Caring for Our Children: Chapter 2 - Program: Activities for Healthy Development Chapter 2: Program Activities for Healthy Development 2.1 PROGRAM OF DEVELOPMENTAL ACTIVITIES GENERAL PROGRAM ACTIVITIES STANDARD 2.001 written daily activity plan and statement of principles Facilities shall establish and implement a written, planned program of daily activities based on the child's individual development at each stage of early childhood. The objective of the program of daily activities shall be to foster incremental developmental progress. Centers shall develop a written statement of principles that sets out the basic elements from which the daily program is to be built. An annual review of the written statement of principles guiding program development shall engage all staff. The elements to be included are those specified in the current edition of Caring for Our Children, the National Health and Safety Performance Standards: Guidelines for Out-of-Home Child Care Programs . RATIONALE: Reviews of children's performance after attending out-of-home child care indicate that children attending facilities with well-developed curricula achieve appropriate levels of development (1, 2). Early childhood specialists agree on the: Inseparability of cognitive, physical, emotional, and social development; Influence of the child's health on all these areas; Central importance of continuity of affectionate care; Relevance of the phase or stage concept; Importance of action (including play) as a mode of learning (3). Those who provide child care and education must be clear about the curriculum they are implementing. All facilities need a written description of the planned program of daily activities so staff and parents can have a common understanding and ability to compare the program's actual performance to the stated intent. Child care is a "delivery of service" involving a contractual relationship between the provider and the consumer. A written plan helps to define the service and contributes to specific and responsible operations that are conducive to sound child development and safety practices and to positive consumer relations. In centers, because more than two child care staff members are involved in operating the facility, a written statement of principles helps achieve consensus about the basic elements from which all staff will plan the daily program. Caregivers need to be properly trained to develop and implement an effective plan. Plans can ensure that some thought goes into programming for children. They also allow for monitoring and accountability. A written plan can provide a basis for staff orientation. COMMENTS: The NAEYC Accreditation Criteria and Procedures, the National Association for Family Child Care (NAFCC) accreditation standards and the National Child Care Association (NCCA) standards can serve as resources. Contact information for the National Association for the Education of Young Children (NAEYC), NAFCC, and NCCA is located in Appendix BB. TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home STANDARD 2.002 program of activities including special interventions Facilities shall have a Program of Activities to include special interventions for children with any special restriction(s) of activities. RATIONALE: All care facilities benefit from a regular activity schedule. For the child with special needs, an individualized education program or an individualized family service plan is required by the IDEA. The child's plan for care in an inclusive setting shall include activities with the other children at the facility as part of the child's regularly scheduled activities. COMMENTS: Children with special needs will be participating in activities, adapted to their abilities, with peers, but may have some separately scheduled activities that may be required to implement the child's Individualized Education Program (IEP). TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home STANDARD 2.003 content of facility activities The facility's activities shall include: a) Both structured and unstructured times; b) Both teacher-directed and child-initiated experiences; c) Family involvement activities. RATIONALE: A planned but flexible program that allows children to make decisions about their activities fosters independence and creative expression. The facility shall implement its program effectively. TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home STANDARD 2.004 helping families cope with separation The staff of the facility shall help the child and parents cope with the experience of separation and loss. For the child, this shall be accomplished by: a) Encouraging parents to spend time in the facility with the child; b) Enabling the child to bring to child care tangible reminders of home/family (such as a favorite toy or a picture of self and parent); c) Helping the child to play out themes of separation and reunion; d) Frequently exchanging information between the child's parents and caregivers, including activities and routine care information; e) Reassuring the child about the parent's return; f) Ensuring that the caregiver(s) are consistent both within the parts of a day and across days. For the parents, this shall be accomplished by: a) Validating their feelings as a universal human experience; b) Providing parents with information about the positive effects for children of high quality facilities with strong parent participation; c) Encouraging parents to discuss their feelings; d) Providing parents with evidence, such as photographs, that their child is being cared for and is enjoying the activities of the facility. RATIONALE: In childhood, some separation experiences facilitate psychological growth by mobilizing new approaches for learning and adaptation. Other separations are painful and traumatic. The way in which influential adults provide support and understanding, or fail to do so, will shape the child's experience (4). Many parents who prefer to care for their young children only at home may have no other option than to place their children in out-of-home child care before 6 weeks of age, because many employers do not provide parental leave. In most other industrialized countries (such as France, Sweden, Norway, Finland, Denmark, and Holland) family leave with pay is available for a minimum of 6 months and can be taken by either mother or father or in some combination. Some parents prefer combining out-of-home child care with parental care to provide good experiences for their children and support for other family members to function most effectively. Whether parents view out-of-home child care as a necessary accommodation to undesired circumstances or a benefit for their family, parents and their children need help from the child care staff to accommodate the transitions between home and out-of-home settings. Many parents experience pain at separation. For most parents, the younger their child and the less experience they have had with sharing the care of their children with others, the more intense their pain at separation. COMMENTS: Depending on the child's develop-mental stage, the impact of separation on the child and parent will vary. Child care facilities should understand and communicate this variation to parents and work with parents to plan developmentally appropriate coping strategies for use at home and in the child care setting. For example, a child at 18 to 24 months of age is particularly vulnerable to separation stress. Entry into child care at this age may trigger behavior problems, such as difficulty sleeping. Even for the child who has adapted well to a child care arrangement before this developmental stage, such difficulties can occur as the child continues in care and enters this developmental stage. For younger children, who are working on understanding object permanence (usually around 9 to 12 months of age), parents who sneak out after bringing their children to the child care facility may create some level of anxiety in the child throughout the day. Sneaking away leaves the child unable to discern when someone the child trusts will leave without warning. TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home STANDARD 2.005 toilet learning/training The facility shall develop and implement a plan that teaches each child how and when to use the toilet. Toilet learning/training, when initiated, shall follow a prescribed, sequential plan that is developed and coordinated with the parent's plan for implementation in the home environment and shall be based on the child's developmental level rather than chronological age. To help children achieve bowel and bladder control, caregivers shall enable children to take an active role in using the toilet when they are physically able to do so and when parents support their children's learning to use the toilet. Caregivers shall take into account the preferences and customs of the child's family. For children who have not yet learned to use the toilet, the facility shall defer toilet learning/training until the child's family is ready to support this learning and the child demonstrates: a) An understanding of the concept of cause and effect; b) An ability to communicate; c) The physical ability to remain dry for up to 2 hours. For school-age children, toilet learning/training shall include frequent opportunities to use the toilet and an emphasis on appropriate handwashing after using the toilet. Children with special needs may require specific instructions or precautions. RATIONALE: A child's achievement of motor and intellectual or developmental skills may be advanced or delayed, depending on the child's abilities, primary disability, or combination of disabilities. The child may not be socially or emotionally ready to learn how to use the toilet, despite the emergence of other skills. Caregivers should enable children to take an active part in controlling the functions of their bodies in a manner that gives them a sense of pride and confidence (27, 28). Toilet learning/training is achieved more rapidly once a child is toilet scheduled and demands from adults across environments are consistent. The family may not be prepared, at the time, to extend this learning/training into the home environment. School-age children may not respond when their bodies signal a need to use the toilet because they are involved in activities or embarrassed about needing to use the toilet. Holding back stool or urine can lead to constipation and urinary tract problems. Also, unless reminded, many children forget to wash their hands after toileting. COMMENTS: The area of toilet learning/training for children with special needs is difficult because there are no age-related, disability-specific rules to follow. As a result, support and counseling for parents and caregivers are required to help them deal with this issue. Some children with multiple disabilities do not demonstrate any requisite skills other than being dry for a few hours. Establishing a toilet routine may be the first step toward learning to use the toilet and at the same time improving hygiene and skin care. Cultural expectations of toilet learning/training need to be recognized and respected. For more information on toilet learning/training, see Tiolet Training/Learning: Guideline for Parents , available from the American Academy of Pediatrics (AAP). Contact information is located in Appendix BB. See also Toilets and Toilet Training Equipment, STANDARD 5.116 through STANDARD 5.124; and Sanitation, Disinfection, and Maintenance of Toilet Learning/Training Equipment, Toilets, and Bathrooms, STANDARD 3.029 through STANDARD 3.033. TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home STANDARD 2.006 communication in native language At least one member of the staff shall be able to communicate in the native language of the parents and children, or the facility shall work with parents to arrange for a translator to communicate with parents and children. RATIONALE: The future development of the child depends on his/her command of language (5). Richness of language increases as a result of experiences as well as through the child's verbal interaction with adults and peers. Basic communication with parents and children requires an ability to speak their language. TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home STANDARD 2.007 diversity in enrollment and curriculum Facilities shall work to increase understanding of cultural, ethnic, and other differences by enrolling children who reflect the cultural and ethnic diversity of the community and by providing cultural curricula that engages children and teaches multicultural learning activities. RATIONALE: Children who participate in programs that reflect and show respect for the cultural diversity of their communities learn to understand and value cultural diversity. This learning in early childhood enables their healthy participation in a democratic pluralistic society throughout life (6, 7, 8). By facilita-ting the expression of cultural development or ethnic identity and by encouraging familiarity with different groups and practices through ordinary interaction and activities integrated into a developmentally appropriate curriculum, a facility can foster children's ability to relate to people who are different from themselves, their sense of possibility, and their ability to succeed in a diverse society, while also promoting feelings of belonging and identification with a tradition. COMMENTS: The facility might celebrate holidays and other events of the cultural and ethnic groups in the community to provide opportunities to introduce children to a range of customs and beliefs. Materials, displays, and learning activities must represent the cultural heritage of the children and the staff to instill a sense of pride and positive feelings of identification in all children and staff members. In order to enroll a diverse group, the facility should market its services in a culturally sensitive way and should make sincere efforts to employ staff members that represent the culture of the children and their families. Children need to see members of their own community in positions of influence in the services they use. TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home STANDARD 2.008 verbal interaction The child care facility shall assure that each child has at least one speaking adult person who engages the child in verbal exchanges linked to daily events and experiences. To encourage the development of language, the caregiver shall demonstrate skillful verbal communication and interaction with the child. · For infants, these interactions shall include · responses to, and encouragement of, soft infant sounds, as well as naming of objects by the caregiver. · For toddlers, the interactions shall include naming of objects and actions and supporting, but not forcing, the child to do the same. · For preschool and school-age children, interactions shall include respectful listening and responses to what the child has to say, amplifying and clarifying the child's intent. RATIONALE: Conversation with adults is one of the main channels through which children learn about themselves, others, and the world in which they live. While adults speaking to children teach the children facts and relay information, the social and emotional communications and the atmosphere of the exchange are equally important. Reciprocity of expression, response, the initiation and enrichment of dialogue are hallmarks of the social function and significance of the conversations (9, 10, 11, 25). The future development of the child depends on his/her command of language (5). Richness of the child's language increases as it is nurtured by verbal interactions and learning experiences with adults and peers. Basic communication with parents and children requires an ability to speak their language. TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home STANDARD 2.009 playing outdoors Children shall play outdoors daily when weather and air quality conditions do not pose a significant health risk. Outdoor play for infants may include riding in a carriage or stroller; however, infants shall be offered opportunities for gross motor play outdoors, as well. Weather that poses a significant health risk shall include wind chill at or below 15 degrees F and heat index at or above 90 degrees F, as identified by the National Weather Service. Air quality conditions that pose a significant health risk shall be identified by announcements from local health authorities or through ozone (smog) alerts. Such air quality conditions shall require that children remain indoors where air conditioners ventilate indoor air to the outdoors. Children with respiratory health problems such as asthma shall not play outdoors when local health authorities announce that the air quality is approaching unhealthy levels. Children shall be protected from the sun by using shade, sun-protective clothing, and sunscreen with UVB-ray and UVA-ray protection of SPF-15 or higher, with permission as described in STANDARD 3.081, during outdoor play. Before prolonged physical activity in warm weather, children shall be well-hydrated and shall be encouraged to drink water during the activity. In warm weather, children's clothing shall be light-colored, lightweight, and limited to one layer of absorbent material to facilitate the evaporation of sweat. Children shall wear sun-protective clothing, such as hats, long-sleeved shirts and pants, when playing outdoors between the hours of 10 AM and 2 PM . In cold weather, children's clothing shall be layered and dry. Caregivers shall check children's extremities for maintenance of normal color and warmth at least every 15 minutes when children are outdoors in cold weather. RATIONALE: Outdoor play is not only an opportunity for learning in a different environment; it also provides many health benefits. Generally, infectious disease organisms are less concentrated in outdoor air than indoor air. Light exposure of the skin to sunlight promotes the production of Vitamin D that growing children require. Open spaces in outdoor areas, even those confined to screened rooftops in urban play spaces encourage children to develop gross motor skills and fine motor play in ways that are difficult to duplicate indoors. Nevertheless, some weather conditions make outdoor play hazardous. Caregivers must protect children from adverse weather and air quality. Wind chill conditions that pose a risk of frostbite as well as heat and humidity that pose a significant risk of heat-related illness are defined by the National Weather Service and are announced routinely. The federal government has established health standards for a number of air pollutants. Child care providers must use this information appropriately. Heat-induced illness and cold injury are preventable. Children have greater surface area-to-body mass ratio than adults. Therefore, children do not adapt to extremes of temperature as effectively as adults when exposed to a high climatic heat stress or to cold. Children produce more metabolic heat per mass unit than adults when walking or running. They also have a lower sweating capacity and cannot dissipate body heat by evaporation as effectively (87). COMMENTS: The Iowa Department of Public Health, Healthy Child Care Iowa has prepared a convenient color-coded guide for child care providers to use to determine which weather conditions are comfortable for outdoor play, which require caution, and which are dangerous. This guide is available on the website for the Iowa Department of Public Health at http://www.idph.state.ia.us/fch/fam-serv/HCCI/products/weatherwatch.pdf. The federal Clean Air Act requires that the Environmental Protection Agency (EPA) establish ambient air quality health standards. Most local health departments monitor weather and air quality in their jurisdiction and make appropriate announcements. To access the latest weather information and warnings, contact the National Weather Service. Contact information is located in Appendix BB. See STANDARD 3.081 for information on requirements for applying sunscreen. TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home PROGRAM ACTIVITIES FROM BIRTH TO 35 MONTHS STANDARD 2.010 personal caregiver relationships for infants and toddlers Opportunities shall be provided for each child to develop a personal and affectionate relationship with, and attachment to, that child's parents and one or a small number of caregivers whose care for and responsiveness to the child ensure relief of distress, experiences of comfort and stimulation, and satisfaction of the need for a personal relationship. The facility shall limit the number of caregivers who interact with any one infant to no more than three caregivers in a given day and no more than five caregivers across the period that the child is an infant in child care. The caregivers shall: a) Hold and comfort children who are upset; b) Engage in social interchanges such as smiling, talking, touching, singing, and eating; c) Be play partners as well as protectors; d) Attune to children's feelings and reflect them back. RATIONALE: Trustworthy adults who give of themselves as they provide care and learning experiences play a key role in a child's development as an active, self-knowing, self-respecting, thinking, feeling, and loving person (9). Limiting the number of adults with whom an infant interacts fosters reciprocal understanding of communication cues that are unique to each child. This leads to a sense of trust of the adult by the infant that the infant's needs will be understood and met promptly (88, 89). Studies of infant behavior show that infants have difficulty forming trusting relationships in settings where many adults interact with a child, e.g., in hospitalization of infants when shifts of adults provide care. This difficulty occurs even if each of the many adults are very caring in their interaction with the child. Assigning a consistent caregiver to an eight-hour shift in such settings has been observed to help. This limits the number of different adults with whom the child interacts in a three to 24-hour period (90, 91). COMMENTS: Kissing, hugging, holding, and cuddling infants and children are expressions of wholesome love that should be encouraged. Caregivers should be advised that it is all right to demonstrate affection for children of both sexes. At all times, caregivers should respect the wishes of children, regardless of their ages, with regard to physical contact and their comfort or discomfort with it. Caregivers should avoid even "friendly contact" (such as touching the shoulder or arm) with a child if the child is uncomfortable with it. This is especially true of school-age children (12). TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home STANDARD 2.011 interactions with infants and toddlers Caregivers shall talk, listen to, and otherwise interact with young infants as they feed, change, and cuddle them. RATIONALE: Richness of language increases by nurturing it through verbal interactions between the child and adults and peers. Adults' speech is one of the main channels through which children learn about themselves, others, and the world in which they live. While adults speaking to children teach the children facts, the social and emotional communications and the atmosphere of the exchange are equally important. Reciprocity of expression, response, the initiation and enrichment of dialogue are hallmarks of the social function and significance of the conversations (9, 10, 11, 25). The future development of the child depends on his/her command of language (5). Richness of language increases as it is nurtured by verbal interactions of the child with adults and peers. Basic communication with parents and children requires an ability to speak their language. COMMENTS: Live, real-time interaction with care- givers is preferred. For example, caregivers' naming objects or singing rhymes to all children supports language development. Children's stories and poems presented on recordings with a fixed speed for sing-along can actually interfere with a child's ability to participate in the singing or recitation. The pace will be too fast for some children, and the activity will have to be repeated for the child to learn it. TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home STANDARD 2.012 space and activity to support learning of infants and toddlers The facility shall provide a safe and clean space, both indoors and outdoors, and colorful material and equipment arranged to support learning. The facility shall provide opportunities for the child to act upon the environment by experiencing age-appropriate obstacles, frustrations, and risks in order to learn to manage inner feelings and resources, as well as the occurrences and demands of the outer world. The facility shall provide opportunities for play that: · Lessen the child's anxiety and help the child adapt to reality and resolve conflicts; · Enable the child to explore the real world; · Help the child practice resolving conflicts; · Use symbols (words, numbers, and letters); · Manipulate objects; · Exercise physical skills; · Encourage language development; · Foster self-expression; · Strengthen the child's identity as a member of a family and a cultural community. RATIONALE: Opportunities to be an active learner are vitally important for the development of motor competence and awareness of one's own body and person, the development of sensory motor intelligence, the ability and motivation to use physical and mental initiative, and feelings of mastery and successful coping. Coping involves original, imaginative, and innovative behavior as well as previously learned strategies. Learning to resolve conflicts constructively in childhood is essential in preventing violence later in life (13, 14). A physical and social environment that offers opportunities for active mastery and coping enhances the child's adaptive abilities (15, 16). The importance of play for developing cognitive skills, for maintaining an affective and intellectual equilibrium, and for creating and testing new capacities is well recognized. Play involves a balance of action and symbolization, and of feeling and thinking (17, 18, 19). For more information regarding appropriate play materials for young children, see Which Toy for Which Child: A Consumer's Guide for Selecting Suitable Toys from the U.S. Consumer Product Safety Commission (CPSC) and The Right Stuff for Children Birth to 8: Selecting Play Materials to Support Development from National Association for the Education of Young Children (NAEYC). Contact information for the CPSC and the NAEYC is located in Appendix BB. TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home STANDARD 2.013 separation of infants and toddlers from older children Except in family style, small, closed groups of mixed aged children, infants and toddlers younger than 3 years of age shall be cared for in a closed room(s) that separates them from older children. In facilities caring for three or more children younger than 3 years of age, activities that bring children younger than 3 years of age in contact with older children shall be prohibited, unless the younger children already have regular contact with the older children as part of a group or because of pooling of children during early morning arrivals or late afternoon departures. Caregivers of infants shall not be responsible for the care of older children who are not a part of the infants' closed child care group. Groups of infants shall receive care in closed room(s) that separate them from other groups of infants and older children. RATIONALE: Infants need quiet, calm environments, away from the stimulation of older children and other groups. Younger infants should be cared for in rooms separate from the more boisterous toddlers. In addition to these developmental needs of infants, separation is important for reasons of disease prevention. Rates of hospitalization for all forms of acute infectious respiratory tract diseases are highest during the first year of life, indicating that respiratory tract illness becomes less severe as the child gets older. Therefore, infants should be a focus for interventions to reduce the incidence of respiratory tract diseases. COMMENTS: This separation of younger children from older children ideally should be implemented in all facilities but may be less feasible in small or large family child care homes. Although a group of children of different ages receiving care together from one or two caregivers may increase this risk of transmission of infection among members of the group, the developmental and curricular advantage of mixed age groupings may offset this risk. Separation of groups of children by low partitions that divide a single common space without sound attenuation or control of interactions among the caregivers who are working with different groups is not acceptable. This arrangement essentially combines the separate smaller groups into a large group. When partitions are used, they must control interaction between groups and control sound transmission. The acoustic controls should limit significant transmission of sound from one group's activity into other group environments. TYPE OF FACILITY: Center PROGRAM ACTIVITIES FOR 3- TO 5-YEAR-OLDS STANDARD 2.014 personal caregiver relationships for 3- to 5-year-olds Facilities shall provide opportunities for each child to build long-term, trusting relationships with a few caring caregivers by limiting the number of adults the facility permits to care for any one child in child care to a maximum of 8 adults in a given year and no more than 3 in a day. RATIONALE: Children learn best from adults who know and respect them; who act as guides, facilitators, and supporters of a rich learning environment; and with whom they have established a trusting relationship (20, 21). When the facility allows too many adults to be involved in the child's care, the child does not develop a reciprocal, sustained, responsive, trusting relationship with any of them. Children should have continuous friendly and trusting relationships with several caregivers who are reasonably consistent within the child care facility. Young children can extract from these relationships a sense of themselves with a capacity for forming trusting relationships and self-esteem. Relationships are fragmented by rapid staff turnover or if the child is frequently moved from one child care facility to another. COMMENTS: Compliance should be measured by staff and parent interviews. Turnover of staff lowers the quality of the facility. High quality facilities maintain low turnover through their wage policies, training and support for staff (22). TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home STANDARD 2.015 opportunities for learning for 3- to 5-year-olds Facilities shall provide opportunities for children to observe, explore, order and reorder, make mistakes and find solutions, and move from the concrete to the abstract in learning. RATIONALE: The most meaningful learning has its source in the child's self-initiated activities. The learning environment that supports individual differences, learning styles, abilities, and cultural values fosters confidence and curiosity in learners (20, 21). TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home STANDARD 2.016 selection of equipment for 3- to 5-year-olds The facility shall select, for both indoor and outdoor play, developmentally appropriate equipment, for safety, for its ability to provide large and small motor experiences, and for its adaptability to serve many different ideas, functions, and forms of creative expression. RATIONALE: An aesthetic, orderly, appropriately stimulating, child-oriented environment contributes to the preschooler's sense of well-being and control (23). COMMENTS: See also Play Equipment, STANDARD 5.081 through STANDARD 5.092. TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home STANDARD 2.017 expressive activities for 3- to 5-year-olds Caregivers shall encourage and enhance expressive activities that include play, painting, drawing, story telling, music, singing, dancing, and dramatic play. RATIONALE: Expressive activities are vehicles for socialization, conflict resolution, and language development. They are, in addition, vital energizers and organizers for cognitive development. Stifling the preschooler's need to play damages a natural integration of thinking and feeling (24). TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home STANDARD 2.018 fostering cooperation of 3- to 5-year-olds Facilities shall foster a cooperative rather than a competitive atmosphere. RATIONALE: As 3-, 4-, and 5-year-olds play and work together, they shift from almost total dependence on the adult to seeking support from peers. The rules and responsibilities of a well-functioning group help children of this age to internalize impulse control and to become increasingly responsible for managing their behavior. A dynamic curriculum designed to include the ideas and values of a broad socioeconomic group of children will promote socialization. The inevitable clashes and disagreements are more easily resolved when there is a positive influence of the group on each child (19). COMMENTS: Encouraging verbal skills and attentiveness to the needs of individuals and the group as a whole supports a cooperative atmosphere. TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home STANDARD 2.019 fostering language development of 3- to 5-year-olds The facility shall be rich in first-hand experiences that offer opportunities for language development. Facilities shall also have an abundance of books of fantasy, fiction, and nonfiction, and provide chances for the children to relate stories. Care-givers shall foster language development by: a) Speaking with children rather than at them; b) Encouraging children to talk with each other by helping them to listen and respond; c) Giving children models of verbal expression; d) Reading books about the child's culture and history, which would serve to help the child develop a sense of self; e) Listening respectfully when children speak. RATIONALE: Language reflects and shapes thinking. A curriculum created to match preschoolers' needs and interests enhances language skills. First-hand experiences encourage children to talk with each other and with adults, to seek, develop, and use increasingly more complex vocabulary, and to use language to express thinking, feeling, and curiosity (10, 25). COMMENTS: Compliance should be measured by structured observation. Examples of verbal encouragement of verbal expression are: "Ask Johnny if you may play with him"; "Tell him you don't like being hit"; "Tell Sara what you saw downtown yesterday"; "Tell Mommy about what you and Johnny played this morning." These encouraging statements should be followed by respectful listening, without pressuring the child to speak. TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home STANDARD 2.020 body mastery for 3- to 5-year-olds The facility shall offer children opportunities to learn about their bodies and how their bodies function in the context of socializing with others. Caregivers shall support the children in their curiosity and body mastery, consistent with parental expectations and cultural preferences. Body mastery includes feeding oneself, learning how to use the toilet, running, skipping, climbing, balan-cing, playing with peers, displaying affection, and using and manipulating space. Autoerotic or masturbatory activity shall be ignored unless it is excessive, interferes with other activities, or is noticed by other children, in which case the caregiver shall make a brief non-judgmental comment that touching of private body parts feels good, but is usually done in a private place. After making such a comment, the caregiver shall offer friendly assistance in going on to other activities. RATIONALE: Achieving the pleasure and gratification of feeling physically competent on a voluntary basis is a basic component of developing self-esteem and the ability to socialize with adults and other children inside and outside the family (12, 15, 16, 20, 21, 24, 26). TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home STANDARD 2.021 health, nutrition and safety awareness for 3- to 5-year-olds Facilities shall address health, nutrition, and safety awareness as an integral part of the overall program. Child care centers shall have written program plans addressing the health and/or nutrition, and safety aspects of each formally structured activity documented in the written curriculum. RATIONALE: The curriculum that best meets the needs of preschool children is one in which the daily events of living together provide the raw materials for an integrated approach. Young children learn better through experiencing an activity and observing behavior than through didactic training (80). There may be a reciprocal relationship between learning and play so that play experiences are closely related to learning (17, 18). Children can accept and enforce rules about health and safety when they have personal experience of why these rules were created. TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home PROGRAM ACTIVITIES FOR SCHOOL-AGE CHILDREN STANDARD 2.022 supervised school-age activities The facility shall have a program of supervised activities designed especially for school-age children, to include: a) Free choice of play; b) Opportunities to develop physical fitness through a program of focused activity; c) Opportunities for concentration, alone or in a group; d) Time to read or do homework; e) Opportunities to be creative, to explore the arts, sciences, and social studies, and to solve problems; f) Opportunities for community service experience (museums, library, leadership development, senior citizen homes, etc.); g) Opportunities for adult-supervised skill-building and self-development groups, such as scouts, team sports, and club activities (as transportation, distance, and parental permission allow). RATIONALE: Programs organized for older children after school or during vacation time should meet the needs of these children for recreation, responsible completion of school work, expanding their interests, learning cultural sensitivity, exploring community resources, and practicing pro-social skills (31, 32). COMMENTS: For more information on school-age standards, see The NSACA Standards for Quality School-Age Care , available from the National School-Age Care Alliance (NSACA). Contact information is located in Appendix BB. TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home STANDARD 2.023 space for school-age activity The facility shall provide a space for indoor and outdoor activities for children in school-age child care. RATIONALE: A safe and secure environment that fosters the growing independence of school-age children is essential for their development (33, 34). TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home STANDARD 2.024 developing relationships for school-age children The facility shall offer opportunities to school-age children for developing trusting,, supportive relationships with the staff and with peers. RATIONALE: Although school-age children need more independent experiences, they continue to need the guidance and support of adults. Peer relationships take on increasing importance for this age group. TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home STANDARD 2.025 planning activities for school-age children The facility shall offer a program based on the needs and interests of the age group, as well as of the individuals within it. Children shall participate in planning the program activities. RATIONALE: A child care facility for school-age children should provide an enriching contrast to the formal school program. Facilities that offer a wide range of activities (such as team sports, cooking, dramatics, art, music, crafts, games, open time, quiet time, use of community resources) allow children to explore new interests and relationships. TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home STANDARD 2.026 community outreach for school-age children The facility shall provide opportunities for and engage with community outreach and involvement of school-age children, such as field trips and community improvement projects. RATIONALE: As the world of the school-age child encompasses the larger community, facility activities should reflect this stage of development. Field trips and other opportunities to explore the community should enrich the child's experience. TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home STANDARD 2.027 communication between child care and school Facilities that accept school-age children directly from school shall devise a system of communication with the child's school teacher. RATIONALE: Activities that have gone on during the day may be important in anticipating and under standing children's after-school behavior. The connection between children's school learning experience and their out-of-school activities is important. COMMENTS: This communication may be facilitated by providing a notebook that is passed between the child care facility and child's teacher. The child's teacher and a staff member from the facility should meet at least once to exchange telephone numbers and to offer a contact in the event relevant information needs to be shared. TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home 2.2 SUPERVISION STANDARD 2.028 methods of supervision Caregivers shall directly supervise infants, toddlers, and preschool children by sight and hearing at all times, even when the children are in sleeping areas. Caregivers shall not be on one floor level of the building, while children are on another floor. School-age children shall be permitted to participate in activities off the premises with written approval by a parent and by the caregiver. Caregivers shall regularly count children on a scheduled basis, at every transition, and whenever leaving one area and arriving at another, to confirm the safe whereabouts of every child at all times. Developmentally appropriate child:staff ratios shall be met during all hours of operation, including indoor and outdoor play and field trips, following precautions for specific areas and equipment. No center-based facility shall operate with fewer than two staff members if more than six children are in care, even if the group otherwise meets the child:staff ratio. Although centers often downsize the number of staff for the early arrival and late departure times, another adult must be present to help in the event of an emergency. The supervision policies of centers and large family child care homes shall be written policies. RATIONALE: Supervision is basic to the prevention of harm. Parents have a contract with caregivers to supervise their children. To be available for super-vision or rescue in an emergency, an adult must be able to hear and see the children. In case of fire, a supervising adult should not need to climb stairs or use a ramp or an elevator. These changes in elevation usually become unusable because they are the pathways for smoke. Children who are presumed to be sleeping might be awake and in need of adult attention. Risk-taking behavior must be detected; and illness, fear, or other stressful behavior must be managed. Children like to test their skills and abilities. This is particularly noticeable around playground equipment. Even if the highest safety standards for playground layout, design and surfacing are met, serious injuries can happen if children are left unsupervised. Adults who are involved, aware, and appreciative of young children's behaviors are in the best position to safeguard their well-being. Active and positive supervision involves: Knowing each child's abilities; Establishing clear and simple safety rules; Being aware of potential safety hazards; Standing in a strategic position; Scanning play activities and circulating; Focusing on the positive rather than the negative to teach a child what is safe for the child and other children. Children should be protected against sexual abuse by limiting situations in which a caregiver, other adult, or an older child is left alone with a child in care without another adult present. See STANDARD 3.059, for additional information regarding safe physical layouts for child care facilities. Many instances have been reported where a child has hidden when the group was moving to another location, or where the child wandered off when a door was opened for another purpose. Regular counting of children will alert the staff to begin a search before the child gets too far or into trouble. Counting children routinely is without substitute in assuring that a child has not slipped into an unobserved location. COMMENTS: Caregivers should record the count on an attendance sheet or on a pocket card, along with notations of any children joining or leaving the group. Caregivers should do the counts before the group leaves an area and when the group enters a new area. The facility should assign and reassign counting responsibility as needed to maintain a counting routine. Facilities might consider counting systems such as using a reminder tone on a watch or musical clock that sounds at timed intervals (about every 15 minutes) to help the staff remember to count. Older preschool children and school-age children may use toilet facilities without direct visual observation. The staff should assess the setting to ascertain how the ability to see and hear child activities might be improved. The use of devices such as convex mirrors to assure visibility around corners, and baby monitors for older preschool and school-age children, who use the toilet by themselves, may be considered. Facilities might also consider the use of surveillance devices or systems placed strategically in areas where they might contribute further to child safety. In addition, these systems are beneficial because they can allow parents to observe the facility; and caregivers can use them as support in the event of an accusation of abuse. Planning must include advance assignments to maintain appropriate staffing. Sufficient staff must be maintained to evacuate the children safely in case of emergency. Compliance with proper child:staff ratios should be measured by structured observation, by counting caregivers and children in each group at varied times of the day, and by reviewing written policies. For additional information on supervision, see STANDARD 5.117, on children using toilet learning/training equipment. TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home 2.3 TRANSPORTATION STANDARD 2.029 competence and training of transportation staff At least one adult who accompanies or drives children for field trips and out-of-facility activities shall receive training by a professional knowledgeable about child development and procedures to ensure the safety of all children. The caregiver shall hold a valid pediatric first aid certificate, including rescue breathing and management of blocked airways, as specified in First Aid and CPR, STANDARD 1.026 through STANDARD 1.028. All drivers, passenger monitors, chaperones, and assistants shall receive instructions in safety precautions. If transportation is provided, these instructions shall include: a) Use of developmentally appropriate safety restraints; b) Proper placement of the child in the motor vehicle; c) Handling of emergency situations. If a child has a chronic medical condition that could result in an emergency (such as asthma, diabetes, seizures), the driver or chaperone shall have written instructions including parent emergency contacts, child summary health information, special needs, and treatment plans, and shall be trained to; 1) Recognize the signs of a medical emergency; 2) Know emergency procedures to follow; 3) Have on-hand, any emergency supplies or medications necessary; d) Map and appropriate route to emergency facility; e) Defensive driving; f) Child supervision during transport, including never leaving a child unattended in a vehicle. The receipt of such instructions shall be documented in a personnel record for any paid staff or volunteer who participates in field trips or transportation activities. Child:staff ratios shall be maintained on field trips and during transport, as specified in STANDARD 1.001 through STANDARD 1.005. RATIONALE: Injuries are more likely to occur when a child's surroundings or routine changes. Activities outside the facility may pose increased risk for injury. When children are excited or busy playing in unfamiliar areas, they are more likely to forget safety measures unless they are closely supervised at all times. Children have died from heat stress from being left unattended in closed vehicles. Temperatures in hot cars can reach dangerous levels within 15 minutes (35). Adults cannot be assumed to be knowledgeable about the various developmental levels or special needs of children. Training by someone with appropriate knowledge and experience is needed to appropriately address these issues. COMMENTS: When field trips are planned, it is recommended that the sites should be visited by child care staff in advance of the actual field trip to ensure that the site is accessible for the children with special needs. This standard also applies when caregivers are walking with children to and from a destination. TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home STANDARD 2.030 qualifications for drivers Any driver who transports children for a child care program shall be at least 21 years of age and shall have: a) A valid driver's license that authorizes the driver to operate the vehicle being driven; b) Evidence of a safe driving record for more than five years, with no crashes where a citation was issued; c) No record of substance abuse or conviction for crimes of violence or child abuse; d) No alcohol or other drugs associated with impaired ability to drive within 12 hours prior to transporting children. Drivers shall ensure that any prescription drugs taken will not impair their ability to drive; e) No criminal record of crimes against or involving children, child neglect or abuse, or any crime of violence. The driver's license number, vehicle insurance information, and verification of current state vehicle inspection shall be on file in the facility. The center director shall require drug testing when noncompliance with the restriction on the use of alcohol or other drugs is suspected. RATIONALE: Driving children is a significant responsibility. Child care programs must assure that anyone who drives the children is competent to drive the vehicle being driven. COMMENTS: The driver should advise the health care provider of his/her job and question whether it is safe to drive children while on medication(s) prescribed. Compliance can be measured by testing blood or urine levels for drugs. Refusal to permit such testing should preclude continued employment. TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home STANDARD 2.031 route to emergency medical facility Any driver who transports children for a child care program shall keep instructions for the quickest route to the nearest hospital from any point on the route in the vehicle. RATIONALE: Driving children is a significant responsibility. Child care programs must assure that anyone who transports children can obtain emergency care promptly. TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home STANDARD 2.032 drop-off and pick-up points The facility shall have, and communicate to staff and parents, a plan for safe, supervised drop-off and pick-up points and pedestrian crosswalks in the vicinity of the facility. The plan shall require drop-off and pick-up only at the curb or at an off-street location protected from traffic. The facility shall assure that any adult who supervises drop-off and loading can see and assure that children are clear of the perimeter of all vehicles before any vehicle moves. RATIONALE: Injuries and fatalities have occurred during the loading and unloading process, especially in situations where vans or school buses are used to transport children. COMMENTS: The child care provider should examine the parking area and determine the safest way to drop off and pick up children. Plans for loading and unloading should be discussed with the children, families, caregivers, and drivers. TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home STANDARD 2.033 vehicle safety restraints When children are driven in a motor vehicle other than a bus, school bus, or a bus operated by a common carrier, the following shall apply: · A child shall be transported only if the child is fastened in an approved developmentally appropriate safety seat, seat belt, or harness appropriate to the child's weight, and the restraint is installed and used in accordance with the manufacturers' instructions for the car seat and the motor vehicle. Each child must have an individual seat belt and be positioned in the vehicle in accordance with the requirements for the safe use of air bags in the back seat; · A child under the age of 4 shall be transported only if the child is securely fastened in a de- velopmentally appropriate child passenger restraint system that meets the federal motor vehicle safety standards contained in the Code of Federal Regulations, Title 49, Section 571.213, and this compliance is so indicated on the safety restraint device; · If small buses or vans have safety restraints installed, children weighing over 40 pounds shall have access to belt-positioning booster seats with lap and shoulder belts. Children weighing under 40 pounds shall use car safety seats; · Vehicles shall accommodate the placement of wheelchairs with four tie-downs affixed according to the manufactures' instructions in a forward-facing direction. The wheelchair occupant shall be secured by a three-point tie restraint during transport. RATIONALE: Safety restraints are effective in reducing death and injury when they are used properly. The best car safety seat is one that fits in the vehicle being used, fits the child being transported, has never been in a crash, and is used correctly every time. The use of restraint devices while riding in a vehicle reduces the likelihood of a passenger's suffering serious injury or death if the vehicle is involved in a crash. The use of child safety seats reduces risk of death by 71% for children less than 1 year of age and by 54% for children ages 1-4 (36). It is reasonable to require that the license holder ensure that the child be placed in restraint devices that conform to state and federal laws. The standard does not apply when children are being transported in vehicles not routinely or commonly equipped with restraints. The standard, however, does clarify that it is the responsibility of the caregiver to ensure that children are fastened in a restraint system. Federal law applies only to vehicles equipped with factory-installed seat belts after 1967. The provision of mandatory restraints, regardless of the driver or age of the vehicle, is necessary to ensure children's health and safety. The use of safety restraints and choice of positioning in the vehicle is determined by close inspection of the manufacturer's instructions for seat restraints and for the vehicle. At all times, vehicles should be ready to transport children who must ride in wheelchairs (38, 39). Manufacturers' specifications should be followed to assure that safety requirements are met. COMMENTS: When school buses meet current standards for the transport of school-age children, containment design features help protect children from injury, although the use of seat belts would provide additional protection. To obtain the Code of Federal Regulations, contact the Superintendent of Documents. Contact information is located in Appendix BB. Many issues are involved in fitting the wide variety of safety restraints into the many different types of motor vehicles. Positioning children in relation to air bags in the vehicle adds a further complication. If the instructions for the safety restraint and for the motor vehicle do not make clear what should be done, contact the National Highway and Transportation Safety Administration (NHTSA) Auto Safety Hotline for more information. Contact information is located in Appendix BB. Parents and others who transport young children should be aware that incompatibility problems between the design of the car safety seat, vehicle seat, and the seat belt system can be life-threatening and can be avoided by: Reading the vehicle owner's manual and child restraint device instructions carefully; Testing the car safety seat for a safe snug fit in the vehicle; Having the car seat installation checked by a certified car seat technician at an approved car seat check station in the community; Remembering that the rear vehicle seat is the safest place for a child of any age to ride. TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home STANDARD 2.034 travel time Children shall not be transported for more than 1 hour per one-way trip on a routine basis. RATIONALE: It is unreasonable to expect young children to remain confined and seated in a transportation device for a period exceeding 1 hour. Com-muting is tiring in general, and particularly difficult if the child spends many hours in child care. The time period may need to be lessened for infants or children with special health needs. Exceptions for a special field trip may be allowed, but these exceptions should occur infrequently and allow for rest and stretch stops during the trip. TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home STANDARD 2.035 No smoking in vehicles There shall be no smoking in the vehicles used by the facility at any time. In each vehicle from a center, a "NO SMOKING" sign shall be posted. RATIONALE: Children in confined spaces, e.g., closed vehicles, should not be exposed to secondhand smoke, particularly children with respiratory problems. Exposure to smoke and smoke fumes could trigger increased respiratory difficulties. COMMENTS: Compliance can be measured by interviewing drivers and inspecting vehicles for evidence of smoking. TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home STANDARD 2.036 distractions while driving The driver shall not play the radio or CD player loudly or use ear phones to listen to music or other distracting sounds while children are in the vehicles operated by the facility. Cellular phones shall be used only when the vehicle is stopped and in emergency situations only. In each vehicle from a center, a sign shall be posted stating "NO LOUD RADIOS, TAPES, OR CDS". RATIONALE: Loud noise interferes with normal conversation and may be especially disturbing to children with central nervous system abnormalities. It is also distracting to the driver and the passenger monitor or assistant attending the children in the vehicle. COMMENTS: A driver's use of a portable radio, tape, or CD player with earphones is unacceptable. TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home STANDARD 2.037 child behavior during transportation Children, as both passengers and pedestrians, shall be instructed in safe transportation behavior with terms and concepts appropriate for their age and stage of development. RATIONALE: Teaching passenger safety to children reduces injury from motor vehicle crashes to young children (40). Young children need to develop skills that will aid them in assuming responsibility for their own health and safety, and these skills can be developed through health education implemented during the early years (37, 41). COMMENTS: Curricula and materials can be obtained from state departments of transportation, the American Automobile Association (AAA), the American Academy of Pediatrics (AAP), the American Red Cross, and the National Association for the Education of Young Children (NAEYC). Contact information is located in Appendix BB. TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home STANDARD 2.038 emergency supplies for field trips First aid kits shall be taken on field trips, as specified in STANDARD 5.093. Cellular phones shall be taken on field trips for use in emergency situations. RATIONALE: The ability to communicate for help in an emergency situation while traveling is critical to the safety of children in a vehicle. TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home 2.4 DISCIPLINE STANDARD 2.039 discipline measures Discipline shall include positive guidance, redirection, and setting clear-cut limits that foster the child's ability to become self-disciplined. Disciplinary measures shall be clear and under-standable to the child, shall be consistent, and shall be explained to the child before and at the time of any disciplinary action. Caregivers shall guide children to develop self-control and orderly conduct in relationships with peers and adults. Caregivers shall show children positive alternatives rather than just telling children "no." Caregivers shall care for children without resorting to physical punishment or abusive language. Caregivers shall acknowledge and model desired behavior. For children 3 or over, facilities shall selectively use "time out" only to enable the child to regain control of himself or herself. The caregiver shall keep the child within visual contact. The caregiver shall take into account the child's developmental stage, tolerances, and ability to learn from "time out." Expectations for children's behavior shall be written and shared with families and children of appropriate age. RATIONALE: The word "discipline" originates from a Latin root that implies learning and education. The modern dictionary defines discipline as: "training that develops self-control, character, or orderliness and efficiency." Unfortunately, common usage has corrupted the word so that many consider discipline as synonymous with punishment, most particularly corporal punishment (52, 85). Discipline is most effective when it is consistent, reinforces desired behaviors, and offers natural and logical consequences for negative behaviors. Research studies find that corporal punishment has limited effectiveness and potentially hurtful side effects (53-57). Children have to be given understandable guidelines for their behavior if they are to develop internal control of their actions. The aim is to develop personal standards in self-discipline, not to enforce a set of institutional rules. COMMENTS: Discipline should be an ongoing process to help children develop inner control so they can manage their own behavior in a socially approved manner. Positive discipline may include brief, supervised separation from the group, or withdrawal of privileges, such as playtime with other children. Natural consequences are effective and useful if not associated with injury (for example, when a child misuses and breaks a toy, the toy does not work any more). Logical consequences of an action (such as not being able to play in the sandbox for a time as a consequence of throwing sand) are also effective methods of positive discipline. "Time out" should not be used with infants and toddlers, as they are too young to cognitively understand this consequence (44). Certain children learn from time out. Time out should be used consistently, for an appropriate duration, not excessively. For more details on the effective use of "time out", see the American Academy of Pediatrics Guidance for Effective Discipline (44). Also see The Magic Years by Selma H. Fraiberg, published by Charles Scribner's Sons. Contact information is located in Appendix BB. For additional requirements related to discipline, see also Management and Health Policy and Statement of Services, STANDARD 8.004 and STANDARD 8.005, on signed parent agreements; Discipline Policy, STANDARD 8.008 through STANDARD 8.010, on dealing with acts of aggression and fighting by children; Posting Documents, STANDARD 8.077, on posting discipline policies; and Child Abuse and Neglect, STANDARD 3.053 through STANDARD 3.059. TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home STANDARD 2.040 handling physical aggression The facility shall use the teaching method described in STANDARD 2.039 immediately when it is important to show that aggressive physical behavior toward staff members or children is unacceptable. Caregivers shall intervene immediately when children become physically aggressive. RATIONALE: Children in out-of-home care in the United States have demonstrated more aggressive behavior than children reared at home or children in facilities in other countries. Children mimic adult behavior; adults who demonstrate loud or violent behavior serve as models for children (45). Caregiver intervention protects children and encourages them to exhibit more acceptable behavior (47). COMMENTS: Children could assist in the rule-making to develop this sense of responsibility. TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home STANDARD 2.041 dispensing discipline in equitable manner Disciplinary practices that the facility establishes shall be dispensed in an equitable manner and shall be designed to encourage children to be fair, to respect property, and to assume personal responsibility and responsibility for others. RATIONALE: To foster social development, a facility should have a clearly defined code of behavior that applies equally to all children and a disciplinary policy to support it. Because not everyone shares the same opinion about what is "right," caregivers should explain to new caregivers and to parents the behavioral goals and disciplinary methods established for the facility. It is important for staff members to be consistent in their approach, and the best results are achieved with family cooperation. Child care administrators and caregivers can facilitate good behavior by creating an environment responsive to the children's needs. A good "fit" between the temperament of the caregiver and the child always helps (48). TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home STANDARD 2.042 prohibited caregiver behaviors The following behaviors shall be prohibited in all child care settings and by all caregivers: a) Corporal punishment, including beating,hit-ting, spanking, shaking, pinching, excessive exercise, exposure to extreme temperatures, and other measures producing physical pain; b) Withdrawal or the threat of withdrawal of food, or forcing of food, rest, or bathroom opportunities; c) Abusive or profane language or verbal abuse, threats, or derogatory remarks about the child or child's family; d) Any form of public or private humiliation, including threats of physical punishment; e) Any form of emotional abuse, including re-jecting, terrorizing, ignoring, isolating, or corrupting a child; f) Binding or tying to restrict movement, such as in a car seat (except when travelling); or enclosing in a confined space such as a closet, locked room, box, or similar cubicle. RATIONALE: Corporal punishment may be physical abuse or may easily become abusive. Emotional abuse can be extremely harmful to children, but, unlike physical or sexual abuse, it is not adequately defined in most state child abuse reporting laws. Corporal punishment is clearly prohibited in small family child care homes and centers in the majority of states (49-51). Research links corporal punishment with negative effects such as later criminal behavior and impairment of learning (53-57). Factors supporting prohibition of certain methods of punishment include current child development theory and practice, legal aspects (namely, that a caregiver does not foster a relationship with the child in place of the parents), and increasing liability suits. The American Academy of Pediatrics (AAP) is opposed to the use of corporal punishment (44). Physicians, educators, and caregivers should neither inflict nor sanction corporal punishment (56). COMMENTS: Appropriate alternatives to corporal punishment vary as children grow and develop. As infants become more mobile, the caregiver must create a safe space and impose limitations by en-couraging activities that distract them from harmful situations. Brief verbal expressions of disapproval help prepare infants and toddlers for later use of reasoning. However, the caregiver cannot expect infants and toddlers to be controlled by verbal reprimands. Preschoolers have begun to develop an understanding of rules and can be expected to understand "time out" (out-of-group activity) under adult supervision as a consequence for undesirable behavior. School-age children begin to develop a sense of personal responsibility and self-control and will recognize the removal of privileges (such as loss of participation in an activity) (44). TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home STANDARD 2.043 using physical restraint When a child's behavior makes it necessary, for his own or others' protection, to restrain the child, the most desirable method of restraint is holding the child by another person as gently as possible to accomplish the restraint. Children shall not be physically restrained longer than necessary to control the situation. No bonds, ties, or straps shall be employed to restrain young children. Children shall not be given medicines, drugs, or herbal or folk remedies that will affect their behavior except as prescribed by their health care provider and with specific written instructions from their health care provider for use of the medicine. The decision to restrain the child shall be made by the staff person with the most experience in child care and shall only be made for extreme circumstances. Training in the use of any form of physical restraint shall be provided by persons with extensive child care experience including experience with children who have required restraint. RATIONALE: Undue physical restraint, especially with bonds, ties, or straps can be abusive, as can the use of medications or drugs to control children's behavior. COMMENTS: For Medication Policy, see STANDARD 8.021 and STANDARD 3.081 through STANDARD 3.083. TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home 2.5 PARENT RELATIONSHIPS GENERAL STANDARD 2.044 mutual responsibility of parents and staff There shall be a reciprocal responsibility of the family and child care staff to observe, participate, and be trained in the care that each child requires. All aspects of child care programs shall be designed to facilitate parental input and involvement. Involved, non-custodial parents shall have access to the same developmental and behavioral information given to the custodial parent, if they have joint legal custody, permission by court order, or written consent from the custodial parent. Caregivers shall informally share with parents daily information about their child's needs and activities. RATIONALE: This plan will help achieve the important goal of carryover of facility components from the child care setting to the child's home environment. The child's learning of new skills is a continuous process occurring both at home and in child care. Research, practice, and accumulated wisdom attest to the crucially important influence of children's relationships with those closest to them. Children's experience in child care will be most beneficial when parents and caregivers develop feelings of mutual respect and trust. In such a situation, children feel a continuity of affection and concern, which facilitates their adjustment to separation and use of the facility. An ongoing source of stress for an infant or a young child is the separation from those they love and depend upon. Of the various programmatic elements in the facility that can help to alleviate that stress, by far the most important is the comfort in knowing that parents and caregivers know the children and their needs and wishes, are in close contact with each other, and can respond in ways that enable children to deal with separation. The encouragement and involvement of parents in the social and cognitive leaps of preschoolers provide parents with the confidence vital to their sense of competence. Communication should be sensitive to ethnic and cultural practices. See STANDARD 2.006 through STANDARD 2.008. The parent/caregiver partnership models positive adult behavior for school-age children and demonstrates a mutual concern for the child's well-being (15, 58-70). In families where the parents are separated, it is usually in the child's best interest for both parents to be involved in the child's care, and informed about the child's progress and problems in care. However, it is generally up to the courts to decide who has legal custody of the child. Child care providers should comply with court orders and written consent from the parent with legal authority, and not try to make the determination themselves regarding the best interests of the child. TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home STANDARD 2.045 parent-to-parent communication The facility shall give consenting parents a list of names and phone numbers of other consenting parents whose children attend the same facility. The list shall include an annotation encouraging parents whose children attend the same facility to communicate with one another about the service. The facility shall update the list at least annually. RATIONALE: Encouraging parents' communication is simple, inexpensive, and beneficial. Such communication may include the exchange of positive aspects of the facility and positive knowledge about children's peers. If parents communicate with each other, they can share concerns about the behavior of a specific caregiver and can identify patterns of action suggestive of abuse. TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home STANDARD 2.046 parent visits Caregivers shall inform all parents that they may visit the site at any time when their child is there, and that, under normal circumstances, they will be admitted without delay. This open-door policy shall be part of the "admission agreement" or other contract between the parent and the caregiver, if they have custody, joint custody, permission by court order, or written consent from the custodial parent. Parents are welcomed and encouraged to speak freely to staff about concerns and suggestions. RATIONALE: This provision may be the single most important method for preventing the abuse of children in child care. Requiring unrestricted access of parents to their children is essential to preventing the abuse of children in child care (71, 72). When access is restricted, areas observable by the parents may not reflect the care the children actually receive. COMMENTS: Child care providers should not attempt to handle on their own an unstable (for example, intoxicated) parent who wants to be admitted but whose behavior poses a risk to the children. Child care providers should consult local police or the local child protection agency about their recommendations for how staff can obtain support from law enforcement authorities to avoid incurring increased by improperly refusing to release a child. Parents can be interviewed to see if the open-door policy is enthusiastically implemented. For additional information on parent relationships in general, see STANDARD 2.050through STANDARD 2.054; see STANDARD 2.006 , on primary language of the parents. For information regarding complaint procedures, see STANDARD 2.052. See Management and Health Policy and Statement of Services, STANDARD 8.004 and STANDARD 8.005, for more information on admission agreements. TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home REGULAR COMMUNICATION STANDARD 2.047 parent conferences Along with short informal daily conversations between parents and caregivers, planned communication (for example, parent conferences) shall be scheduled with at least one parent of every child in care: a) To review the child's development and adjustment to care; b) To reach agreement on appropriate, nonviolent, disciplinary measures; c) To discuss the child's strengths, specific health issues, and concerns such as persistent behavior problems, developmental delays, special needs, overweight, underweight, or eating or sleeping problems. At these planned conferences a caregiver shall review with the parent the child's health report and the health record to identify medical and developmental issues that require follow-up or adjustment of the facility. Each review shall be documented in the child's facility health record with the signature of the parent and the staff reviewer. These planned conferences shall occur: a) As part of the intake process; b) At each health update interval; c) On a calendar basis, scheduled according to the child's age: 1) Every 6 months for children under 6 years of age; 2) Every year for children 6 years of age and older; d) Whenever new information is added to the child's facility health record. Additional conferences shall be scheduled if the parent or caregiver has a concern at any time about a particular child. Any concern about a child's health or development shall not be delayed until a scheduled conference date. Notes about these planned communications shall be maintained in each child's record at the facility and shall be available for review. RATIONALE: Parents and caregivers alike should be aware of, and should have arrived at, an agreement concerning each other's beliefs and knowledge about how to deal with children. Reviewing the health record with parents ensures correct information and can be a valuable teaching and motivational tool (73). It can also be a staff learning experience, through insight gained from parents on a child's special circumstances. A health history is the basis for meeting the child's health, mental, and social needs in the child care setting (73). Review of the health record can be a valuable educational tool for parents, through better understanding of the health report and immunization requirements (73). A goal of out-of-home care of infants and children is to identify parents who are in need of instruction so they can provide preventive health/nutrition care at a critical time during the child's growth and development. It is in the child's best interest that the staff communicates with parents about the child's needs and progress. Parent support groups and parent involvement at every level of facility planning and delivery are usually beneficial to the children, parents, and staff. Communication among parents whose children attend the same facility helps the parents to share useful information and to be mutually supportive. Both parents and caregivers have essential rights in helping to shape the kind of child care service their children receive. COMMENTS: The need for follow-up on needed intervention increases when an understanding of the need and motivation for the intervention has been achieved through personal contact. A health history is most useful if the health advocate (see Qualifications of Health Advocates, STANDARD 1.021) personally reviews the records and updates the parents. A health history ensures that all information needed to care for the child is available to the appropriate staff member. Special instructions, such as diet, can be copied for everyday use. Compliance can be assessed by reviewing the records of these planned communications. Parents who use child care services should be regarded as active participants and partners in facilities that meet their needs as well as their children's. Compliance can be measured by interviewing parents and staff. See Plan for Child Health Services, STANDARD 8.013 through STANDARD 8.017, on health assessment; and STANDARD 3.004, on nutrition assessment and follow-up. See STANDARD 8.046 through STANDARD 8.051, for more information on health reports; and see STANDARD 8.051 and STANDARD 8.052, for more information on health records. TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home STANDARD 2.048 designated staff for parent contact The facility shall assign a specific staff member to each parent to ensure contact between the designated staff member and parent that may take place at the beginning and end of the day or when a parent drops in. In small family child care homes, this contact will be with the child care provider. The contact shall consist of: a) Discussions between the parent and staff member regarding observations of the child (including health issues); b) Providing an opportunity for the parents to observe the child's playmates and surroun-dings. RATIONALE: A designated staff member with health training is helpful in developing a personal interest in the child and maintaining an ongoing relationship with the parent(s) (74, 75). A plan for personal contact and documentation of a designated staff person will ensure specific attempts to communicate directly with families about health-related matters. COMMENTS: The facility should have a plan for personal contact with parents, even though contact may not be possible on a daily basis. Compliance can be documented by spot observations or self-reporting. In larger facilities, the designated staff person might be the "health advocate." See Qualifications of Health Advocates, STANDARD 1.021. For additional information on regular communication, see also STANDARD 8.043 , on transition contacts with parents. TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home LOG FOR INFANTS, TODDLERS, AND PRESCHOOLERS STANDARD 2.049 daily log For infants, toddlers, and preschoolers, the facility shall have a method, such as a daily log or notebook entry, whereby parents and staff can exchange observations, concerns, and comments. RATIONALE: Notebooks can substitute, in part, for direct parent contact, when the latter is not possible (66). Notebooks also can be an effective means for parents to express their concerns and wishes when they might feel intimidated in a face-to-face "conference" setting. Notebooks can be educational for parents by pointing out concerns or the need for special considerations in the child care setting, and by including health information or resources as appropriate. COMMENTS: The staff should maintain a daily log at the facility for review by staff and parents; the parent can carry the notebook to and from the facility. Alternative methods (regular phone contact, daily face-to-face conversation, and the like) might be more effective for parents or caregivers who have difficulty with written communication. TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home PARENTAL INVOLVEMENT STANDARD 2.050 seeking parent input Each caregiver shall, at least twice a year, seek the views of parents about the strengths and needs of the facility. Caregivers shall honor parents' requests for more frequent reviews. RATIONALE: This standard strengthens the recognition by parent and caregiver alike that parents have essential rights in helping to shape the kind of child care service their children receive. COMMENTS: Small and large family child care homes should have group meetings of all parents once or twice a year. This standard avoids mention of procedures that are inappropriate to small family child care, as it does not require any explicit mechanism (such as a parent advisory council) for obtaining or offering parental input. Individual or group meetings with parents would suffice to meet this standard. Seeking consumer input is a cornerstone of facility planning and evaluation. TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home STANDARD 2.051 support services for parents Centers shall establish parent groups and parent support services. Centers shall document these services and shall include intra-agency activities or other community support group offerings. The caregiver shall record parental participation in these on-site activities in the facility record. RATIONALE: Parental involvement at every level of program planning and delivery and parent support groups are elements that are usually beneficial to the children, parents, and staff of the facility. The parent association group facilitates mutual understanding between the center and parents. Parental involvement also helps to broaden parents' knowledge of admini-stration of the facility and develops and enhances advocacy efforts. COMMENTS: Parent meetings within a facility are useful means of communication that supplement mailings and indirect contacts. TYPE OF FACILITY: Center STANDARD 2.052 parent complaint Procedures Facilities shall have in place complaint procedures to jointly resolve with parents any problems that may arise. Arrangements for the resolutions shall be documented. Centers shall develop mechanisms for holding formal and informal meetings between staff and groups of parents. RATIONALE: Coordination between the facility and the parents is essential to promote their respective child care roles and to avoid confusion or conflicts surrounding values. In addition to routine meetings, special meetings can deal with crises and unique problems. COMMENTS: These meetings could identify facility needs, assist in developing resources, and recommend facility and policy changes to the governing body. See Identifiable Governing Body/Accountable Individual, STANDARD 8.001 through STANDARD 8.003. It is most helpful to document the proceedings of these meetings to facilitate future communications and to ensure continuity of service delivery. Facility-sponsored activities could take place outside facility hours. TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home STANDARD 2.053 parent consent The facility shall require parental consent and participation when significant decisions involving a child's services are made and during the process of formal evaluation of a child. Parents shall be explicitly invited to: a) Participate in discussions of the results of their child's evaluations and the relationship of their child's needs to the caregivers' ability to serve that child appropriately; b) Give alternative perspectives; c) Share their expectations and goals for their child and have these expectations and goals integrated with any plan for their child. The facility shall document parents' presence at these meetings and invitations to attend. If the parents do not attend the assessment, the caregiver shall inform the parents of the results, and offer an opportunity for discussion. RATIONALE: To provide services effectively, facilities must recognize parents' observations and reports about the child and their expectations for the child, as well as the family's need of child care services. A marked discrepancy between professional and parental observations of, or expectations for, a child necessitates further discussion and development of a consensus on a plan of action. Parents need to have accurate information about their children. An evaluation of a child is complete only when the facility has discussed the information with the parent. The caregiver should explain the results to parents honestly, but sensitively, without using technical jargon (64). COMMENTS: Parents need to be included in the process of shaping decisions about their children, e.g., adding, deleting, or changing a service. Efforts should be made to provide notification of meetings in the primary language of the parents. Efforts to schedule meetings at times convenient to parents should be encouraged. Those conducting an evaluation, and when subsequently discussing the findings with the family, should consider parents' input. Parents have both the motive and the legal right to be included in decision-making and to seek other opinions. A second, independent opinion can be offered to the family to confirm the original evaluation, but extensive "shopping" for a more desirable or favorable opinion should be discouraged. TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home HEALTH INFORMATION SHARING STANDARD 2.054 parents' information on their child's health and behavior The facility shall ask parents for information regarding the child's health and behavioral status upon registration or if there has been an extended gap in the child's attendance at the facility. RATIONALE: Admission of children without this information will leave the center unprepared to deal with daily and emergent health needs of the child, other children, and staff if there is a question of communicability of disease. COMMENTS: Some parents may resist providing this information. If so, the caregiver should invite them to view this exchange of information as an opportunity to express their own concerns about the facility. For information on inclusion/exclusion/dismissal policy, see STANDARD 3.065 through STANDARD 3.069. TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home USE OF COMMUNITY HEALTH RESOURCES STANDARD 2.055 family source of health care The facility shall help families who have no regular health care provider to locate a resource that can meet their needs. RATIONALE: Primary care and preventive health services for children and adults will assist the parents' ability to support their children's healthy growth and development and can identify problems early for intervention. Health services should be comprehensive and range from preventive activities (such as immunizations, injury prevention, diet changes for good nutrition and for allergies) to acute treatments (such as skin problems, ear infections, behavioral issues) to more complicated matters (such as evaluation and referral for potential chronic health problems, hearing, neuromuscular issues). COMMENTS: Linking families to the health care system (such as a well-child clinic, public health department, private physician, or health insurance programs for which they or the child might be eligible) is a primary prevention goal. Child care providers can assist families to obtain information about their child's eligibility for their state Children's Health Insurance Program (CHIP) and access to a medical home. As a last resort, the family should know what emergency room is closest to their home. Emergency rooms are not designed to provide primary, preventive health care for children or adults. Every state has a Maternal and Child Health helpline where parents can call for help in finding out about how to pay for child health care and how to locate a source of primary care for their children and for themselves. The regional offices of the Maternal and Child Health Bureau, Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services can provide the helpline numbers for the states in their region. Additional resources include child care resource and referral agencies, county health departments, EPSDT programs, hospital pediatric departments and county medical societies. See also STANDARD 8.015, on the family's health care provider. TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home STANDARD 2.056 community human service resources information The facility shall make available to parents and staff information about human service resources in the community. RATIONALE: To meet the individual needs of the families, community resources should be identified and the information made available to families. Families' primary and trusted source of information about community resources may be the child care provider. Daily contacts with families give child care providers unique opportunities to support family needs. COMMENTS: Local resource and referral agencies, mental health services, social services, community health centers, hospitals, private physicians, public health nurses, Head Start, clinic groups, the American Red Cross, public schools, early intervention programs, and county extension services are but a few examples of potential resources. Parents and care- givers will be more aware of these community resources when the child care facility calls their attention to them. The facility can do this by providing information on how to access resource directories and helpline numbers and by inviting personnel from community agencies to participate in staff and parent meetings, or "open houses." Information on how to access resource directories or helpline numbers can also be obtained from resource and referral agencies, child care consultants in some states, health advocates in center-based programs, and in public health departments. TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home STANDARD 2.057 enabling parents as child advocates Child care providers shall inform parents about programs and sources of information that will improve parents' capability as advocates for the children's needs. When the facility does not directly offer applicable services, the child care provider shall refer parents to agencies with experience in working with the needs of their children. Facilities shall document any referrals in writing. RATIONALE: Applicable referrals will make parents more effective advocates for their children's needs. COMMENTS: Information should be shared with parents in the parents' primary language and with sensitivity to the parents' ethnic and cultural practices. Advocacy training can be provided by a service provider or an outside agency. In the case of a child with special needs, the family can be referred to agencies involved with special needs. For additional information on parental participation, see Parental Involvement, STANDARD 2.050through STANDARD 2.053, and Health Information Sharing, STANDARD 2.054. TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home STANDARD 2.058 on-site services for children with special health needs Child care providers shall be aware of all on-site services, including the following service providers, that may be of use for children in care: a) Special clinics the child may attend, including sessions with medical specialists and registered dieticians; b) Special therapists for the child (such as occupational, physical, speech, nutrition); c) Counselors, therapists, or mental health service providers for parents (such as social workers, psychologists, psychiatrists). All care providers shall provide written docu-mentation of the services rendered in the primary language of the parent. Information shall be exchanged only with the prior written, informed consent of the parent. RATIONALE: Knowing who is treating the child and coordinating services with these individuals is vital to program implementation. There should be a liaison with special clinics for specific disabilities and illnesses when children are seen for consultation at these units. Services provided onsite at the facility should be coordinated with those offered at another site (77, 78). COMMENTS: Although information is best related in writing, telephone contacts are also helpful. Confi-dentiality should be respected both with written and verbal communication. Regular contacts between professionals working with the child and family served by the child care facility improve coordination of care, minimize confusion for the family and prevent dupli-cation. Caregivers, however, must strictly adhere to guidelines concerning confidentiality. Documentation of special therapy is necessary for monitoring purposes. These therapies may be provided by private therapists or by clinics or centers specializing in such services. Some social and psychological data may have to be exchanged within the limits of discretion and confidentiality. TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care STANDARD 2.059 communication from specialists Providers who come into the facility to furnish special services to a child shall also communicate at each visit with the caregiver at the facility who is responsible for sharing information with the parent. These providers may include, but are not limited to, physicians, registered nurses, occu-pational therapists, physical therapists, speech therapists, educational therapists, and registered dietitians. The discussions shall be documented in the child's written record. RATIONALE: Therapeutic services must be coordinated with the child's general education program and with the parents and caregivers so everyone understands the child's needs. To be most useful, the providers must share the therapeutic techniques with the caregivers and parents and integrate them into the child's daily routines, not just at therapy sessions. Parental consent to share some information may be necessary. COMMENTS: See Child Records, 8.046 through 8.052, for information regarding child health records. TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home 2.6 HEALTH EDUCATION HEALTH EDUCATION FOR CHILDREN STANDARD 2.060 health education Activities Caregivers shall talk about healthy behaviors while they carry out routine daily activities. Activities shall be accompanied by words of encouragement and praise for achievement. Facilities shall use developmentally appropriate health education materials in the children's activities and shall also share these with the families whenever possible. All health education activities shall be geared to the child's developmental age and shall take into account individual personalities and interests. RATIONALE: This is an important way to demonstrate and reinforce health behaviors of caregivers and children alike.The effectiveness of health education is enhanced when shared between the provider and the parent (79). Young children learn better through experiencing an activity and observing behavior than through didactic training (80). Learning and play have a reciprocal relationship; play experiences are closely related to learning (17, 18). COMMENTS: Caregivers are important in the lives of the young children in care. They should be educated and supported to be able to interact optimally with children in their care. Compliance shall be documented by observation. Consultation can be sought from a certified health education specialist. The American Association for Health Education (AAHE) and the National Commission for Health Education Credentialing, Inc. (NCCHEC) provide information on this specialty. Contact information for the AAHE and NCCHEC is located in Appendix BB. An extensive education program to make such ex-periential learning possible must be supported by strong community resources in the form of both consultation and materials from sources such as the health department, nutrition councils, and so forth. Suggestions for topics and methods of presentation are widely available. Examples include, but are not limited to, crossing streets safely, car seat safety, latch key programs, health risks from secondhand smoke, and tooth brushing. Risk Watch is a prepared curriculum from the National Fire Protection Association (NFPA) offering comprehensive injury prevention strategies for children in preschool through eighth grade. Contact information for the NFPA is located in Appendix BB. TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home STANDARD 2.061 health education topics Health education for children and staff shall include physical, oral, mental/emotional, nutritional, and social health and shall be integrated daily in the program of activities, to include such topics as: a) Body awareness; b) Families (including cultural heritage); c) Personal/social skills; d) Expression of feelings; e) Self-esteem; f) Nutrition; g) Personal hygiene; h) Safety (such as home, vehicular care seats and belts, playground, bicycle, fire, and firearms); i) Conflict management and violence prevention; j) First aid; k) Physical health; l) Handwashing; m) Awareness of special needs; n) Importance of rest and sleep; o) Fitness; p) Oral health; q) Health risks of secondhand smoke; r) Taking medications; s) Dialing 911 for emergencies. RATIONALE: For young children, health and education are inseparable. Children learn about health and safety by experiencing risk taking and risk control, fostered by adults who are involved with them. Whenever opportunities for learning arise; facilities should integrate education to promote healthy behaviors. Health education should be seen not as a structured curriculum, but as a daily component of the planned program that is part of child development. Certified health education specialists are a good resource for this instruction. The American Association for Health Education (AAHE), the National Commission for Health Education Credentialing, Inc. (NCCHEC), and the State and Territorial Injury Prevention Directors' Association (STIPDA) provide information on this specialty. Contact information for the AAHE, NCCHEC, and STIPDA is located in Appendix BB. TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home STANDARD 2.062 gender and sexuality The facility shall prepare caregivers to appropriately discuss with the children anatomical facts related to gender identity and sexuality differences. RATIONALE: Open discussions among adults concerning childhood sexuality increase their comfort with the subject. The adults' comfort may reduce children's anxiety about sexuality. COMMENTS: Developing a common approach to matters involving young children, sexuality and gender identity is not always easy because the views of facility administrators, caregivers, parents, and community leaders do not always coincide (53). TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home STANDARD 2.063 staff modeling of healthy behavior The facility shall require all staff members to model healthy behaviors and attitudes in their contact with children in the facility, including eating nutritious foods, complying with no tobacco use policies, and handwashing protocols. RATIONALE: Modeling is an effective way of con-firming that a behavior is one to be imitated. COMMENTS: Modeling healthy behavior and attitudes can be specified in the plan as compliance with no tobacco use policies, handwashing protocols, and so forth. See Policy on Smoking, Tobacco Use, Prohibited Substances, and Firearms, STANDARD 8.038 and STANDARD 8.039. See also Hygiene, STANDARD 3.012 through STANDARD 3.019, on handwashing protocols. TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home HEALTH EDUCATION FOR STAFF STANDARD 2.064 health education topics for staff Health education for staff shall include physical, oral, mental/emotional, nutritional, and social health of children. At a minimum, the topics shall include those listed in STANDARD 2.061. RATIONALE: Children learn about health and safety by experiencing risk taking and risk control, fostered and managed by adults. Whenever opportunities for learning arise, facilities should integrate health edu-ation to promote healthy behaviors. Health education should be seen not as a structured curriculum, but instead, as a daily component of the planned program that is part of child development. COMMENTS: Community resources could provide written health-related materials. Consultation can be sought from a certified health education specialist. Small and large family child care home providers can cover physical, oral, mental, and social health on an informal basis, as the small size of the homes and the varied ages of the enrollees preclude a "curriculum" per se. The American Association for Health Education (AAHE) and the National Commission for Health Education Credentialing, Inc. (NCCHEC) provide information on certified health education specialists. Contact information for the AAHE and NCCHEC is located in Appendix BB. For additional information on health education for staff, see also Training, STANDARD 1.023 through STANDARD 1.036, for a comprehensive description of staff training topics. See Health Education for Children for topics, STANDARD 2.061. TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home HEALTH EDUCATION FOR PARENTS STANDARD 2.065 opportunities for health education of parents Parents shall be given opportunities to observe staff members modeling healthy behavior and facilitating child development. Parents shall also have opportunities to ask questions and to describe how effective the modeling has been. RATIONALE: Modeling can be an effective educational tool (37,44). COMMENTS: By providing a one-way observation area or other opportunities for parents to learn by example, the facility can avoid intimidating parents. TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home STANDARD 2.066 methods for health education of parents The facility shall schedule regular health education programs for parents, designed to meet the unique characteristics of the enrolled families. These programs may be in a variety of forms including open-house meetings with guest speakers, opportunities for discussion, newsletters, a video lending library, children's projects, health and safety fact sheets. The facility shall offer health education programs and information on a regular basis. RATIONALE: Health education of all those who participate in the child care setting in any way is an integrated approach to ensure child care health and safety. The incorporation of healthy behaviors is accomplished by consistency between home and child care settings. If done using established adult learning techniques that are sensitive to ethnic and cultural practices, didactic teaching can be effective for educating parents. If not done well, there is a danger of demeaning parents and making them feel less, rather than more, capable (82, 83). COMMENTS: Even small family-child-care homes can plan for these meetings. Frequently, the parents who might benefit most do not attend. Severe time constraints on many families may preclude their partici-pation. Community resources that may provide help with these programs include: The Women, Infants and Children (WIC) Supplemental Food Program; Medical and dental societies; Departments of social services; Mental health, drug, and alcohol programs; Child development specialists; Public health departments; SAFE KIDS coalitions; Local safety councils; Certified health education specialists; Parent education organizations; Midwifery and birthing centers; Visiting Nurse Associations. The American Association for Health Education (AAHE) and the National Commission for Health Education Credentialing, Inc. (NCCHEC) provide infor-mation on certified health education specialists. Contact information for the AAHE and NCCHEC is located in Appendix BB. TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home STANDARD 2.067 parent education plan The content of a parent education plan shall be individualized to meet each family's needs and shall be sensitive to cultural values and beliefs. Written material, at a minimum, shall address the most important health and safety issues for all age groups served, shall be in a language understood by families, and may include the topics listed in STANDARD 2.061, with special emphasis on the following: a) Safety (such as home, community, playground, firearm, vehicular, or bicycle); b Oral health promotion and disease prevention; c) Value of healthy lifestyle choices (such as exercise, nutrition, avoidance of substance abuse and tobacco use); d) Importance of well child care (such as immunizations, hearing/vision screening, monitoring growth and development); e) Child development; f) Parental health (such as pregnancy care, substance abuse prevention, smoking cessation, HIV/AIDS prevention, stress management, or subjects of concern to the parent); g) Domestic violence; h) Conflict management and violence prevention; i) Prevention and management of infectious disease, including the need for parents of infants in child care to adopt some handwashing and diapering procedures (as done in child care) for the parents' protection as well as for the protection of the other children and adults in the family; j) Child behavior (normal and problematic); k) Handling emergencies/first aid; l) Child advocacy skills; m) Special needs. Health education for parents shall utilize principles of adult learning to maximize the potential for parents to learn about key concepts. Facilities shall utilize opportunities for learning, such as the case of an illness present in the facility, to inform parents about illness and prevention strategies. The staff shall introduce seasonal topics when they are relevant to the health and safety of parents and children. RATIONALE: Adults learn best when they are motivated, comfortable, and respected, when they can immediately apply what they have learned, and when multiple learning strategies are used. Individualized content and approaches are needed for successful intervention. Parent attitudes, beliefs, fears, and educational and socioeconomic levels all should be given consideration in planning and conducting parent education (81, 82). Parental behavior can be modified by education. Parents should be involved closely with the facility. If done well, didactic teaching can be effective for educating parents. If not done well, there is a danger of demeaning parents and making them feel less, rather than more, capable (81, 82). The concept of parent control and empowerment is key to successful parent education in the child care setting. Support and education for parents lead to better parenting abilities. Knowing the family will help the health advocate. See Qualifications of Health Advocates, STANDARD 1.021, to determine content and method of the parent education plan. Specific attention should be paid to the parents' need for support and consultation or help with resources for their own problems. If the facility suggests a referral or resource, this should be documented in the child's record. Specifics of what the parent shared need not be recorded. COMMENTS: Community resources could provide written health-related materials. Small and large family child care home providers can cover physical, oral, mental, and social health on an informal basis, as the small size of the homes and the varied ages of the enrollees preclude a "curriculum" per se. School-age child care facilities do not need to incorporate child health education into their programs, as enrollees receive this information in school. TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home REFERENCES 1. Colker LJ, et al. Curriculum for infants and toddlers: who needs it? Child Care Infor Exch. 1996;112:74-78. 2. Smith AB. Quality programs that care and educate. Child Educ. 1996;72:330-336. 3. Dimidijian VJ, ed . Play's Place in Public Education for Young Children. Washington, DC: National Education Association (NEA) Early Childhood Education (NEA); 1992. NEA's Early Childhood Education Series. 4. Blecher-Sass H. Good-byes can build trust . Young Child. 1997;52:12-14. 5. Moerk EL. The guided acquisition of first language skills. Adv Appl Dev Psychol. 2000;20:248. 6. Wardle F. Meeting the needs of multicultural and multiethnic children in early childhood settings. Early Child Educ J. 1998;26:7-11. 7. Ramsey PG. Teaching and Learning in a Diverse World: Multicultural Education for Young Children. 2 nd ed. New York, NY: Teachers College Press; 1998. 8. Ramsey PG. Growing up with the contradictions of race and class. Research in review. Young Child. 1995;50:18-22. 9. Baron N, Schrank LW. Children Learning Language: How Adults Can Help . Lake Zurich, Ill: Learning Seed; 1997. 10. Szanton ES, ed. Creating Child-Centered Programs for Infants and Toddlers, Birth to 3 Year Olds, Step by Step: A Program for Children and Families. New York, NY: Children's Resources International, Inc.; 1997. 11. Kontos S, Wilcox-Herzog A. Teachers' interactions with children: why are they so important? Research in review. Young Child. 1997;52:4-12. 12. Botkin D, et al. Children's affectionate behavior: gender differences. Early Educ Dev. 1991;2(4):270-86. 13. Massey MS. Early Childhood Violence Prevention: ERIC Digest. Champaign,Ill: ERIC Clearinghouse on Elementary and Early Childhood Education; 1998. 14. Levin DE. Teaching Young Children in Violent Times: Building a Peaceable Classroom. A Preschool-Grade 3 Violence Prevention and Conflict Resolution Guide . Cambridge, Mass: Educators for Social Responsibility; 1994. 15. Mayr T, Ulich M. Children's well-being in day care centres: an exploratory empirical study. Int J Early Years Educ. 1999;7(3):229-39. 16. Cartwright S. Group trips: an invitation to cooperative learning. Child Care Infor Exch. 1998;124: 95-7. 17. Evaldson A, Corsaro WA. Play and games in the peer cultures of preschool and preadolescent children: an interpretative approach. Childhood. 1998;5:377-402. 18. Petersen EA. The amazing benefits of play. Child Fam. 1998;17:7-8. 19. Pica R. Beyond physical development: why young children need to move. Young Child. 1997;52:4-11. 20. Rodd, J . Understanding Young Children's Behavior: A Guide for Early Childhood Professionals. New York, NY: Teacher's College Press; 1996. 21. Greenberg, P . Character Development: Encouraging Self-esteem & Self-discipline in Infants, Toddlers and Two-Year-Olds . Washington, DC: National Association for the Education of Young Children; 1991. 22. Whitebook M, Bellm D. Taking on Turnover: An Action Guide for Child Care Center Teachers and Directors . Washington, DC: Center for the Child Care Workforce; 1998. 23. Torelli L, Durrett C. Landscape for learning: the impact of classroom design on infants and toddlers. Early Child News. 1996;8:12-17. 24. Cooney M, et al. From hitting to tattling to communication and negotiation: the young child's stages of socialization. Early Child Educ J. 1996;24:23-27. 25. Snow CE, Burns SM, Griffin, P. Language and literacy environments in preschools.