohibited uses of food, 182 socialization during meals, 179–180 tableware and feeding utensils, 178 Meals from outside vendors or central kitchens approved off-site food services, 195 food safety during transport, 195 holding of food prepared at off-site food service facilities, 195 Mealtime activities, participation of older children and staff in, 180 Measles, 318 immunization against, 304, 318 notification of parents/guardians, 145 staff exclusion and, 135 temporary exclusion of children and, 133 Measles-mumps-rubella (MMR) vaccine, 304, 318 Measurable objectives, development of, for children with special health care needs and disabilities, 338–340 Media, limiting, 66–68 Medical care authorization form, Appendix KK coordinating, 356-357 for children with special health care needs, 336-337 for frostbite, 94 for hypothermia, 94 when to seek, Appendix P written plan and training for handling urgent, or threatening incidents, 364–365 571 Medical home, identification of, 356–357 Medical procedures, caring for children who require, 130–131 Medications administration, 141–142 labeling, storage, and disposal, 143 non-prescription, over-the-counter (OTC), 141-142 parents/guardians notification on use of, 357–358 policy on use of, 358–360 standing orders, 142 toxicity of, 228 training of caregivers/teachers to administer, 143–144 Medications record, 359–360 contents of, 391 Meningococcal infections informing public health authorities of, 305–306 recommended control measures for invasive, 305 staff exclusion and, 135 Mental health, See Consultants Menus, written, 159–160 Mercury lamps, 218 Methicillin-resistant Staphylococcus aureus (MRSA), 320–321 Microfiber cloths, used for cleaning, 259 Microwave ovens, 188 Milk See also Human milk allergy to, 153, 159, 161, 169 cow’s, 169-170 dry, 189 flavored, 155t, 169 low-fat, 169-170, 190 one-percent, 169-170, 190 skim, 189-190 soy, 169 two-precent, 169-170, 190 whole, 169-170, 190 Mini-blinds, 235-236 Minimum age to enter child care, 7–9 Mixed age groups, 4, 27, 29, 59 Mixed director/teacher role, 12 Modeling, opportunities for, of health and safety education for parents/guardians, 84 Model work standards, development of, 376 Molluscum contagiosum, 318–319 Mops for cleaning, 259 Mop sinks, 248 Mosquito-borne viruses, 228 Mouth cleaning and sanitizing objects intended for, 118 temporary exclusion of children and sores of, 133 Multidisciplinary assessment, compensation for participation in, for children with special health care or education needs, 405-406 Multiple use of rooms, 202–203 Multi-vapor lamps, 218 Mumps, 304–305 temporary exclusion of children and, 133 Index Caring for Our Children: National Health and Safety Performance Standards N Nap time area for, 101, 118 child-staff ratio for, 3, Nasal bulb syringes, use of, 114–116 Nasal secretions, procedure for, 114–116 Native language, communication in, other than English, 55 Natural lighting, 217 Neisseria meningitides, 305–306 notification of parents/guardians, 145 Nicotine withdrawal, caregivers/teachers stress related to, 42 Nighttime child care, plans for, 362 Nipples, 165, 170, 172, 233 Noise, levels of, 218–219 Nondiscriminatory policy, 350–351 Nurse, substitute, 32 Nutrition assessment and planning of, for individual children, 153 food handling staff, 29–30 for infants, 162–174 cleaning and sanitizing equipment used for bottle feeding, 172 feeding age-appropriate solid foods to, 173–174 feeding cow’s milk, 169–170 feeding human milk to another mother’s child, 167 feeding on cue by consistent caregivers/teachers, 164–165 general plan for feeding, 162–164 introduction of age-appropriate solid foods to, 172–173 preparing, feeding and storing formula, 167–169 and storing human milk, 165–166 soy-based formula and soy milk for, 169 techniques for bottle feeding, 170–171 warming bottles and foods, 171–172 need for written plan in, 152–153 Nutrition and Food Service, 151–195 approved off-site, 195 assessment and planning of nutrition for individual children, 153 availability of drinking water, 157 care for children with food allergies, 160–161 categories of foods, 155–156 education for parents/guardians, 185 feeding plans and dietary modifications, 158–159 food brought from home nutritional quality of, 183 selection and preparation of, 182 food safety cleaning food areas and equipment, 193 compliance with Food and Drug Administration, U S (FDA) sanitation standards, state and local, 188 Index cutting boards, 193 dishwashing in centers, 193–194 dishwashing in small and large family child care homes, 194 leftovers, 191 precautions for safe food supply, 189–191 preparation for and storage of food in refrigerator, 191–192 staff restricted from food preparation and handling, 188–189 storage of dry bulk foods, 192 storage of foods not requiring refrigeration, 192 supply of food and water for disasters, 192–193 washing dishes by hand, 194–195 fruit juice, 157–158 ingestion of substances that not provide nutrition, 161–162 kitchen and equipment design of food service equipment, 186 food preparation area, 185–186 food preparation sinks, 187 handwashing sink separate from food zones, 187 maintaining safe food temperatures, 187 maintenance of food service surfaces and equipment, 186–187 microwave ovens, 188 ventilation over cooking surfaces, 187–188 learning experiences for children, 183–185 meal and snack patterns, 156–157 meal service, seating, and supervision, 177–182 activities that are incompatible with eating, 178–179 adult supervision of children who are learning to feed themselves, 180 developmentally appropriate seating and utensils for meals, 177–178 experience with familiar and new foods, 181 foods that are choking hazards, 181 hot liquids and foods, 181 numbers of children fed simultaneously by one adult, 180 participation of older children and staff in mealtime activities, 180 prohibited uses of food, 182 socialization during meals, 179–180 tableware and feeding utensils, 178 meals from outside vendors or central kitchens approved off-site food services, 195 food safety during transport, 195 holding of food prepared at off-site food service facilities, 195 need for written nutrition plan, 152–153 staffing, 176–177 572 food service staff by type of facility and food service, 176 use of nutritionist/registered dietitian, 176–177 use of USDA-CACFP guidelines, 153–154 vegetarian/vegan diets, 162 written menus and introduction of new foods, 159–160 Nutritionist/registered dietitian approval of dietary modifications, 159 availability of, to facilitate, 403 employment of, 152 use of, 176–177 Nutrition service, records of, 386 O Obesity over consumption of fruit juices and, 158 prevention of, 18, 20, 22, 33–34, 50, 81–84, 90-91, 100, 151–152, 157–158, 164, 177, 182, 185, 362, 552 risk of, 66-67, 158, 163, 170, 179, 182 screening for, 389 Observation of caregivers/teachers, 44 Occupational hazards, caregivers/teachers and, 41 Occupational risk, training on, related to handling body fluids, 30–31 Occupational Safety and Health Administration (OSHA), 40 Odors chemicals used to control, 234 ventilation to control, 213–215 Office space, separating from child care areas, 202 Oil heaters, 214–215 On-site inspections, statutory authorization of, 409–410 On-site sewage systems, 225 containment of garbage, 225 containment of soiled diapers, 226 labeling, cleaning, and disposal of waste and diaper containers, 226 removal of garbage, 225 storage and disposal of infectious and toxic wastes, 226 Open-door policy, 380 Operation permits, 398 Oral health education for, 103–104 policy, 362 routine hygiene activities, 101–102 toothbrushes and toothpaste, 102–103 Oral hygiene, caregivers/teachers in promoting, 170 Orientation for care of children with special health care needs, 22–23 initial, of all staff, 21–22 of substitutes, 32–33 topics, 23–24 Orthotic devices, 244 Outdoor play areas, 93–94 elevated, 266–267 enclosures for, 268 Caring for Our Children: National Health and Safety Performance Standards Outdoor play areas (cont.) inspection of, 277 location near bodies of water, 267 protection from air pollution, 94–95 removal of hazards from, 259–260 on rooftops, 266 shading of, 267–268 size and requirements of, 265 surfacing of, 270, 273–274 transitioning within programs, 54–55 visibility of, 267 Outdoor playground as exit, 206 Outlets maintenance, electrical fixtures and, 261 P Pacifiers cleaning, 100 as strangulation hazard, 129 sudden infant death syndrome (SIDS) and, 98, 100 use of, 97, 99 Pain abdominal, 133, 141, 146 bone, 320 chest, 316 eye, 132 first aid for, 25 from bite, 382 health check and, 89 joint, 135, 320 medication, 360 oral, 327 Paints lead in, 162, 236–239, 259–260 volatile organic compounds (VOC), 237, 239 Pandemic flu/influenza See influenza Paneled areas, ventilation of recently, 213 Parental leave, unpaid and paid, Parents/guardians availability of documents to, 380–381 caregivers/teachers handling of intoxicated, 372 caregivers/teachers weaning of infants from, 100 communication between caregivers/ teachers and, 159–160, 173 complaint procedures for, 80 concern about plagiocephaly, 98 concerns over safety of vaccines, 298–299 conferences with, 78–79 consent for information exchange, 356–357 contents of admission agreement between child care program and, 388 defined, xxiii documentation of drop-off, pick-up, daily attendance of child, and communication, 372–373 documentation of notification of injury, illness, or death in program, 383 education plan of, 84–85 enrollment information to, 349–350 health education for, 84–85 helping cope with separation, 53–54 infectious diseases that require notification, 145 informing, of Haemophilus influenzae type B (HIB) exposure, 302 licensing agency provision of written agreements for, 403 list of excludable and reportable conditions for, 145–146 monitoring children’s development/obtaining consent for screening, 51–53 mutual responsibility of staff and, 77–78 notification about infectious diseases or other problems, 145 notification of use of insect repellent, 128 notification on use of medication, 357–358 nutrition as basic responsibility of, 151 nutrition education for, 185 nutrition learning experiences for children and, 183–185 obtaining health information from, 89 procedure for notification about exposure of children to infectious disease, 144 provision of information on their child’s health and behavior, 80–81 resources for, of children with special health care needs and disabilities, 405 seeking input, 79–80 staff’s notification about varicella-zoster (chickenpox) virus and, 328–329 support services for, 80 unimmunized children and, 298–299 visits of, 78 Parvovirus B19 attendance of children with, 306 notification of parents/guardians, 145 Passenger vans, 293–294 Path of egress, 207 Paved surface, drainage of, 210 Payment for continuing education, 31 PCV7 vaccine, 308 PCV13 vaccine, 308 Peanut allergy, need for epinephrine and, 161 Pediatric first aid, child-staff ratio and, Pediculosis capitis (head lice), 319 Performance monitoring of licensing inspectors, 406-407 Personal articles, storage and labeling of, 256 Pertussis, 306–307 exclusion for, 307 notification of parents/guardians, 145 prophylactic treatment for, 306–307 staff exclusion and, 135 temporary exclusion of children and, 133 Pest management, integrated, 226–228 Pets See Animals pregnant women’s exposure to cat feces, 120, 122 Phthalates, 233 Physical abuse See Child abuse and neglect Physical activities active opportunities for, 90–93 barriers to, 353 caregivers/teachers encouragement of, 95–96 573 policies and practices that promote physical activity, 353–364 time spent on, 90-91 weight management and, 151 Physical activity consultant, availability of, to facilitate, 404 Physical aggression, handling, 72–73 Physical restraint, using, 76–77 Physical therapy equipment, 244, Appendix X space for, 255-256 Pica, 161 Pick-up, 289 Pick-up child authorized persons for, 371–372 documentation of, and parents/guardians communication, 372–373 Pick-up points, 209 Picky eater, 152 Pillows, 252 Pink eye See conjunctivitis Pipes, installation of, 224 Plagiocephaly, concern about, 98 Planned program of daily activities, written description of, 49–50 Plants prohibition of poisonous, 234 safe, 234, Appendix Y Plastic bags, storage of, 257 Plastic containers, 232–234 Plastic toys, 118, 232–234 Play and teaching equipment, storage of, 256 Play area and playground surfacing inspection of, 277–278 prohibited surfaces for placing climbing equipment, 273–274 Play areas/playgrounds clearance requirements of, 273 elevated, 266–267 enclosures for outdoor, 268 inspection of, 277–278 inspection of indoor and outdoor, 277 location of, near bodies of water, 267 policies on, 374–375 records of proper installation and maintenance of facility equipment, 375 reports of annual audits/monthly maintenance checks of equipment, 375 use and maintenance of, 374–375 on use and maintenance of, 374–375 reports of annual audits/monthly maintenance checks of, 375 rooftops as, 266 shading of, 267–268 shoes in infant, 236–237 size and location of, 265 size and requirements of indoor, 265–266 soil in, 200 visibility of, 267 water, 278–283 Play dough, use of, 232 Play equipment Americans with Disabilities Act requirements for, 270 Index Caring for Our Children: National Health and Safety Performance Standards Play equipment (cont.) arrangement of, 272 ball pits, 276 connecting and linking devices, 270–271 crawl spaces in, 271 design of, 270 enclosure of moving parts on, 271 entrapment hazards of, 272 installation of, 270 location of moving, 272–273 material defects and edges on, 271–272 requirements for, 269–270 sandboxes, 274 sensory table materials, 275–276 trampolines, 276 use zone for fixed, 272 water play tables, 275 Play materials, surfaces of, 239–240 Play yard requirements, 242 Plumbing installation of fixtures, 224 maintenance of, 261 Poison center, use of, 229 Poisonous plants, prohibition of, 234 Policies, 348–375 content of, 348 enrollment information to parents/guardians and caregivers/teachers, 349–350 exchange of information upon enrollment, 350 food and nutrition service, 361 health, 353–364 infant feeding, 361–362 nondiscriminatory, 350–351 oral health, 362–363 play area, 374–375 review and communication of written, 349 sanitation, 360–361 transportation, 373–374 written discipline, 351 Polybrominated diphenyl ether (PBDE), 239 Polyvinyl chloride (PVC), 232–233 Pooling, 59 Pools See Swimming pools Pool toys, 283–285 Portable electric space heaters, 215 Portable fire extinguishers, 221 Portable gas stoves, 214–215 Portable wading pools, 283 Portable water supply, handwashing sink using, 224 Pre-admission enrollment information for each child, 387–388 Pregnant women, exposure to cats’ feces, 120, 122 Preschool-age children appropriate amount of physical activity for, 92 body mastery for, 62–63 caregivers/teachers qualifications for, 15 expressive activities for, 62 fostering cooperation of, 62 fostering language development of, 62 guardrails and protective barriers for, 210 housing of child care units for, 201 Index nutrition for meal and snack patterns for, 174–175 serving size for, 174–175 outdoor play of, 91 personal caregivers/teacher relationships for, 61 selection of equipment for, 61 short structured activities for, 91 supervision for, toilet facilities for, 65–66 toilet height for, 246 Pre-service qualifications caregivers/teachers, 12–19 director’s, 10–11 mixed director/teachers, 12 Pre-service training, 19–21 Prevention and management of toxic substances, 228–229 carbon monoxide detectors, 229–231 chemicals used to control odors, 234 construction and remodeling during hours of operation, 237 exposure to asbestos or other friable materials, 231 informing staff regarding presence of toxic substances, 229–230 plastic containers and toys, 232–234 prohibition of poisonous plants, 234 proper use of art and craft materials, 231–232 radon concentrations, 230 shoes in infant play areas, 236–237 testing for lead, 235–236 treatment of chromated copper arsenate (CCA) pressure-treated wood, 234–235 use and storage of toxic substances, 228 use of play dough and other manipulative art of sensory materials, 232 use of poison center, 229 Prevention of obesity See obesity Preventive health services provision of routine, 90 written policy for obtaining information, 355–356 Primary care provider, defined, xxiii Privacy See also Health Insurance Portability and Accountability Act (1996) (HIPAA) toilet location and, 245 Private residence, use of, as child care facility, 199 Product recall monitoring, 238 Professional development/training, pre-service training, 19–21 Program consultant, availability of, to facilitate, 403 Prohibited animals, 121 Prohibited surfaces for placing climbing equipment, 273–274 Projectile toys, 285 Prophylactic treatment for pertussis, 306–307 Propping bottle See bottle propping Prosthetic devices, 244 Public health authorities, informing of hepatitis B virus cases, 323 of invasive Haemophilus influenzae type 574 B (HIB) cases, 302–303 of invasive Streptococcus pneumoniae, 309 of meningococcal infections, 305–306 of pertussis cases, 306 Public policy issues and resource development, 416-417 Public-private collaboration on children who are ill, 400 Pull-ups, changing soiled, 108–110 Punishment See corporal punishment Q Quality, sources of technical assistance to support, of child care, 402–406 Quality improvement, management principles of, 347 Quality rating and improvement systems (QRIS), 408 R Radon concentrations, 230 Rags, used for cleaning, 259 Raisins, 181 Rash staff exclusion and, 135 temporary exclusion of children and, 133 Ratios See Child-staff ratios Rational basis of regulations, 398 Reading, 67 Reasonableness as legal standard, 340 Recalls See product recall monitoring Recipes, provision of, in nutrition education for parents/guardians, 185 Records, 377–393 See also Staff records access to facility, 379 availability of documents to parents/guardians, 380–381 on inspections of fire protection devices, 385 to licensing agency, 380 child, 386–392 community resource information, 386 documentation of child care health consultation/training visits, 385–386 documentation of parents/guardians notification of injury, illness, and death in program, 383 evacuation and shelter-in-place drill, 385 facility, 377–386 facility records/reports, 377–386 of illness, 381–382 of injury, 382 maintenance and display of inspection, 384 maintenance of, on incidents of diarrhea, 314–315 medication, 359–360, 391 of nutrition service, 386 requirements for compliance of contract services, 381 review and accessibility of injury and illness, 383–384 staff, 392–393 Caring for Our Children: National Health and Safety Performance Standards Records (cont.) training, 393 of valid license, certificate, or registration of facility, 384 written plan/record to resolve deficiencies, 384–385 written policy of facility confidentiality, 378–379 Recreational equipment, 244 References, checking in background screening, 10 Refrigeration, storage of foods not requiring, 192 Refrigerator, preparation for and storage of food in, 191–192 Registration of facility, record of valid, 384 Regulations, xxi rational basis of, 398 Regulatory agency, provision of caregivers/ teachers and consumer training and support services, 414–416 Regulatory enforcement, state statute support of, 397 Regulatory policy adequacy of staff and funding for enforcement, 397 regulation of all out-of-home child care, 397 state statute support of enforcement, 397 Rehabilitation Act (1973), Section 504 of, accessibility of facilities and, 199 Reimbursement for children with special health care needs and disabilities, 340 Relationships, developing, for school-age children, 64 Religious beliefs, dietary modifications based on, 159 Remodeling, during hours of operation, 237 Reports, facility, 377–386 Resource and referral agencies, development of, 416-417 Respiratory illness, staff exclusion and, 135 Respiratory syncytial virus (RSV), 307–308 attendance of children with, 307–308 Respiratory tract infections (RTIs) attendance of children with, 307–308 group A streptococcal infections, 300–301 Haemophilus influenzae type B, 301–303 influenza, 303–304 mumps, 304–305 Neisseria meningitides, 305–306 parvovirus B19, 306 pertussis, 306–307 respiratory syncytial virus, 307–308 Streptococcus pneumoniae, 308–309 tuberculosis, 309–311 unspecified, 311 Rest areas, unscheduled access to, 101 Rest periods, scheduled, 100–101 Retaining wall in creating elevated play areas, 266–267 Rifampin treatment of children exposed to child with Haemophilus influenzae type B (HIB) disease, 302 Ringworm, attendance of children with, 319–320 Rooftops as play areas, 266 Roseola, 327–328 Routine health supervision, 89–90 Rubella staff exclusion and, 135 temporary exclusion of children and, 133 S Safe sleep practices See sleep Safety strangulation hazards, 129 sun, 126–127 Safety covers for electrical outlets, 219 for swimming pools, 279 Safety guards for glass windows/doors, 205 Safety straps for diaper changing table, 106109 Salmonella, See Exclusion for illness; food safety; animals Salmonellosis, 190, 315 St Louis encephalitis, 228 Sand as a surfacing material, 274 type used in sandboxes, 274 Sandboxes, 274 Sanitation of objects intended for mouth, 118 policies and procedures, 360–361 routine, 116–117 toys, 117–118 Satellite dish, location of, 211 Scabies, 321 attendance of children with, 321 staff exclusion and, 135 temporary exclusion of children and, 133 School, communication between child and, 64 School-age activities space for, 63–64 supervised, 63 School-age child care facility, 407 School-age children areas for, 204 bike routes for, 287 caregivers/teachers qualifications for, 15–16 community outreach for, 64 developing relationships, 64 fostering collaboration to establish programs for, 416 guardrails and protective barriers for, 210 home room for, housing of child care units for, 201 limiting screen time for, 95 meal and snack patterns for, 175–176 planning activities for, 64 in small family child care homes, supervision of, 64–66 use of toilet facilities of, 65–66 Scrapes, body fluids and, 114 Screening, obtaining consent for, 51–53 Screens for ventilation openings, 205 Screen time 575 caregivers/teachers awareness of, 95 limiting, 66–68 for school-age children, 95 Section 504 of the Rehabilitation Act (1973) for children with special health care needs and disabilities, 335, 341, 342 Self-feeding, encouraging by older infants and toddlers, 175 Self-stimulatory behaviors, ignoring, 63 Sensors or remote monitors for swimming pools, 279 Sensory table materials, 275–276 Separation, helping families cope with, 53–54 Separation of operations from child care areas, 202 Service plan, developing, for children with special health care needs and disabilities, 337–340 Services, planning for child’s transition to new, 351–352 Sewage systems, on-site, 225 Sex offender registries, 401, 408 in background screening, 10 Sexual abuse See Child abuse and neglect Shading of play areas, 267–268 Shaken baby syndrome/abusive head trauma preventing and identifying, 125 prevention of, 18 Shelter-in-place, 368 Shelter-in-place drills evacuation and records of, 385 records of, 385 Shigella See exclusion for illness Shingles, staff exclusion and, 135 Shock protection devices for electrical outlets, 219 Shoes in infant play areas, 236–237 Showers ratio and location of, 250–251 safety of, 251 Sick leave, 43 in minimizing infectious diseases, 377 SIDS See Sudden infant death syndrome (SIDS) Sign-in/sign-out system, 371 Single service cups, 258 Sippy cups See Cups Site location, environmental audit of, 200 Skin and mucous membrane infections, 315 conjunctivitis, 315 enteroviruses, 316 human papillomaviruses, 316 impetigo, 317 lymphadenitis, 317–318 measles, 318 molluscum contagiosum, 318–319 notification of parents/guardians, 145 Pediculosis capitis (head lice), 319 scabies, 321 staff exclusion and, 135 Staphylococcus aureus skin infections including MRSA, 320–321 thrush, 321 tinea capitis and tinea cruris, 319–320 Index Caring for Our Children: National Health and Safety Performance Standards Sleep, 96–99 pacifier use and, 99–100 safe practices and SIDS/suffocation risk reduction, 96 supervision during, swaddling and, 99 Sleep and rest areas bunk beds, 255 cribs, 253–254 equipment and supplies, 251–253 futons, 255 stackable cribs, 254–255 Sleeping equipment and supplies, 251–253 Small family child care homes, xxii child-staff ratio for, 3–4 continuing education for caregivers/ teachers of, 31 defined, 407–408 dishwashing in, 194 food service staff at, 176 frequency of inspections for, 409 locks in, 207 mixed use of rooms, 202 school-age children in, transportation policy for, 373–374 written daily activity plan and statement of principles, 49–50 written human resource management policies for, 376–377 Smoke alarms, 221 Smoke detection systems, 221 Smoking, policies prohibiting, 363 Sneezing etiquette, 114 See also Cough and sneeze Socialization during meals, 179–180 Social policies, efforts to strengthen, Social Security Act (1935), social policies and, Social security trace in background screening, 10 Soil in play areas, 200 Solid foods, introduction of age-appropriate, 172–173 Sound abatement, caregivers/teachers need for help with, 219 Soy-based formulas, use of, 169 Soy milk, use of, 169 Space for children with special health care needs, 255-256 for play areas per child, 265 for school-age activity, 63–64 per child, 223 to support learning of infants and toddlers, 58–59 Space for children who are ill, injured, or need special therapies space for ill children, 255 space for therapy services, 255–256 Space heaters, portable electric, 215 Special adaptive equipment, 244 Special health care needs, recognition of health problems in, 26–27 Specialists, communication from, 81 Special Supplemental Nutrition Programs for Women, Infants, and Children (WIC) nutrition training and, 27 Index soy-based formula and soy milk, 169 Square footage See space Stackable cribs, 254–255 Staff See also Caregivers/teachers adequacy of, and funding for regulatory enforcement, 397 competence and training of transportation, 287–288 content and development of plan for care of, who are ill, 354 designating role of person responsible for coordinating care in child care facility, 338 education of policies on cytomegalovirus (CMV) and, 326 preventing transmission of HIV infection, 325 on prevention of bloodborne diseases, 323 exclusion for illness, 135 food service, by type of facility and food service, 176 health appraisals by, 408 health limitations of, 41 health of daily check, 40–41 pre-employment and ongoing adult health appraisals, including immunization, 39–40 informing, regarding presence of toxic substances, 229–230 maintenance of attendance records for, who care for children, 393 notification of parents/guardians about varicella-zoster (chickenpox) virus, 328–329 nutritionist/registered dietitian as member of, 176–177 participation in mealtime activities, 180 recruitment of, restriction from food preparation and handling, 188–189 Staff-child ratios See Child-staff ratios Staff records, 392–393 maintenance and content of, 392–393 maintenance of attendance, who care for children, 393 training, 393 Stairway access openings, guards at, 209 Standard (defined), xxi Standing orders guidance, 142 Staphylococcus aureus skin infections including MRSA, 320–321 State child abuse registries in background screening, 10 State early childhood advisory council, 399–400 State health department interaction with, concerning infectious diseases, 329 role of, 411–414 State law, whistle-blower protection under, 410 State statute support of regulatory enforcement, 397 Stationary activity centers, 242 Statutory authorization of on-site inspections, 576 409–410 Steps and stairs, 208–209 Storage areas coat hooks/cubicles, 256 firearms, 257 of flammable materials, 256–257 inaccessibility to matches, candles, and lighters, 257 maintenance and ventilation, 260 of plastic bags, 257 of play and teaching equipment and supplies, 256 for soiled and clean linens, 256 storage and labeling of personal articles, 256 Storage for adaptive equipment, 244 Stoves, wood/corn pellet, 215–216 Strangulation hazards, 129 Strep throat, staff exclusion and, 135 Streptococcal pharyngitis, temporary exclusion of children and, 133 Streptococcus pneumoniae, 308–309 informing public health authorities of invasive, 309 Stress for caregivers/teachers, 41–43 Strings on children’s clothing as strangulation hazard, 129 Stroller requirements, 242 Structurally sound facility, 201 Structure maintenance, 261 Substances, ingestion of, not providing nutrition, 161–162 Substitutes age of, 32 employment of, 32 illness of, 41 orientation of, 32–33 Sudden infant death syndrome (SIDS) accusation of child abuse and neglect and, 147 in child care, 18 deaths in child care facilities attributable to, 97 pacifier use and, 98, 100 reducing risk of, 96, 97, 98 risk of, 20, 32, 33, 35, 99 Suffocation, 96-99 Sun safety, 126–127 Sunny weather, outdoor play in, 93 Sunscreen, 126–127 Supervision methods of, 64–66 near bodies of water, 68–69 for preschoolers, for school-age activity, 63 during sleep, for swimming, wading, and water play, for toddlers, touch, Supervision during transportation, child-staff ratio and, Supplies for bathrooms and handwashing sinks, 258–259 first aid and emergency, 257–258 Caring for Our Children: National Health and Safety Performance Standards Supplies (cont.) microfiber cloths, rags, and disposable towels and mops used for cleaning, 259 single service cups, 258 Support networks for, family child care, 19 Support services for parents/guardians, 80 Suspensions, 73–75 Swaddling, 98 Swimming cardiopulmonary resuscitation (CPR) training for, 26 supervision for, Swimming pools accessibility to aboveground, 279 behavior around, 69 deck swimming, 279–280 drain covers, 280 electrical safety for areas, 282 equipment, 281 hot tubs, spas, and saunas in areas around, 283 maintenance, 281–282 safety covers for, 279 safety rules, 280 supervision of pool pump, 280 water quality of, 282–283 water temperature, 282 Swings, clearance space for, 273 Syrup of ipecac, 258 T Tableware and feeding utensils, 178 Tamper-resistant electrical outlets, 219 Teacher aides assistant teachers and, 13 qualifications for, 13 Technical assistance to facilities to address diversity in community, 406 from licensing agency, 402–406 Telephone, availability and use of, 243 Television, limiting time, 66-68 Temperature human, 89, 94, 132 indoor, 212 interior of vehicles, 291–292 for laundering, 251 of bottles and infant foods, 171–172 of foods, 187 of swimming pool water, 282 thermometers for taking human, 135–136 wind chill, 93 Temporary Assistance for Needy Families (TANF), 35 Termination of child attending facility See Expulsions Therapeutic equipment, 244 Therapy services, space for, 255–256 Thermometers for taking human temperatures, 135–136 type and placement of room, 214 Threatening incidents, written plan and training for handling urgent medical care or, 364–365 Three-to-five year olds See Preschool-age children Thrush (candidiasis), 321 Ticks protecting children from, 128 removal of, 128 Tinea capitis and tinea cruris (ringworm), 319–320 Title V, 35 Tobacco drug use and, 118–119 policies prohibiting, 363 Toddlers appropriate amount of physical activity for, 92 caregivers/teachers qualifications for, 14–16 child-staff ratio for, 3-4 cleaning of individual bedding for, 118 encouraging self-feeding by older, 175 guardrails and protective barriers for, 210 housing of child care units for, 201 importance of low child-staff ratios for, interactions with caregivers/teachers, 57–58 limiting time in crib, high chair, car seat, etc., 66 nutrition for encouraging self-feeding by older, 175 meal and snack patterns for, 174–175 serving size for, 174–175 outdoor play of, 90–91 personal caregivers/teachers relationships for, 57 preventing entry to toilet rooms by, 245 sensory table materials and, 275 separation of, from older children, 59 short structured activities for, 91 space and activity to support learning of, 58–59 supervision for, swimming pools risk for, 68–69 toilet height for, 246 toilet learning/training, 59–60 Toilet and handwashing areas ability to open toilet room doors, 245 chemical toilets, 245–246 cleaning and disinfection, 247 general requirements for, 245 handwashing sinks, 247–248 learning/training equipment, 246–247 location of toilets and privacy issues, 245 mop sinks, 248 preventing entry to toilet rooms by infants and toddlers, 245 prohibited uses of handwashing sinks, 248 ratios of toilets, urinals, and hand sinks to children, 246 waste receptacles in child care facility and in child care facility toilet rooms, 247 Toilet learning/training equipment, 246–247 Toilet rooms ability to open, 245 577 ability to open door of, 245 preventing entry to, by infants and toddlers, 245 Toilets chemical, 245–246 cleaning and disinfecting, 247 location of, 245 ratios of, to children, 246 use of, 65–66 Toilet training, changing children’s soiled underwear/pull-ups and clothing and, 108–110 Tongue thrust, dietary modifications and, 159 Tooth brushing, 101 Toothpaste, 101 Touch supervision, Towels for cleaning, 259 for handwashing, 111 storage as personal article, 256 Toxic substances informing staff regarding presence of, 229–230 policies prohibiting, 363 prevention and management of, 228–229 carbon monoxide detectors, 229–231 chemicals used to control odors, 234 construction and remodeling during hours of operation, 237 exposure to asbestos or other friable materials, 231 informing staff regarding presence of toxic substances, 229–230 plastic containers and toys, 232–234 prohibition of poisonous plants, 234 proper use of art and craft materials, 231–232 radon concentrations, 230 shoes in infant play areas, 236–237 testing for lead, 235–236 treatment of chromated copper arsenate (CCA) pressure-treated wood, 234–235 use and storage of toxic substances, 228 use of play dough and other manipulative art of sensory materials, 232 use of poison center, 229 use and storage of, 228–229 Toxoplasmosis, 274 congenital, 122 Toys cleaning and sanitizing, 117–118 crib, 285 inaccessibility of, or objects to children under three years of age, 284–285 projectile, 285 riding, with wheels and wheeled equipment, 286 sleep policy regarding, 96 surfaces of, 239–240 Training of caregivers/teachers, 414–416 on administering medications, 143–144 Index Caring for Our Children: National Health and Safety Performance Standards Training (cont.) on care of children with special health care needs, 22 on emergency/disaster planning and response, 366–368 on first aid and CPR, 24 on food handling, 29–30 on health topics, 83-84 on safe sleep practices, 96–97 pre-service, 20-21 documentation of child care health consultation, 385–386 of licensing personnel about child abuse, 407 licensing staff, 406–407 record of, 393 Training time and professional development leave, 31 Transition plan, format for, 352 Transitions, 351–353 exchange of information at, 352–353 format for, 352 planning for child’s, to new services, 351–352 Transportation child behavior during, 291 distractions while driving, 292 food safety during, 195 interior temperature of vehicles, 291–292 passenger vans, 293 policies, 373–374 for centers, 373 for large family child care homes, 373 for small family child care homes, 373 qualifications for drivers, 288–289 route to emergency medical services, 292–293 Transportation safety child passenger safety, 289–291 drop-off and pick-up, 289 Transportation staff, competence and training of, 287–288 Trash See Garbage Trauma, abusive head, preventing and identifying, 125 Tree nut allergy, need for epinephrine and, 161 Tremolite, 274 Tube feeding, 130, 159 Tuberculin skin test (TST), 310 Tuberculosis, 309–311 attendance of children with latent infection or active disease, 310–311 measures for detection, control, and reporting of, 309–310 notification of parents/guardians, 145 staff exclusion and, 135 temporary exclusion of children and, 133 Tummy time for infants, 91 Twenty-four hour care See Evening care U Underwear, changing soiled, 108–110 Uniform categories and definitions, 407–408 Index Unimmunized children, 298–299 Universal precautions See Standard precautions Unrelated business in child care area, 201–202 Unscheduled access, to rest areas, 101 Unspecified respiratory tract infection, 311 attendance of children with, 311 Upper respiratory infections, exposure to cold air and, 94 Urgent care, review of written plan for, 365–366 Urinals, ratios of, to children, 246 Use zone for fixed play equipment, 272 Utensils, tableware and feeding, 178 V Vaccines See Immunizations Varicella-zoster (chickenpox) virus, 328–329 notification of parents/guardians, 145 staff and parents/guardians notification about, 328–329 Vector-borne diseases, protection from, 127–128 Vegetarian/vegan diets, 162 Vehicles interior temperature of, 291–292 passenger vans, 293–294 Ventilation, 211–217 to control odors, 213–214 over cooking surfaces, 187–188 of recently carpeted or paneled areas, 213 screens for openings, 205 storage area and, 260 when using art materials, 213 Verbal interaction, 56–57 Video watching, limiting, 66-68 Visibility of outdoor play area, 267 Visits, parents/guardians, 78 Volatile organic compounds (VOC), paints, 237 Voluntary records, maintenance and content of, 392–393 Volunteers age of, 32 assistant teachers and, 13 illness of, 41 qualifications for, 13 Vomiting staff exclusion and, 135 temporary exclusion of children and, 133 W Wading, supervision for, Wading pools, portable, 283 Walking surfaces, 210 Walkways construction and maintenance of, 209–210 designated, 209 Walls, 240–241 Warm weather, outdoor play in, 93 Waste containers, labeling, cleaning, and disposal of, 226 Waste receptacles in child care facility and in child care facility toilet rooms, 247 578 Wastes, storage and disposal of infectious and toxic, 226 Water access to safety around bodies of, 278–279 availability of drinking, 157 bodies of location of play areas near, 268 bottled, 223 in containers, 283 emergency safe drinking, 223 handling and treatment equipment, 223–224 handwashing sink using portable supply, 224 heating devices and temperature allowed, 216 location of electrical devices near, 220 location of play areas near bodies of, 267 supervision near bodies of, 68–69 supply of, for disaster, 192–193 testing for lead and copper levels in drinking, 222–223 testing of drinking, not from public system, 222 Water play cardiopulmonary resuscitation (CPR) training for, 26 supervision for, Water play areas access to and safety around bodies of water, 278–279 hot tubs, spas, and saunas, 283 portable wading pools, 283 Water play tables, 275 Water-related injuries, circumstances surrounding, Water supply, 221–222 Water temperature for laundering, location of laundry equipment and, 251 Water test results, 223 Water-tightness of opening, 204 Weather Radio All Hazards (NWR), provision of weather information, 94 Weather-tightness of opening, 204 Weight management, physical activity and, 151 Western equine encephalitis, 228 West Nile virus, 228 Wheeled vehicles, areas used by children for, 210 Wheels and wheeled equipment, riding toys with, 286 Whistle-blower protection, under state law, 410 Whooping cough, 298, 300, 306-307 See also Pertussis Wind chill advisory, 93 Wind chill temperature, 93 Windows covering cords as strangulation hazard, 129 possibility of exit from, 204–205 Wireless communication device, availability and use of, 243 Wood/corn pellet stoves, 215–216 Wood frame construction, buildings of, 201 Caring for Our Children: National Health and Safety Performance Standards Written daily activity plan and statement of principles, 49 Written discipline policies, 351 Written plan and training for handling urgent medical care or threatening incidents, 364–365 Z Zoning, 384 579 Index ... Public Health Association, National Resource Center for Health and Safety in Child Care and Early Education 2011 Caring for our children: National health and safety performance standards; Guidelines. .. to release the 3rd edition of Caring for Our Children: National Health and Safety Performance Standards; Guidelines for Early Care and Education Programs These national standards represent the... Advice to User Caring for Our Children: National Health and Safety Performance Standards NEW AND SIGNIFICANT CHANGES IN Caring for Our Children (CFOC) STANDARDS SINCE THE 2ND EDITION Standard 2.2.0.4: