Chapter02

CHAPTER 2:
Program Activities for Healthy Development

2.1 Program of Developmental Activities

2.1.1 General Program Activities

STANDARD 2.1.1.1: Written Daily Activity Plan and Statement of Principles

Facilities should have a written comprehensive and coordinated planned program of daily activities based on a statement of principles for the facility and each child’s individual development, as well as appropriate activities for groups of children at each stage of early childhood. The objective of the program of daily activities should be to foster incremental developmental progress in a healthy and safe environment and should be flexible to capture the interests of the children and the individual abilities of the children.

Centers, large and small family child care homes should develop a written statement of principles that set out the basic elements from which the daily indoor/outdoor program is to be built. These principles should include the following elements:

Overall child health and safety;
Physical development, which facilitates small and large motor skills;
Family development, which acknowledges the role of the family, including culture and language;
Social development, which leads to cooperative play with other children and the ability to make relationships with other children and adults and children of other backgrounds and ability levels;
Emotional development, which facilitates self awareness and self confidence;
Cognitive development, which includes an understanding of the world and environment in which they live and leads to understanding science, math, and literacy concepts, as well as increasing the use and understanding of language to express feelings and ideas.

The planned program should provide for the incorporation of specific health education topics on a daily basis throughout the year. Topics of health education should include health promotion and disease prevention topics, e.g., handwashing, oral health, nutrition, physical activity, etc.

Health and safety behaviors should be modeled by staff in order to insure that children and parents/guardians understand the need for a safe indoor and outdoor learning/play environment and feel comfortable.

Continuity and consistency by a caring staff is vital so that children and parents/guardians know what to expect. All of the principles should be developed with play being the foundation of the planned curriculum. Material such as blocks, clay, paints, books, puzzles, and/or other manipulatives should be available indoors and outdoors to the children to further the planned curriculum.

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 and interdependence of cognitive, physical, emotional, communication and social development. Social-emotional capacities do not develop or function separately;
Influence of the child’s health and safety on all these areas;
Central importance of continuity and consistent relationships with affectionate care that is the formation of strong, nurturing relationships between caregivers/teachers and children;
Relevance of the phase or stage concept;
Importance of action (including play) as a mode of learning, and to express self (3).

Those who provide child care and early education must be able to articulate components of the curriculum they are implementing and the related values/principles on which the curriculum is based. In centers and large family child care homes, because more than two caregivers/teachers 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 (4).

A written description of the planned program of daily activities allows staff and parents/guardians to have a common understanding and gives them the 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 caregiver/teacher 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 (4). For infants and toddlers who learn through healthy and ongoing relationships with primary caregivers/teachers, a relationship-based plan should be shared with parents/guardians that include opportunities for parents/guardians to be an integral partner and member of this relationship system. Professional development is often required to enable staff to develop proficiency in the development and implementation of a curriculum that they use to carry out daily activities appropriately (6).

Planning ensures that some thought goes into indoor and outdoor programming for children. The plans are tools for monitoring and accountability. Also, a written plan is a tool for staff orientation.

COMMENTS: The National Association for the Education of Young Children (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 for planning program activities.

Parents/guardians and staff can experience mutual learning in an open, supportive setting. Suggestions for topics and methods of presentation are widely available. For example, the publication catalogs of the NAEYC and of the American Academy of Pediatrics (AAP) contain many materials for child, parent/guardian, and staff education on child development, the importance of attachment and temperament, and other health issues. A certified health education specialist (CHES) can also be a source of assistance. The American Association for Health Education (AAHE) at http://www
.aahperd.org/AAHE/, and the National Commission for Health Education Credentialing (NCHEC) at http://www
.nchec.org, provide information on this specialty.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. Colker L. J., A. L. Dombro, D. T. Dodge. 1996. Curriculum for infants and toddlers: Who needs it? Child Care Info Exch 112:74-78.

2. Smith A. B. 1996. Quality programs that care and educate. Child Education 72:330-36.

3. Dimidjian, V. J., ed. 1992. Play’s place in public education for young children. National Education Association Early Childhood Education Series. Washington, DC: NEAECE.

4. The Family Child Care Accreditation Project, Wheelock College and The National Association for Family Child Care. 2005. Quality standards for NAFCC accreditation. 4th ed. http://www.nafcc.org/documents/QualStd.pdf.

5. National Child Care Information Center (NCCIC). NCCIC resources. U.S. Department of Health and Human Services, Administration for Children and Families. http://nccic.acf.hhs.gov/nccic-resources/.

6. Nell, M. 2009. Using the integrative research approach to facilitate early childhood teacher planning. J Early Child Teach Edu 30:79-88.

STANDARD 2.1.1.2: Health, Nutrition, Physical Activity, and Safety Awareness

Early care and education programs should have and implement written program plans addressing the health, nutrition, physical activity, and safety aspects of each formally structured activity documented in the written curriculum. These plans should include daily opportunities to learn health habits that prevent infection and significant injuries, and health habits that support healthful eating, nutrition education, and physical motor activity. Awareness of healthy and safe behaviors, including good nutrition and physical activity, should be an integral part of the overall program.

RATIONALE: Young children learn better through experiencing an activity and observing behavior than through didactic methods (1). There may be a reciprocal relationship between learning and play so that play experiences are closely related to learning (2,3). Children can live by rules about health and safety when their personal experience helps them to understand why these rules were created. National guidelines for children birth to age five encourage their engagement in daily physical activity that promotes movement, motor skills and the foundations of health-related fitness (4). Physical activity is important to overall health and to overweight and obesity prevention (5).

COMMENTS: Resources for activities can be found at:

Fit Source – http://nccic.acf.hhs.gov/fitsource/;
Go Out and Play – http://www.cdc.gov/ncbddd/actearly/pdf/ccp_pdfs/GOP_kit.pdf; and
Center of Excellence for Training and Research Translation – http://www.center-trt.org.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. Fleer, M., ed. 1996. Play through profiles: Profiles through play. Watson, Australia: Australian Early Childhood Association.

2. Evaldsson, A., W. A. Corsaro. 1998. Play and games in the peer cultures of preschool and preadolescent children: An interpretative approach. Childhood 5:377-402.

3. Petersen, E. A. 1998. The amazing benefits of play. Children and Families 17:7-8, 10.

4. National Association for Sport and Physical Education (NASPE). 2009. Active start: A statement of physical activity guidelines for children birth to five years. 2nd ed. Reston, VA: NASPE.

5. U.S. Department of Health and Human Services, U.S. Department of Agriculture. 2010. Dietary guidelines for Americans. 7th ed. Washington, DC: Government Printing Office. http://www
.cnpp.usda.gov/Publications/DietaryGuidelines/2010/PolicyDoc/PolicyDoc.pdf.

STANDARD 2.1.1.3: Coordinated Child Care Health Program Model

Caregivers/teachers should follow these guidelines for implementing coordinated health programs in all early care and education settings. These coordinated health programs should consist of health and safety education, physical activity and education, health services and child care health consultation, nutrition services, mental health services, healthy and safe indoor and outdoor learning environment, health and safety promotion for the staff, and family and community involvement. The guidelines consist of the following eight interactive components:

1. Health Education: A planned, sequential, curriculum that addresses the physical, mental, emotional, and social dimensions of health. The curriculum is designed to motivate and assist children in maintaining and improving their health, preventing disease and injury, and reducing health-related risk behaviors (1,2).

2. Physical Activity and Education: A planned, sequential curriculum that provides learning experiences in a variety of activity areas such as basic movement skills, physical fitness, rhythms and dance, games, sports, tumbling, outdoor learning and gymnastics. Quality physical activity and education should promote, through a variety of planned physical activities indoors and outdoors, each child’s optimum physical, mental, emotional, and social development, and should promote activities and sports that all children enjoy and can pursue throughout their lives (1,2,6).

3. Health Services and Child Care Health Consultants: Services provided for child care settings to assess, protect, and promote health. These services are designed to ensure access or referral to primary health care services or both, foster appropriate use of primary health care services, prevent and control communicable disease and other health problems, provide emergency care for illness or injury, promote and provide optimum sanitary conditions for a safe child care facility and child care environment, and provide educational opportunities for promoting and maintaining individual, family, and community health. Qualified professionals such as child care health consultants may provide these services (1,2,4,5).

4. Nutrition Services: Access to a variety of nutritious and appealing meals that accommodate the health and nutrition needs of all children. School nutrition programs reflect the U.S. Dietary Guidelines for Americans and other criteria to achieve nutrition integrity. The school nutrition services offer children a learning laboratory for nutrition and health education and serve as a resource for linkages with nutrition-related community services (1,2).

5. Mental Health Services: Services provided to improve children’s mental, emotional, and social health. These services include individual and group assessments, interventions, and referrals. Organizational assessment and consultation skills of mental health professionals contribute not only to the health of students but also to the health of the staff and child care environment (1,2).

6. Healthy Child Care Environment: The physical and aesthetic surroundings and the psychosocial climate and culture of the child care setting. Factors that influence the physical environment include the building and the area surrounding it, natural spaces for outdoor learning, any biological or chemical agents that are detrimental to health, indoor and outdoor air quality, and physical conditions such as temperature, noise, and lighting. Unsafe physical environments include those such as where bookcases are not attached to walls and doors that could pinch children’s fingers. The psychological environment includes the physical, emotional, and social conditions that affect the well-being of children and staff (1,2).

7. Health Promotion for the Staff: Opportunities for caregivers/teachers to improve their own health status through activities such as health assessments, health education, help in accessing immunizations, health-related fitness activities, and time for staff to be outdoors. These opportunities encourage caregivers/teachers to pursue a healthy lifestyle that contributes to their improved health status, improved morale, and a greater personal commitment to the child care’s overall coordinated health program. This personal commitment often transfers into greater commitment to the health of children and creates positive role modeling. Health promotion activities have improved productivity, decreased absenteeism, and reduced health insurance costs (1,2).

8. Family and Community Involvement: An integrated child care, parent/guardian, and community approach for enhancing the health and safety, and well-being of children. Parent/guardian-teacher health advisory councils, coalitions, and broadly based constituencies for child care health can build support for child care health program efforts. Early care and education settings should actively solicit parent/guardian involvement and engage community resources and services to respond more effectively to the health-related needs of children (1,2).

RATIONALE: Early care and education settings provide a structure by which families, caregivers/teachers, administrators, primary care providers, and communities can promote optimal health and well-being of children (3,4). The coordinated child care health program model was adapted from the Center for Disease Control and Prevention (CDC) Division of Adolescent and School Health’s (DASH) Coordinated School Health Program (CSHP) model (2).

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. Centers for Disease Control and Prevention. 2008. Healthy youth! Coordinates school health programs. http://www.cdc.gov/healthyyouth/CSHP/.

2. Cory, A. C. 2007. The role of the child care health consultant in promoting health literacy for children, families, and educators in early care and education settings. Paper presented at the annual meeting of the American School Health Association.

3. Fiene, R. 2002. 13 indicators of quality child care: Research update. Washington, DC: U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation. http://aspe.hhs.gov/hsp/ccquality-ind02/.

4. U.S. Department of health and Human Services, Office of Child Care. 2010. Coordinating child care consultants: Combining multiple disciplines and improving quality in infant/toddler care settings. http://nitcci.nccic.acf.hhs.gov/resources/consultation
_brief.pdf.

5. Coordinated Health/Care. Maximize your benefits: FAQs about care coordination. https://www.cchcare.com/router
.php?action=about.

6. Friedman, H. S., L. R. Martin, J. S. Tucker, M. H. Criqui, M. L. Kern, C. A. Reynolds. 2008. Stability of physical activity across the lifespan. J Health Psychol 13:1092-1104.

STANDARD 2.1.1.4: Monitoring Children’s Development/Obtaining Consent for Screening

Child care settings provide daily indoor and outdoor opportunities for promoting and monitoring children’s development. Caregivers/teachers should monitor the children’s development, share observations with parents/guardians, and provide resource information as needed for screenings, evaluations, and early intervention and treatment. Caregivers/teachers should work in collaboration to monitor a child’s development with parents/guardians and in conjunction with the child’s primary care provider and health, education, mental health, and early intervention consultants. Caregivers/teachers should utilize the services of health and safety, education, mental health, and early intervention consultants to strengthen their observation skills, collaborate with families, and be knowledgeable of community resources.

Programs should have a formalized system of developmental screening with all children that can be used near the beginning of a child’s placement in the program, at least yearly thereafter, and as developmental concerns become apparent to staff and/or parents/guardians. The use of authentic assessment and curricular-based assessments should be an ongoing part of the services provided to all children (5-9). The facility’s formalized system should include a process for determining when a health or developmental screening or evaluation for a child is necessary. This process should include parental/guardian consent and participation.

Parents/guardians should be explicitly invited to:

Discuss reasons for a health or developmental assessment;
Participate in discussions of the results of their child’s evaluations and the relationship of their child’s needs to the caregivers’/teachers’ ability to serve that child appropriately;
Give alternative perspectives;
Share their expectations and goals for their child and have these expectations and goals integrated with any plan for their child;
Explore community resources and supports that might assist in meeting any identified needs that child care centers and family child care homes can provide;
Give written permission to share health information with primary health care professionals (medical home), child care health consultants and other professionals as appropriate;

The facility should document parents’/guardians’ presence at these meetings and invitations to attend.

If the parents/guardians do not attend the screening, the caregiver/teacher should inform the parents/guardians of the results, and offer an opportunity for discussion. Efforts should be made to provide notification of meetings in the primary language of the parents/guardians. Formal evaluations of a child’s health or development should also be shared with the child’s medical home with parent/guardian consent.

Programs are encouraged to utilize validated screening tools to monitor children’s development, as well as various measures that may inform their work facilitating children’s development and providing an enriching indoor and outdoor environment, such as authentic-based assessment, work sampling methods, observational assessments, and assessments intended to support curricular implementation (5,9). Programs should have clear policies for using reliable and valid methods of developmental screening with all children and for making referrals for diagnostic assessment and possible intervention for children who screen positive. All programs should use methods of ongoing developmental assessment that inform the curricular approaches used by the staff. Care must be taken in communicating the results. Screening is a way to identify a child at risk of a developmental delay or disorder. It is not a diagnosis.

If the screening or any observation of the child results in any concern about the child’s development, after consultation with the parents/guardians, the child should be referred to his or her primary care provider (medical home), or to an appropriate specialist or clinic for further evaluation. In some situations, a direct referral to the Early Intervention System in the respective state may also be required.

RATIONALE: Seventy percent of children with developmental disabilities and mental health problems are not identified until school entry (10). Daily interaction with children and families in early care and education settings offers an important opportunity for promoting children’s development as well as monitoring developmental milestones and early signs of delay (1-3). Caregivers/teachers play an essential role in the early identification and treatment of children with developmental concerns and disabilities (6-8) because of their knowledge in child development principles and milestones and relationship with families (4). Coordination of observation findings and services with children’s primary care providers in collaboration with families will enhance children’s outcomes (6).

COMMENTS: Parents/guardians need to be included in the process of considering, identifying and shaping decisions about their children, (e.g., adding, deleting, or changing a service). To provide services effectively, facilities must recognize parents’/guardians’ 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 parent/guardian observations of, or expectations for, a child necessitates further discussion and development of a consensus on a plan of action.

Consideration should be given to utilizing parent/guardian-completed screening tools, such as the Ages and Stages Questionnaire (ASQ) (for a list of validated developmental screening tools, see the American Academy of Pediatric’s [AAP] list of developmental screening tools at http://www
.medicalhomeinfo.org/downloads/pdfs/DPIPscreeningtool
grid.pdf). The caregiver/teacher should explain the results to parents/guardians honestly, with sensitivity, and without using technical jargon (11).

Resources for implementing a program that involves a formalized system of developmental screening are available at the Centers for Disease Control and Prevention (CDC) at http://www.cdc.gov/ncbddd/actearly/ and the AAP at http://www.healthychildcare.org.

Scheduling meetings at times convenient for parent/guardian participation is optimal. Those conducting an evaluation, and when subsequently discussing the findings with the family, should consider parents’/guardians’ input. Parents/guardians have both the motive and the legal right to be included in decision-making and to seek other opinions.

A second, independent opinion could be provided by the program’s child care health consultant or the child’s primary care provider.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. Copple, C., S. Bredekamp. 2009. Developmentally appropriate practice in early childhood programs serving children at birth through age 8. 3rd ed. Washington, DC: National Association for the Education of Young Children.

2. Dworkin, P. H. 1989. British and American recommendations for developmental monitoring: The role of surveillance. Pediatrics 84:1000-1010.

3. Brothers, K. l., F. Glascoe, N. Robertshaw. 2008. PEDS: Developmental milestones - An accurate brief tool for surveillance and screening. Clinical Pediatrics 47:271-79.

4. Kostelnik, M. J., A. K. Soderman, A. P. Whiren. 2006. Developmentally appropriate curriculum best practices in early childhood education. Upper Saddle River, NJ: Prentice Hall.

5. Squires, J., D. Bricker. 2009. Ages and stages questionnaires. Baltimore: Brookes Publishing.

6. Centers for Disease Control and Prevention. Learn the signs. Act early. http://www.cdc.gov/ncbddd/actearly/.

7. American Academy of Pediatrics, Council on Children With Disabilities, Section on Developmental Behavioral Pediatrics, Bright Futures Steering Committee and Medical Home Initiatives for Children With Special Needs Project Advisory Committee. 2006. Identifying infants and young children with developmental disorders in the medical home: An alogorithm for developmental surveillance and screening. Pediatrics 118:405-20.

8. Hagan, J. F., J. S. Shaw, P. M. Duncan, eds. 2008. Bright futures: Guidelines for health supervision of infants, children, and adolescents. 3rd ed. Elk Grove Village, IL: American Academy of Pediatrics.

9. Gilliam, W. S., S. Meisels, L. Mayes. 2005. Screening and surveillance in early intervention systems. In A developmental systems approach to early intervention: National and international perspectives, ed. M. J. Guralnick, 73-98. Baltimore, MD: Brookes Publishing.

10. Glascoe, F. P. 2005. Screening for developmental and behavioral problems. Mental Retardation Develop Disabilities 11:173-79.

11. O’Connor, S., et al. 1996. ASQ: Assessing school age child care quality. Wellesly, MA: Center for Research on Women.

STANDARD 2.1.1.5: Helping Families Cope with Separation

The staff of the facility should engage strategies to help a child and parents/guardians cope with the experience of separation and reunion, such as death of family members, divorce, or placement in foster care.

For the child, this should be accomplished by:

Encouraging parents/guardians to spend time in the facility with the child and supporting the separation transition;
Providing a comfortable setting both indoors and outdoors for parents/guardians to be with their children to transition or to have conversation with staff;
Having established routines for drop-off and pick-up times to assist with transition;
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/guardian);
Encouraging parents/guardians to reassure the child of their return and to calmly say “goodbye”;
Helping the child play out themes of separation and reunion;
Frequently exchanging information between the child’s parents/guardians and caregivers/teachers, including activities and routine care information particularly during greeting and departing;
Reassuring the child about the parent’s/guardian’s return;
Ensuring the caregivers/teachers are consistent both within the parts of a day and across days;
Requesting assistance from early childhood mental health consultants, mental health professionals, developmental-behavioral pediatricians, parent/guardian counselors, etc. when a child’s adjustment continues to be problematic over time;
When a family is experiencing separation due to a military deployment, explore changes in children’s behavior that may be related to feelings of anger, fear, sadness, or uncertainty related to changes in family structure as a result of deployment. Work with the parent/guardian at home to help the child adjust to these changes, including providing activities that help the child remain connected to the deployed parent/guardian and manage their emotions throughout the deployment cycle.

For the parents/guardians, this should be accomplished by:

Validating their feelings as a universal human experience;
Providing parents/guardians with information about the positive effects for children of high quality facilities with strong parent/guardian participation;
Encouraging parents/guardians to discuss their feelings;
Providing parents/guardians with evidence, such as photographs, that their child is being cared for and is enjoying the activities of the facility;
Ask parents/guardians to bring pictures from home that may be placed in the room or cubby and displayed throughout the indoor and outdoor learning/play environment at the child’s eye level;
Where a family is experiencing separation due to a military deployment, collaborate with the parent/guardian at home to address changes in children’s behavior that may be related to the deployment, providing parents/guardians with information about activities in care and at home may help promote their child’s positive adjustment throughout the deployment cycle (connect parents/guardians with services/resources in the community that can help to support them);
Requesting assistance from early childhood mental health consultants, mental health professionals, developmental-behavioral pediatricians, parent/guardian counselors, etc. when a child’s adjustment continues to be problematic over time.

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 (1).

Many parents/guardians 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 three months of age. Some parents/guardians prefer combining out-of-home child care with parental/guardian care to provide good experiences for their children and support for other family members to function most effectively. Whether parents/guardians view out-of-home child care as a necessary accommodation to undesired circumstances or a benefit for their family, parents/guardians and their children need help from the caregivers/teachers to accommodate the transitions between home and out-of-home settings (2).

Many parents/guardians experience distress at separation. For most parents/guardians, the younger their child and the less experience they have had with sharing the care of their children with others, the more intense their distress at separation (3).

Although children’s responses to deployment separation will vary depending on age, personality, and support received, children will be aware of a parent’s/guardian’s long-term absence and may mourn. Children may feel uncertain, sad, afraid, or angry. These feelings can manifest as increased clinginess, aggression, withdrawal, changes in sleeping or eating patterns, regression or other behaviors. Young children don’t often have the vocabulary to express their emotions, and may need support to express their feelings in healthy and safe ways (2). Additionally, the parent/guardian at home may be experiencing stress, anxiety, depression, or fear. These parents/guardians may benefit from additional outreach from caregivers/teachers, who are part of their community support system, and can help them with strategies to promote children’s adjustment and connect them with resources in the community (3).

COMMENTS: Depending on the child’s developmental stage, the impact of separation on the child and parent/guardian will vary. Child care facilities should understand and communicate this variation to parents/guardians and work with parents/guardians to plan developmentally appropriate coping strategies for use at home and in the child care setting. For example, a child at eighteen to twenty-four months of age is particularly vulnerable to separation issues and may show visible distress when experiencing separation from parents/guardians. 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 nine to twelve months of age), parents/guardians 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. Parents/guardians and caregivers/teachers reminding a child that the parent/guardian returned as promised reinforces truthfulness and trust. Parents/guardians of children of any age should be encouraged to visit the facility together before the child care officially begins. Parents/guardians of infants may benefit from feeling assured by the caregivers/teachers themselves. Depending on the child’s temperament and prior care experience, several visits may be recommended before enrolling as well opportunities to practice the process and consistency of a separation experience in the first weeks of entering the child care. Using a phasing-in period can also be helpful (e.g., spend only a part of the day with parents/guardians on the first day, half-day on the second day, and parents/guardians leave earlier, etc.)

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. Blecher-Sass, H. 1997. Good-byes can build trust. Young Child 52:12-14.

2. Kim, A. M., J. Yeary. 2008. Making long-term separations easier for children and families. Young Children 63:32-37.
3. Gonzalez-Mena, J. 2007. Separation: Helping children and families. In 50 Early childhood strategies for working and communicating with diverse families, 96-97. Upper Saddle River, NJ: Prentice Hall.

STANDARD 2.1.1.6: Transitioning within Programs and Indoor and Outdoor Learning/Play Environments

Caregivers/teachers should take into consideration the individual needs of children when transitioning them to a new indoor and outdoor learning/play environment. The transitioning child/children should be offered the opportunity to visit the new space with a familiar caregiver/teacher with enough time to allow them to display comfort in the new space. The program should allow time for communication with the families regarding the process and for each child to follow through a comfortable time line of adaptation to the new indoor and outdoor learning/play environment, caregiver/teachers, and peers.

Children need time to manipulate, explore and familiarize themselves with the new space and caregivers/teachers. This should be done before they are part of a new group to allow them time to explore to their personal satisfaction. Eating is a primary reinforcer and need. The opportunity to share food within the new space will help reassure a child and help adults assess how the transition is going. Toileting involves another level of trust. Diapering/toileting should be introduced in the new space with a familiar teacher.

New routines should be introduced by the new staff with a familiar caregiver/teacher present to support the child/children. Transitions to the indoor and outdoor learning/play environment, especially if the space is different than the one from which they are familiar, should follow similar procedures as moving to another indoor space. Parents/guardians should be part of the transition as they too are in the process of learning to trust a new indoor and outdoor learning/play environment for their child. Primary needs need to be met to support a smooth transition.

Transitions should be planned in advance, based on the child’s readiness. A written plan should be developed and shared with parents/guardians, describing how and when the transition will occur. Children should not be moved to a new indoor and outdoor learning/play environment for the sole purpose of maintaining child: staff ratios.

RATIONALE: Supporting the achievement of developmental tasks for young children is essential for their social and emotional health. Establishing trust with caregivers/teachers and successful adaptation to a new indoor and outdoor learning/play environment is a critical component of quality care. Young children need predictability and routine. They need to feel secure and to understand the expectations of their environment. By taking time to allow them to familiarize themselves with their new caregivers/teachers and environment, they are better able to handle the emotional, cognitive, and social requirements of their new space (1-5).

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. Erikson, E. H. 1950. Childhood and society. New York: W.W. Norton and Co.

2. Gorski, P. A., S. P. Berger. 2005. Emotional health in child care. In Health in child care: A manual for health professionals, ed. J. R. Murph, S. D. Palmer, D. Glassy, 173-86. Elk Grove Village, IL: American Academy of Pediatrics.

3. Lally, R. L., L. Y. Torres, P. C. Phelps. 1994. Caring for infants and toddlers in groups: Necessary considerations for emotional, social, and cognitive development. Zero to Three 14:1-8.

4. Mahler, M., F. Pine, A. Bergman. 1975. The Psychological birth of the human infant. New York: Basic Books.

5. Maslow, A. 1943. A theory of human motivation. Psychological Review 50:370-96

STANDARD 2.1.1.7: Communication in Native Language Other Than English

At least one member of the staff should be able to communicate with the parents/guardians and children in the family’s native language (sign or spoken), or the facility should work with parents/guardians to arrange for a translator to communicate with parents/guardians and children. Efforts should be made to support a child’s and family’s native language while providing resources and opportunities for learning English (2). Children should not be used as translators. They are not developmentally able to understand the meaning of all words as used by adults, nor should they participate in all conversations that may be regarding the child.

RATIONALE: The future development of the child depends on his/her command of language (1). 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/guardians and children requires an ability to speak their language. Learning English while maintaining a family’s native language enriches child development and strengthens family cultural traditions.

COMMENTS: For resources on bilingual and dual language learning, see the American Academy of Pediatrics Section on Developmental and Behavioral Pediatrics (SODBP) at http://www.aap.org/sections/dbpeds/.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. Moerk, E. L. 2000. The guided acquisition of first language skills. Advances Applied Dev Psychol 20:248.

2. Olsen, L. 2006. Ensuring academic success of English learners. 2006. U.C. Linguistic Minority Research Institute 15:1-7.

STANDARD 2.1.1.8: Diversity in Enrollment and Curriculum

Programs should work to increase understanding of cultural, ethnic, and other similarities and differences by enrolling children who reflect the cultural and ethnic diversity of the community. Programs should provide cultural curricula that engage children and families and teach multicultural learning activities. Indoor and outdoor learning/play environments should have an array of toys, materials, posters, etc. that reflect diverse cultures and ethnicities. Stereotyping of any culture must be avoided.

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 (peaceful coexistence of different interests, convictions, and lifestyles) throughout life (1-3,11,12). By facilitating 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: Sharing information about the child on a daily basis with the children’s families shows respect for the children’s cultures by creating an opportunity to learn more about the families’ background, beliefs, and traditions (5-9). 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 (4). 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 (10). Children need to see members of their own community in positions of influence in the services they use. Scholarships and tuition assistance can be used to increase the diversity among enrolled children.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. Wardle, F. 1998. Meeting the needs of multicultural and multiethnic children in early childhood settings. Early Child Education J 26:7-11.

2. Ramsey, P. G. 1998. Teaching and learning in a diverse world: Multicultural education for young children. 2nd ed. New York: Teachers College Press.

3. Ramsey, P. G. 1995. Growing up with the contradictions of race and class. Young Child 50:18-22.

4. Maschinot, B. 2008. The changing face of the United States: The influence of culture on early child development. Washington, DC: Zero to Three. http://www.zerotothree.org/site/DocServer/Culture_book.pdf?docID=6921.

5. Williams, K. C., M. H. Cooney. 2006. Young children and social justice. Young Children 61:75-82.

6. Gonzalex-Mena, J. 2008. Diversity in early care and education: Honoring differences. 5th ed. Boston: McGraw-Hill.

7. Gonzalez-Mena, J. 2007. 50 early childhood strategies for working and communicating with diverse families. Upper Saddle River, NJ: Pearson Merrill Prentice Hall.

8. Bradely, J., P. Kibera. 2006. Closing the gap: Culture and promotion of inclusion in child care. Young Children 61:34-40.

9. Romero, M. 2008. Promoting tolerance and respect for diversity in early childhood: Toward a research and practice agenda. Report of the Promoting Tolerance and Respect for Diversity in Early Childhood Meeting, Brooklyn, NY, June 25, 2007. http://www.nccp
.org/publications/pdf/text_812.pdf.

10. Matthews, H. 2008. Supporting a diverse and culturally competent workforce: Charting progress for babies in child care. Charting Progress for Babies in Child Care: A CLASP Child Care and Early Education Project, Washington, DC. http://www.clasp
.org/babiesinchildcare/recommendations?id=0005.

11. Parent Services Project (PSP). Making room in the circle. Training Curriculum, PSP, San Rafael, CA.

12. Fox, R. K. 2007. One of the hidden diversities in schools: Families with parents who are Lesbian or Gay. Childhood Education 83:277-81.

STANDARD 2.1.1.9: Verbal Interaction

The child care facility should assure that a rich environment of spoken language by caregivers/teachers surrounds and includes all children with opportunities to expand their language communication skills. Each child should have at least one speaking adult person who engages the child in frequent verbal exchanges linked to daily events and experiences. To encourage the development of language, the caregiver/teacher should demonstrate skillful verbal communication and interaction with the child.

For infants, these interactions should include responses to, and encouragement of, soft infant sounds, as well as identifying objects, feelings, and desires by the caregiver/teacher.
For toddlers, the interactions should include naming of objects, feelings, listening to the child and responding, along with actions and supporting, but not forcing, the child to do the same.
For preschool and school-age children, interactions should include respectful listening and responses to what the child has to say, amplifying and clarifying the child’s intent, and not reinforcing mispronunciations (e.g., Wambulance instead of Ambulance).
Frequent interchange of questions, comments, and responses to children, including extending children’s utterances with a longer statement, by teaching staff.
For children with special needs, alternative methods of communication should be available, including but not limited to: sign language, assistive technology, picture boards, picture exchange communication systems (PECS), FM systems for hearing aids, etc. Communication through methods other than verbal communication can result in the same desired outcomes.
Profanity should not be used at any time.

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 teaches the children facts and relays information, the social and emotional communications and the atmosphere of the exchange are equally important. Reciprocity of expression, response, and the initiation and enrichment of dialogue are hallmarks of the social function and significance of the conversations (1-4).

The future development of the child depends on his/her command of language (5). Research suggests that language experiences in a child’s early years have a profound influence on that child’s language and vocabulary development, which in turn has an impact on future school success (6). 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/guardians and children requires an ability to speak their language. Discussing the impact of actions on feelings for the child and others helps to develop empathy.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. Mayr, T., M. Ulich. 1999. Children’s well-being in day care centers: An exploratory empirical study. Int J Early Years Education 7:229-39.

2. Baron, N., L. W. Schrank. 1997. Children learning language: How adults can help. Lake Zurich, IL: Learning Seed.

3. Szanton, E. S., ed. 1997. Creating child-centered programs for infants and toddlers, birth to 3 year olds, step by step: A Program for children and families. New York: Children’s Resources International, Inc.

4. Kontos, S., A. Wilcox-Herzog. 1997. Teachers’ interactions with children: Why are they so important? Young Child 52:4-12.

5. Moerk, E. L. 2000. The guided acquisition of first language skills. Advances in Applied Dev Psychol 20:248.

6. Pikulski, J. J., Templeton, S. 2004. Teaching and developing vocabulary: Key to long-term reading success. Geneva, IL: Houghton Mifflin Company. http://www.eduplace.com/state/author/pik_temp.pdf.

2.1.2 Program Activities for Infants and Toddlers from Three Months to Less Than Thirty-Six Months

STANDARD 2.1.2.1: Personal Caregiver/Teacher Relationships for Infants and Toddlers

The facility should practice a relationship-based philosophy that promotes consistency and continuity of caregivers/teachers for infants and toddlers. The facility should limit the number of caregivers/teachers who interact with any one infant (1,2) to no more than five caregivers/teachers across the period that the child is an infant in child care. The caregiver/teacher should:

Hold and comfort children who are upset;
Engage in frequent, multiple, and rich social interchanges such as smiling, talking, touching, singing, and eating;
Be play partners as well as protectors;
Be attuned to children’s feelings and reflect them back;
Communicate consistently with parents/guardians;
Interact with children and develop a relationship in the context of everyday routines (diapering, feeding, etc.)

Opportunities should be provided for each child to develop a personal and affectionate relationship with, and attachment to, that child’s parents/guardians and one or a small number of caregivers/teachers 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.

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 (3,6). 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 (5). 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 (4,6). This difficulty occurs even if each of the many adults is very caring in their interaction with the child (7). There should be breaks at least every four hours and in accordance with U.S. Department of Labor laws.

COMMENTS: Hugging, holding, and cuddling infants and children are expressions of wholesome love that should be encouraged. Caregivers/teachers should be advised that it is alright to demonstrate affection for children of both sexes. At all times, caregivers/teachers should respect the wishes of children, regardless of their ages, with regard to physical contact and their comfort or discomfort with it. Caregivers/teachers should avoid even “friendly contact” (such as touching the shoulder or arm) with a child if the child is uncomfortable with it.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. Creyer, D., S. Hurwitz, M. Wolery. 2003. Continuity of caregiver for infants and toddlers. ERIC Clearinghouse on Elementary and Early Care Education. http://www.ericdigests.org/2004-3/
infants.html.

2. Theilheimer, R. 2006. Molding to the children: Primary caregiving and continuity of care. Zero to Three 26:50-54.

3. Baron, N., L. W. Schrank. 1997. Children learning language: How adults can help. Lake Zurich, IL: Learning Seed.

4. Botkin, D., et al. 1991. Children’s affectionate behavior: Gender differences. Early Education Dev 2:270-86.

5. Cassidy J., Shaver, P., eds. 1999. Handbook of attachment: Theory, research and clinical applications, 671-87. 2nd ed. New York: Guilford Press.

6. Raikes, H. 1996. A secure base for babies: Applying attachment concepts to the infant care setting. Young Children 51:59-67.

7. Lally, R. J. 2000. Infants have their own curriculum: A responsive approach to curriculum planning for infants and toddlers. U.S. Department of Health and Human Services, Administration for Children and Families, Early Childhood Learning and Knowledge Center. http://eclkc.ohs.acf.hhs.gov/hslc/tta-system/teaching/eecd/Curriculum/Definition and Requirements/edudev_art_00032_071005.html.

STANDARD 2.1.2.2: Interactions with Infants and Toddlers

Caregivers/teachers should provide consistent, continuous and inviting opportunities to talk, listen to, and otherwise interact with young infants throughout the day (indoors and outdoors) including feeding, changing, playing with, and cuddling 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 (2-5). Infants and toddlers learn through meaningful relationships and interaction with consistent adults and peers.

The future development of the child depends on his/her command of language (1). Richness of language increases as it is nurtured by verbal interactions of the child with adults and peers. Basic communication with parents/guardians and children requires an ability to speak their language. A language-rich environment and warm, responsive interactions between staff and children are among the elements that produce positive impacts (6).

COMMENTS: Live, real-time interaction with caregivers/teachers is preferred. For example, caregivers/teachers naming objects in the indoor and outdoor learning/play environment 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. With fixed-speed activities, the pace may be too fast for some children, and the activity may have to be repeated for some children or the caregiver/teacher will need to try a different method for learning.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. Moerk, E. L. 2000. The guided acquisition of first language skills. Advances Applied Dev Psychol 20:248.

2. Baron, N., L. W. Schrank. 1997. Children learning language: How adults can help. Lake Zurich, Ill: Learning Seed.

4. Kontos, S., A. Wilcox-Herzog. 1997. Teachers’ interactions with children: Why are they so important? Young Child 52:4-12.

5. Snow, C. E., M. S. Burns, P. Griffin. 1999. Language and literacy environments in preschools. ERIC Digest (January).

6. National Forum on Early Childhood Program Evaluation, National Scientific Council on the Developing Child. 2007. A science-based framework for early childhood policy: Using evidence to improve outcomes in learning, behavior, and health for vulnerable children. Cambridge, MA: Center on the Developing Child, Harvard University. http://developingchild.harvard.edu/index.php/library/reports_and_working_papers/policy_framework/.

STANDARD 2.1.2.3: Space and Activity to Support Learning of Infants and Toddlers

The facility should provide a safe and clean learning environment, both indoors and outdoors, colorful materials and equipment arranged to support learning. The indoor and outdoor learning/play environment should encourage and be comfortable with staff on the floor level when interacting with active infant crawlers and toddlers. The indoor and outdoor play and learning settings should provide opportunities for the child to act upon the environment by experiencing age-appropriate obstacles, frustrations, and risks in order to learn to negotiate environmental challenges. The facility should 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 and experience the natural world;
Help the child practice resolving conflicts;
Use symbols (words, numbers, etc.);
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;
Promote sensory exploration.

For infants and toddlers the curriculum should be based on the child’s development at the time and connected to a sound understanding as to where they are in their developmental course.

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 skills, the ability to demonstrate initiative through active outdoor and indoor play, 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 (1,2). A physical and social environment that offers opportunities for active mastery and coping enhances the child’s adaptive abilities (3,4,9). 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 (8). Play involves a balance of action and symbolization, and of feeling and thinking (5-7). Children need access to age-appropriate toys and safe household objects.

COMMENTS: 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 the National Association for the Education of Young Children (NAEYC). For information regarding appropriate materials for outdoor play, see POEMS: Preschool Outdoor Environment Measurement Scale (10).

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. Massey, M. S. 1998. Early childhood violence prevention. ERIC Digest (October).

2. Levin, D. E. 1994. Teaching young children in violent times: Building a peaceable classroom, A preschool-grade 3 violence prevention and conflict resolution guide. Cambridge, MA: Educators for Social Responsibility.

3. Mayr, T., M. Ulich. 1999. Children’s well-being in day care centers: An exploratory empirical study. Int J Early Years Education 7:229-39.

4. Cartwright, S. 1998. Group trips: An invitation to cooperative learning. Child Care Infor Exch 124:95-97.

5. Evaldsson, A., W. A. Corsaro. 1998. Play and games in the peer cultures of preschool and preadolescent children: An interpretative approach. Childhood 5:377-402.

6. Petersen, E. A. 1998. The amazing benefits of play. Child Family 17:7-8.

7. Pica, R. 1997. Beyond physical development: Why young children need to move. Young Child 52:4-11.

8. Tepperman, J., ed. 2007. Play in the early years: Key to school success, a policy brief. El Cerrito, CA: Early Childhood Funders. http://www.4children.org/images/pdf/play07.pdf.

9. Torelli, L., C. Durrett. 1996. Landscape for learning: The impact of classroom design on infants and toddlers. Early Childhood News 8 (March-April): 12-17. http://www.spacesforchildren.com/landc1.pdf.

10. DeBord, K., L. Hestenes, R. Moore, N. Cosco, J. McGinnis. 2005. Preschool outdoor environment measurement scale. Lewisville, NC: Kaplan Early Learning Co.

STANDARD 2.1.2.4: Separation of Infants and Toddlers from Older Children

Infants and toddlers younger than three years of age should be cared for in a closed room(s) that separates them from older children, except in small family child care homes with closed groups of mixed aged children.

In facilities caring for three or more children younger than three years of age, activities that bring children younger than three years of age in contact with older children should be prohibited, unless the younger children already have regular contact with the older children as part of a group.

Pooling, as a practice in larger settings where the infants/toddlers are not part of the group all day – as in home care – should be avoided for the following reasons:

Unfamiliarity with caregivers/teachers if not the primary one during the day;
Concerns of noise levels, space ratios, social-emotional well-being, etc.;
Occurs at times when children are least able to handle transitions;
Increases the number of transitions for children,
Increases the number of adults caring for infants and toddlers, a practice to be avoided if possible.

Caregivers/teachers of infants should not be responsible for the care of older children who are not a part of the infants’ closed child care group.

Groups of younger infants should receive care in closed room(s) that separates them from other groups of toddlers and older children.

When partitions are used, they must control interaction between groups, provide separated ventilation of the spaces and control sound transmission. The acoustic controls should limit significant transmission of sound from one group’s activity into other group environments.

RATIONALE: Infants need quiet, calm environments, away from the stimulation of older children. 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 (1). Therefore, infants should be a focus for interventions to reduce the incidence of respiratory tract diseases. Handwashing and sanitizing practices are key.

Depending on the temperament of the child, an increase in transitions can increase anxiety in young children by reducing the opportunity for routine and predictability (2), and it increases basic health and safety concerns of cross contamination with older children who have more contact with the environment.

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.

Separation of groups of children by low partitions that divide a single common space is not acceptable. Without sound attenuation, limitation of shared air pollutants including airborne infectious disease agents, or control of interactions among the caregivers/teachers who are working with different groups, the separate smaller groups are essentially one large group.

TYPE OF FACILITY: Center

REFERENCES:

1. Izurieta, H. S., W. W. Thompson, P. Kramarz, et al. 2000. Influenza and the rates of hospitalization for respiratory disease among infants and young children. New England J Med 342:232-39.

2. Poole, C. 1998. Routine matters. Scholastic Parent Child (August/September).

STANDARD 2.1.2.5: Toilet Learning/Training

The facility should develop and implement a plan that teaches each child how and when to use the toilet. Toilet learning/training, when initiated, should follow a prescribed, sequential plan that is developed and coordinated with the parent’s/guardian’s plan for implementation in the home environment. Toilet learning/training should be based on the child’s developmental level rather than chronological age.

To help children achieve bowel and bladder control, caregivers/teachers should enable children to take an active role in using the toilet when they are physically able to do so and when parents/guardians support their children’s learning to use the toilet.

Diapering/toilet training should not be used as rationale for not spending time outdoors. Practices and policies should be offered to address diapering/toileting needs outdoors such as providing staff who can address children’s needs, or provide outdoor diapering and toileting that meets all sanitation requirements.

Caregivers/teachers should 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 should defer toilet learning/training until the child’s family is ready to support this learning and the child demonstrates:

An understanding of the concept of cause and effect;
An ability to communicate, including sign language;
The physical ability to remain dry for up to two hours;
An ability to sit on the toilet, to feel/understand the sense of elimination;
A demonstrated interest in autonomous behavior.

For preschool and school-age children, an emphasis should be placed on appropriate handwashing after using the toilet and they should be provided frequent and unrestricted opportunities to use the toilet.

Children with special health care needs may require specific instructions, training techniques, adapted toilets, and/or supports or precautions. Some children will need to be taught special techniques like catheterization or care of ostomies. This can be provided by trained staff or older children can sometimes learn self-care techniques. Any special techniques should be documented in a written care plan. The child care health consultant can provide training or coordinate resources necessary to accommodate special toileting techniques while in child care.

Cultural expectations of toilet learning/training need to be recognized and respected.

RATIONALE: A child’s achievements of motor and cognitive or developmental skills assist in determining when s/he is ready for toilet learning/training (1). Physical ability/neurological function also includes the ability to sit on the toilet and to feel/understand the sense of elimination.

Toilet learning/training is achieved more rapidly once expectations from adults across environments are consistent (3). The family may not be prepared, at the time, to extend this learning/training into the home environment (2).

School-age and preschool 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 (4). Also, unless reminded, many children forget to correctly wash their hands after toileting.

COMMENTS: The area of toilet learning/training for children with special health care needs is difficult because there are no age-related, disability-specific rules to follow. As a result, support and counseling for parents/guardians and caregivers/teachers 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. The child care health consultant should be considered a resource to assist is supporting special health care needs.

Sometimes children need to increase their fluid intake to help a medical condition and this can lead to increased urination. Other conditions can lead to loose stools. Children should be given unrestricted access to toileting facilities, especially in these situations. Children who are recovering from gastrointestinal illness might temporarily lose continence, especially if they are recently toilet trained, and may need to revert to diapers or training pants for a short period of time. Children who are experiencing stress (e.g., a new infant in the family) may regress and also return to using diapers for a period of time.

For more information on toilet learning/training, see “Toilet Training: Guidelines for Parents,” available from the American Academy of Pediatrics (AAP) at http://www.aap.org and the AAP Section on Developmental and Behavioral Pediatrics at http://www.aap.org/sections/dbpeds/.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. Mayo Clinic. 2009. Potty training: How to get the job done. http://www.mayoclinic.com/health/potty-training/CC00060/.

2. American Academy of Pediatrics. 2009. When is the right time to start toilet training? http://www.aap.org/publiced/BR_ToiletTrain.htm.

3. Anthony-Pillai, R. 2007. What’s potty about early toilet training? British Med J 334:1166.

4. Schmitt, B. D. 2004. Toilet training problems: Underachievers, refusers, and stool holders. Contemporary Pediatrics 21:71-77.

2.1.3 Program Activities for Three- to Five-Year-Olds

STANDARD 2.1.3.1: Personal Caregiver/Teacher Relationships for Three- to Five-Year-Olds

Facilities should provide opportunities for each child to build long-term, trusting relationships with a few caring caregivers/teachers by limiting the number of adults the facility permits to care for any one child in child care to a maximum of eight adults in a given year and no more than three primary caregivers/teachers in a day. Children with special health care needs may require additional specialists to promote health and safety and to support learning; however, relationships with primary caregivers/teachers should be supported.

RATIONALE: Children learn best from adults who know and respect them; who act as guides, facilitators, and supporters within a rich learning environment; and with whom they have established a trusting relationship (1,2). When the facility allows too many adults to be involved in the child’s care, the child does not develop a reciprocal, sustained, responsive, and trusting relationship with any of them.

Children should have continuous friendly and trusting relationships with several caregivers/teachers 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, staffing reassignment, or if the child is frequently moved from one room to another or one child care facility to another.

COMMENTS: Compliance should be measured by staff and parent/guardian 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 (3).

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. Rodd, J. 1996. Understanding young children’s behavior: A guide for early childhood professionals. New York: Teacher’s College Press.

2. Greenberg, P. 1991. Character development: Encouraging self-esteem and self-discipline in infants, toddlers, and two-year-olds. Washington, DC: National Association for the Education of Young Children.

3. Whitebook, M., D. Bellm. 1998. Taking on turnover: An action guide for child care center teachers and directors. Washington, DC: Center for the Child Care Workforce.

STANDARD 2.1.3.2: Opportunities for Learning for Three- to Five-Year-Olds

Programs should provide children a balance of guided and self-initiated play and learning indoors and outdoors. These should include opportunities to observe, explore, order and reorder, to make mistakes and find solutions, and to 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 (1,2).

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. Rodd, J. 1996. Understanding young children’s behavior: A guide for early childhood professionals. New York: Teacher’s College Press.

2. Ritchie, S., B. Willer. 2008. Teaching: A guide to the NAEYC early childhood standard and related accreditation criteria. Washington, DC: National Association for the Education of Young Children.

STANDARD 2.1.3.3: Selection of Equipment for Three- to Five-Year-Olds

The program should select, for both indoor and outdoor play and learning, developmentally appropriate equipment and materials, 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 indoor and outdoor learning/play environment contributes to the preschooler’s sense of well-being and control (1,2,4,5).

COMMENTS: “Play and learning settings that motivate children to be physically active include pathways, trails, lawns, loose parts, anchored playground equipment, and layouts that stimulate all forms of active play” (3). If traditional playground equipment is used, caregivers/teachers may want to consult with an early childhood specialist or a certified playground inspector for recommendations on developmentally appropriate play equipment. For more information on play equipment also contact the National Program for Playground Safety (http://www.uni.edu/playground/).

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. Torelli, L., C. Durrett. 1996. Landscape for learning: The impact of classroom design on infants and toddlers. Early Child News 8:12-17.

2. Center for Environmental Health. The safe playgrounds project. http://www.safe2play.org.

3. DeBord, K., L. Hestenes, R. Moore, N. Cosco, J. McGinnis. 2005. Preschool outdoor environment measurement scale. Lewisville, NC: Kaplan Early Learning Co.

4. Banning, W., G. Sullivan. 2009. Lens on outdoor learning. St. Paul, MN: Red Leaf Press.

5. Keeler, R. 2008. Natural playscapes: Creating outdoor play environments for the soul. Redmond, WA: Exchange Press.

STANDARD 2.1.3.4: Expressive Activities for Three- to Five-Year-Olds

Caregivers/teachers should encourage and enhance expressive activities that include play, painting, drawing, storytelling, sensory play, music, singing, dancing, and dramatic play.

RATIONALE: Expressive activities are vehicles for socialization, conflict resolution, and language development. They are vital energizers and organizers for cognitive development (2). Stifling the preschooler’s need to play damages a natural integration of thinking and feeling (1).

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. Cooney, M., L. Hutchinson, V. Costigan. 1996. From hitting to tattling to communication and negotiation: The young child’s stages of socialization. Early Child Education J 24:23-27.

2. Tepperman, J., ed. 2007. Play in the early years: Key to school success, a policy brief. El Cerrito, CA: Early Childhood Funders. http://www.4children.org/images/pdf/play07.pdf.

STANDARD 2.1.3.5: Fostering Cooperation of Three- to Five-Year-Olds

Programs should foster a cooperative rather than a competitive indoor and outdoor learning/play environment.

RATIONALE: As three-, four-, and five-year-olds play and work together, they shift from almost total dependence on the adult to seeking social opportunities with peers that still require adult monitoring and guidance. 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 (1).

COMMENTS: Encouraging communication skills and attentiveness to the needs of individuals and the group as a whole supports a cooperative atmosphere. Adults need to model cooperation.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. Pica, R. 1997. Beyond physical development: Why young children need to move. Young Child 52:4-11.

STANDARD 2.1.3.6: Fostering Language Development of Three- to Five-Year-Olds

The indoor and outdoor learning/play environment should be rich in first-hand experiences that offer opportunities for language development. They should also have an abundance of books of fantasy, fiction, and nonfiction, and provide chances for the children to relate stories. Caregivers/teachers should foster language development by:

Speaking with children rather than at them;
Encouraging children to talk with each other by helping them to listen and respond;
Giving children models of verbal expression;
Reading books about the child’s culture and history, which would serve to help the child develop a sense of self;
Reading to children and re-reading their favorite books;
Listening respectfully when children speak;
Encouraging interactive storytelling;
Using open-ended questions;
Provide opportunities during indoor and outdoor learning/play to use writing supplies and printed materials;
Provide and read books relevant to their natural environment outdoors (for example, books about the current season, local wildlife, etc.);
Provide settings that encourage children to observe nature, such as a butterfly garden, bird watching station, etc.;
Providing opportunities to explore writing, such as through a writing area or individual journals.

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 (1-3).

COMMENTS: Compliance with development 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;” “can you 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

REFERENCES:

1. Szanton, E. S., ed. 1997. Creating child-centered programs for infants and toddlers, birth to 3 year olds, step by step: A Program for children and families. New York: Children’s Resources International.

2. Snow, C. E., M. S. Burns, P. Griffin. 1999. Language and literacy environments in preschools. ERIC Digest (January).

3. Maschinot, B. 2008. The changing face of the United States: The influence of culture on early child development. Washington, DC: Zero to Three. http://www.zerotothree.org/site/DocServer/Culture_book.pdf?docID=6921.

STANDARD 2.1.3.7: Body Mastery for Three- to Five-Year-Olds

The caregivers/teachers should offer children opportunities, indoors and outdoors, to learn about their bodies and how their bodies function in the context of socializing with others. Caregivers/teachers should support the children in their curiosity and body mastery, consistent with parental/guardian expectations and cultural preferences. Body mastery includes feeding oneself, learning how to use the toilet, running, skipping, climbing, balancing, playing with peers, displaying affection, and using and manipulating objects.

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 (1-5).

COMMENTS: Self-stimulatory behaviors, such as thumb sucking or masturbation, should be ignored. If the masturbation is excessive, interferes with other activities, or is noticed by other children, the caregiver/teacher should make a brief non-judgmental comment that touching of private body parts is normal, but is usually done in a private place (7,8). After making such a comment, the caregiver/teacher should offer friendly assistance in going on to other activities. These behaviors may be signs of stress in the child’s life, or simply a habit. If the child’s sexual play is more explicit or forceful toward other children or the child witnessed or was exposed to adult sexuality, the caregiver/teacher may need to consider that abuse is possible (6).

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. Botkin, D., et al. 1991. Children’s affectionate behavior: Gender differences. Early Education Dev 2:270-86.

2. Mayr, T., M. Ulich. 1999. Children’s well-being in day care centers: An exploratory empirical study. Int J Early Years Education 7:229-39.

3. Cartwright, S. 1998. Group trips: An invitation to cooperative learning. Child Care Infor Exch 124:95-97.

4. Rodd, J. 1996. Understanding young children’s behavior: A guide for early childhood professionals. New York: Teacher’s College Press.

5. Cooney, M., L. Hutchinson, V. Costigan. 1996. From hitting to tattling to communication and negotiation: The young child’s stages of socialization. Early Child Education J 24:23-27.

6. Kellogg, N., American Academy of Pediatrics Committee on Child Abuse and Neglect. 2005. Clinical report: The evaluation of sexual abuse in children. Pediatrics 116:506-12.

7. Johnson, T. C. 2007. Understanding children’s sexual behaviors: What’s natural and healthy. San Diego: Institute on Violence, Abuse and Trauma.

8. Friedrich, W. N., J. Fisher, D. Broughton, M. Houston, C. R. Shafran. 1998. Normative sexual behavior in children: A contemporary sample. Pediatrics 101: e9.

2.1.4 Program Activities for School-Age Children

STANDARD 2.1.4.1: Supervised School-Age Activities

The facility should have a program of supervised activities designed especially for school-age children, to include:

Free choice of play;
Opportunities, both indoors and outdoors, for vigorous physical activity which engages each child daily for at least sixty minutes and are not limited to opportunities to develop physical fitness through a program of focused activity that only engages some of the children in the group;
Opportunities for concentration, alone or in a group, indoors and/or outdoors;
Time to read or do homework, indoors and/or outdoors;
Opportunities to be creative, to explore the arts, sciences, and social studies, and to solve problems, indoors and/or outdoors;
Opportunities for community service experience (museums, library, leadership development, elderly citizen homes, etc.);
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);
Opportunities to rest;
Opportunities to seek comfort, consolation, and understanding from adult caregivers/teachers;
Opportunities for exercise and exploration out of doors.

RATIONALE: Programs organized for older children after school or during vacation time should provide indoor and outdoor learning/play environments that meet the needs of these children for physical activity, recreation, responsible completion of school work, expanding their interests, learning cultural sensitivity, exploring community resources, and practicing pro-social skills (1,2).

COMMENTS: For more information on school-age standards, see [The NAA Standards for Quality School-Age Care,] available from the National AfterSchool Association (NAA).

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. Coltin, L. 1999. Enriching children’s out-of-school time. ERIC Digest (May).

2. Fashola, O. S. 1999. Implementing effective after-school programs. Here’s How 17:1-4

STANDARD 2.1.4.2: Space for School-Age Activity

The facility should 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 (1,2). Active connection with nature promotes children’s sensitivity, confidence, exploration, and self-regulation.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. Greenspan, S. L. 1997. Building children’s minds: Early childhood development for a better future. Our Child 23:6-10.

2. Maxwell, L. E. 1996. Designing early childhood education environments: A partnership between architect and educator. Education Facility Planner 33:15-17.

STANDARD 2.1.4.3: Developing Relationships for School-Age Children

The facility should 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. Community service opportunities can be valuable for this age group.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

STANDARD 2.1.4.4: Planning Activities for School-Age Children

The facility should offer a program based on the needs and interests of the age group, as well as of the individuals within it. Children should participate in planning the program activities. Parents/guardians should be engaged and their work commitments should be honored when planning program activities.

RATIONALE: A child care facility for school-age children should provide an enriching contrast to the formal school program, but also offer time for children to complete homework assignments. Programs that offer a wide range of activities (such as team sports, cooking, dramatics, art, music, crafts, games, open time, quiet time, outdoor play and learning, and 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 2.1.4.5: Community Outreach for School-Age Children

The facility should provide opportunities for school-age children to participate in community outreach and involvement, 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 (1).

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. Taras, H. L. 2005. School-aged child care. In Health in child care: A manual for health professionals, ed. J. R. Murph, S. D. Palmer, D. Glassy, 411-21. 4th ed. Elk Grove Village, IL: American Academy of Pediatrics.

STANDARD 2.1.4.6: Communication Between Child Care and School

Facilities that accept school-age children directly from school should arrange a system of communication with the child’s school teacher. Families should be included in this communication loop.

RATIONALE: Activities and experiences that occurred during the school day may be important in anticipating and understanding children’s after-school behavior (1). The connection between children’s learning at school experience and their out-of-school activities is important (1).

COMMENTS: This communication may be facilitated by phone or email between the child’s teacher and the school-age child care facility. School-age child care programs should include parent/guardian permissions which allow school teachers to communicate relevant information to caregivers/teachers. Parents/guardians should also be notified of any significant event so that a system of communication is established between and among family, school, and caregivers/teachers. The child’s school 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

REFERENCES:

1. National Association of Elementary School Principals, National AfterSchool Association. Leading a new day for learning. http://www.naaweb.org/downloads/Principal Documents/leading_joint_statement-r3_.pdf.

2.2 Supervision and Discipline

STANDARD 2.2.0.1: Methods of Supervision of Children

Caregivers/teachers should directly supervise infants, toddlers, and preschoolers by sight and hearing at all times, even when the children are going to sleep, napping or sleeping, are beginning to wake up, or are indoors or outdoors. School-age children should be within sight or hearing at all times. Caregivers/teachers should not be on one floor level of the building, while children are on another floor or room. Ratios should remain the same whether inside or outside.

School-age children should be permitted to participate in activities off the premises with appropriate adult supervision and with written approval by a parent/guardian and by the caregiver. If parents/guardians give written permission for the school-age child to participate in off-premises activities, the facility would no longer be responsible for the child during the off-premises activity and not need to provide staff for the off-premises activity.

Caregivers/teachers should regularly count children (name to face on a scheduled basis, at every transition, and whenever leaving one area and arriving at another), going indoors or outdoors, to confirm the safe whereabouts of every child at all times. Additionally, they must be able to state how many children are in their care at all times.

Developmentally appropriate child:staff ratios should be met during all hours of operation, including indoor and outdoor play and field trips, and safety precautions for specific areas and equipment should be followed. No center-based facility or large family child care home should 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 should be written policies.

RATIONALE: Supervision is basic to safety and the prevention of injury and maintaining quality child care. Parents/guardians have a contract with caregivers/teachers to supervise their children. To be available for supervision 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 to reach the children. Stairs, ramps, and elevators may become unstable because they can be pathways for fire and smoke.

Children who are presumed to be sleeping might be awake and in need of adult attention. A child’s risk-taking behavior must be detected and illness, fear, or other stressful behaviors must be noticed and managed.

The importance of supervision is not only to protect children from physical injury, but from harm that can occur from topics discussed by children or by teasing/bullying/inappropriate behavior. It is the responsibility of caregivers/teachers to monitor what children are talking about and intervene when necessary.

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 childrens’ 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 and scanning for potential safety hazards;
Standing in a strategic position;
Scanning play activities and circulating around the area;
Focusing on the positive rather than the negative to teach a child what is safe for the child and other children;
Teaching children the appropriate and safe use of each piece of equipment (e.g., using a slide correctly – feet first only – and teaching why climbing up a slide can cause injury, possibly a head injury).

Children are going to be more active in the outdoor learning/play environment and need more supervision rather than less outside. Playground supervisors need to be designated and trained to supervise children in play areas (1). Supervision of the playground is a strategy of watching all the children within a specific territory and not engaging in prolonged dialog with any one child or group of children (or other staff). Other adults not designated to supervise may facilitate outdoor learning/play activities and engage in conversations with children about their exploration and discoveries. Facilitated play is where the adult is engaged in helping children learn a skill or achieve specific outcome of an activity. Facilitated play is not supervision (2).

Children need spaces, indoors and out, in which they can withdraw for alone-time or quiet play in small groups. However, program spaces should be designed with visibility that allows constant unobtrusive adult supervision. To protect children from maltreatment, including sexual abuse, the environment layout should limit situations in which an adult or older child is left alone with a child without another adult present (3,4).

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 (name to face) will alert the staff to begin a search before the child gets too far, into trouble, or slips into an unobserved location.

Caregivers/teachers 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/teachers 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 fifteen minutes) to help the staff remember to count.

Caregivers/teachers should be ready to provide help and guidance when children are ready to use the toilet correctly and independently. Caregivers/teachers should make sure children correctly wash their hands after every use of the toilet, as well as monitor the bathroom to make sure that the toilet is flushed, the toilet seat and floor are free from stool or urine, and supplies (toilet paper, soap, and paper towels) are available.

Older preschool children and school-age children may use toilet facilities without direct visual observation but must remain within hearing range in case children need assistance and to prevent inappropriate behavior. If toilets are not on the same floor as the child care area or within sight or hearing of a caregiver/teacher, an adult should accompany children younger than five years of age to and from the toilet area. Younger children who request privacy and have shown capability to use toilet facilities properly should be given permission to use separate and private toilet facilities.

Planning must include advance assignments, monitoring, and contingency plans to maintain appropriate staffing. During times when children are typically being dropped off and picked up, the number of children present can vary. There should be a plan in place to monitor and address unanticipated changes, allowing for caregivers/teachers to receive additional help when needed. 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/teachers and children in each group at varied times of the day, and by reviewing written policies.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. National Program for Playground Safety. 2006. Playground supervision training for childcare providers. University of Northern Iowa. http://www.playgroundsafety.org/training/online/childcare/course_supervision.htm.

2. National Program for Playground Safety. 2006. NPPS Website. http://www.playgroundsafety.org.

3. National Association for the Education of Young Children. 1996. Position Statement. Prevention of child abuse in early childhood programs and the responsibilities of early childhood professionals to prevent child abuse.

4. Fiene, R. 2002. 13 indicators of quality child care: Research update. Washington, DC: U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation. http://aspe.hhs.gov/hsp/ccquality-ind02/.

ADDITIONAL READINGS:

Harms, T., R. M. Clifford, D. Cryer. 2005. Early childhood environment rating scale, revised ed. Frank Porter Graham Child Development Institute, University of North Carolina. http://ers.fpg
.unc.edu/node/82/.

Harms, T., D. Cryer, R. M. Clifford. 2005. Infant/toddler environment rating scale, revised ed. Frank Porter Graham Child Development Institute, University of North Carolina. http://ers.fpg.unc.edu/node/84/.

Chen, X., M. Beran, R. Altkorn, S. Milkovich, K. Gruaz, G. Rider, A. Kanti, J. Ochsenhirt. 2006. Frequency of caregiver supervision of young children during play. Intl J Injury Control and Safety Promotion 14:122-24.

Schwebel, D. C., A. L. Summerlin, M. L. Bounds, B. A. Morrongiello. 2006. The stamp-in-safety program: A behavioral intervention to reduce behaviors that can lead to unintentional playground injury in a preschool setting. J Pediatric Psychology 31:152-62.

U.S. Consumer Product Safety Commission (CPSC). 2010. Public playground safety handbook. http://www.cpsc.gov/cpscpub/pubs/325.pdf.

STANDARD 2.2.0.2: Limiting Infant/Toddler Time in Crib, High Chair, Car Seat, Etc.

A child should not sit in a high chair or other equipment that constrains his/her movement (1,2) indoors or outdoors for longer than fifteen minutes, other than at meals or snack time. Children should never be left out of the view and attention of adult caregivers/teachers while in these types of equipment/furniture. A least restrictive environment should be encouraged at all times. Children should not be left to sleep in equipment, such as car seats, swings, or infant seats that does not meet ASTM International (ASTM) product safety standards for sleep equipment.

RATIONALE: Children are continually developing their physical skills. They need opportunities to use and build on their physical abilities. This is especially true for infants and toddlers who are eagerly using their bodies to explore their environment. Extended periods of time in the crib, high chair, car seat, or other confined space limits their physical growth and also affects their social interactions. Injuries and Sudden Infant Death Syndrome (SIDS) have occurred when children have been left to sleep in car seats or infant seats when the straps have entrapped body parts, or the children have turned the seats over while in them. Sleeping in a seated position can restrict breathing and cause oxygen desaturation in young infants (3). Sleeping should occur in equipment manufactured for this activity. When children are awake, restricting them to a seat may limit social interactions. These social interactions are essential for children to gain language skills, develop self-esteem, and build relationships (4).

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. Kornhauser Cerar, L., C.V. Scirica, I. Stucin Gantar, D. Osredkar, D. Neubauer, T.B. Kinane. 2009. A comparison of respiratory patterns in healthy term infants placed in care safety seats and beds. Pediatrics 124:e396-e402.

2. Benjamin, S.E., S.L. Rifas-Shiman, E.M. Taveras, J. Haines, J. Finkelstein, K. Kleinman, M.W. Gillman. 2009. Early child care and adiposity at ages 1 and 3 years. Pediatrics 124:555-62.

3. Bass, J. L., M. Bull. 2008. Oxygen desaturation in term infants in car safety seats. Pediatrics 110:401-2.

4. New York State Office of Children and Family Services. Website. http://www.ocfs.state.ny.us/main/.

STANDARD 2.2.0.3: Limiting Screen Time – Media, Computer Time

In early care and education settings, media (television [TV], video, and DVD) viewing and computer use should not be permitted for children younger than two years. For children two years and older in early care and early education settings, total screen time should be limited to not more than thirty minutes once a week, and for educational or physical activity use only. During meal or snack time, TV, video, or DVD viewing should not be allowed (1). Computer use should be limited to no more than fifteen-minute increments except for school-age children completing homework assignments (2) and children with special health care needs who require and consistently use assistive and adaptive computer technology.

Parents/guardians should be informed if screen media are used in the early care and education program. Any screen media used should be free of advertising and brand placement. TV programs, DVD, and computer games should be reviewed and evaluated before participation of the children to ensure that advertising and brand placement are not present.

RATIONALE: In the first two years of life, children’s brains and bodies are going through critical periods of growth and development. It is important for infants and young children to have positive interactions with people and not sit in front of a screen that takes time away from social interaction with parents/guardians and caregivers/teachers. Before age three, television viewing can have modest negative effects on cognitive development of children (3). For that reason, the American Academy of Pediatrics (AAP) recommends television viewing be discouraged for children younger than two years of age (4). Interactive activities that promote brain development can be encouraged, such as talking, playing, singing, and reading together.

For children two years and older, the AAP recommends limiting children’s total (early care and education, and home) media time (with entertainment media) to no more than one to two hours of quality programming per twenty-four hour period (3). Because children may watch television before and after attending early care and education settings, limiting media time during their time in early care and education settings will help meet the AAP recommendation. When TV watching is intended to be interactive, with the adult interacting with children about what they are watching, caregivers/teachers can sing along and comment on what children are watching. Caregivers/teachers should always consider whether children could learn the skill better in another way through hands-on experiences.

Studies have shown a relationship between TV viewing and overweight in young children. For example, watching more than eight hours of television per week has been associated with an increased risk of obesity in young children and exposure to two or more hours of television per day increased the risk of overweight for three- to five-year-olds (5,6). Among four-year-olds, research has shown that as body mass index increases, average hours of TV viewing increases (7). Also, young children who watch TV have been shown to have poor diet quality. For each one-hour increment of TV viewing per day, three-year-olds were found to have higher intakes of sugar-sweetened beverage and lower fruit and vegetable intakes (8). Children are exposed to extensive advertising for high-calorie and low-nutrient dense foods and drinks and very limited advertising of healthful foods and drinks during their television viewing. Television advertising influences the food consumption of children two-to eleven-years-old (9).

About two-thirds (66%) of children ages six months to six years watch television every day. About a quarter (24%) watch videos or DVDs every day, and nearly two-thirds (65%) watch them several times a week or more. Additionally, young children engage in other forms of screen activity several times a week or more including using a computer (27%), playing console video games (13%), and playing handheld video games (8%) (10). Survey data show that by three months of age, about 40% of infants regularly watch television, DVDs, or videos. By twenty-four months, this rose to 90% (1).

Caregivers/teachers cannot determine which child does and does not watch TV at home. It is important for early care and education programs to limit TV viewing so that the AAP goal of less than two hours a day, accompanied by more physical activity and increased interaction with reading, can be achieved. A study of TV viewing in early care and education settings reported that, on average, preschool-aged children watched more than four times as much television while at home-based programs than at center-based programs (1.39 hours per day vs. 0.36 hours per day); with significant differences between groups in the type of television content viewed, and in the proportions of programs in which no television viewing occurred at all. The proportion of programs where preschool-aged children watched no television during the early care and education day was 65% in center-based programs and 11% in home-based programs (11).

COMMENTS: It is important for caregivers/teachers to be a role model for children in early care and education settings by not watching TV during the care day. In addition, when adults watch television (including the news) in the presence of children, children may be exposed to inappropriate language or frightening images. The USDA has tips on limiting media time – “How Much Inactive Time Is Too Much” at http://www.choosemyplate.gov/foodgroups/physicalactivity_why.html.

The AAP provides a description of the TV programming rating scale and tips for parents/guardians at http://www.healthychildren.org/English/family-life/Media/Pages/TV
-Ratings-A-Guide-for-Parents.aspx. Caregivers/teachers are discouraged from having a TV in a room where children are present.

Caregivers/teachers should begin reading to children when they are six months of age and facilities should have age-appropriate books available for each cognitive stage of development. See “Reach Out and Read” at http://www.reachoutandread.org for more information.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. Zimmerman, F. J., D. A. Christakis, A. N. Meltzoff. 2007. Television and DVD/video viewing in children younger than 2 years. Arch Pediatric Adolescent Med 161:473-79.

2. Harms, T., R. M. Clifford, D. Cryer. 2005. Early childhood environment rating scale, revised ed. Frank Porter Graham Child Development Institute, University of North Carolina. http://ers.fpg
.unc.edu/node/82/.

3. Zimmerman, F. J., D. A. Christakis. 2005. Children’s television viewing and cognitive outcomes. Arch Pediatric Adolescent Med 159:619-25.

4. American Academy of Pediatrics, Council on Communications and Media. 2009. Policy statement: Media violence. Pediatrics 124:1495-1503.

5. Reilly, J. J., J. Armstrong, A. R. Dorosty. 2005. Early life risk factors for obesity in childhood: Cohort study. British Medical J 330:1357.

6. Lumeng, J. C., S. Rahnama, D. Appugliese, N. Kaciroti, R. H. Bradley. 2006. Television exposure and overweight risk in preschoolers. Arch Pediatric Adolescent Med 160:417-22.

7. Levin, S., M. W. Martin, W. F. Riner. 2004. TV viewing habits and Body Mass Index among South Carolina Head Start children. Ethnicity and Disease 14:336-39.

8. Miller, S. A., E. M. Taveras, S. L. Rifas-Shiman, M. W. Gillman. 2008. Association between television viewing and poor diet quality in young children. Int J Pediatric Obesity 3:168-76.

9. Committee on Food Marketing and the Diets of Children and Youth. 2006. Food marketing to children and youth: Threat or opportunity. Ed. J. M. McGinnis, J. A. Gootman, V. I. Kraak. Washington, DC: National Academies Press.

10. Taveras, E. M., T. J. Sandora, M. C. Shih, D. Ross-Degnan, D. A. Goldmann, M. W. Gillman. 2006. The association of television and video viewing with fast food intake by preschool-age children. Obesity 14:2034-41.

11. Christakis, D. A., M. M. Garrison, F. J. Zimmerman. 2006. Television viewing in child care programs: A national survey. Communication Reports 19:111-20.

ADDITIONAL READINGS:

Dennison, B. A., T. A. Erb, P. L. Jenkins. 2002. Television viewing and television in bedroom associated with overweight risk among low-income preschool children. Pediatrics 109:1028-35.

Funk, J. B., J. Brouwer, K. Curtiss, E. McBroom. 2009. Parents of preschoolers: Expert media recommendations and ratings knowledge, media-effects beliefs, and monitoring practices. Pediatrics 123:981-88.

National Association for the Education of Young Children. 1994. Media violence in children’s lives. Position Statement. http://www.naeyc.org/files/naeyc/file/positions/PSMEVI98.PDF.

National Association for the Education of Young Children. 2012. Technology and interactive media as tools in early childhood programs serving children from birth through age 8. Position Statement. http://www.naeyc.org/files/naeyc/PS_technology_WEB.pdf

Martinez-Gomez, D., J. Tucker, K. A. Heelan, G. J. Welk, J. C. Eisenmann. 2009. Associations between sedentary behavior and blood pressure in young children. Arch Pediatr Adolesc Med 163:724-30.

Nixon, G. M., J. M. D. Thompson, D. Y. Han, et al. 2009. Falling asleep: The determinants of sleep latency. Arch Dis Child 94:686-89.

McMurray, R. G., S. I. Bangdiwala, J. S. Harrell, L. D. Amorim. 2008. Adolescents with metabolic syndrome have a history of low aerobic fitness and physical activity levels. Dynamic Med 7:5.

McDonough, P. 2009. TV viewing among kids at an eight-year high. Nielsen Wire (October 26). http://blog.nielsen.com/nielsenwire/media_entertainment/tv-viewing-among-kids-at-an-eight-year-high/.

Tandon, P. S., C. Zhou, P. Lozano, D. A. Christakis. 2010. Preschoolers’ total daily screen time at home and by type of child care. J Pediatr 158:297-300.

STANDARD 2.2.0.4: Supervision Near Bodies of Water

Constant and active supervision should be maintained when any child is in or around water (1). During any swimming/wading/water play activities where either an infant or a toddler is present, the ratio should always be one adult to one infant/toddler. Children ages thirteen months to five years of age should not be permitted to play in areas where there is any body of water, including swimming pools, ponds and irrigation ditches, built-in wading pools, tubs, pails, sinks, or toilets unless the supervising adult is within an arm’s length providing “touch supervision”.

Caregivers/teachers should ensure that all pools meet the Virginia Graeme Baker Pool and Spa Safety Act, requiring the retrofitting of safe suction-type devices for pools and spas to prevent underwater entrapment of children in such locations with strong suction devices that have led to deaths of children of varying ages (2).

RATIONALE: Small children can drown within thirty seconds, in as little as two inches of liquid (3).

In a comprehensive study of drowning and submersion incidents involving children under five years of age in Arizona, California, and Florida, the U.S. Consumer Product Safety Commission (CPSC) found that:

Submersion incidents involving children usually happen in familiar surroundings;
Pool submersions involving children happen quickly, 77% of the victims had been missing from sight for five minutes or less;
Child drowning is a silent death, and splashing may not occur to alert someone that the child is in trouble (4).

Drowning is the second leading cause of unintentional injury-related death for children ages one to fourteen (5).

In 2006, approximately 1,100 children under the age of twenty in the U.S died from drowning (11). A national study that examined where drowning most commonly takes place concluded that infants are most likely to drown in bathtubs, toddlers are most likely to drown in swimming pools and older children and adolescents are most likely to drown in freshwater (rivers, lakes, ponds) (11).

While swimming pools pose the greatest risk for toddlers, about one-quarter of drowning among toddlers are in freshwater sites, such as ponds or lakes.

The American Academy of Pediatrics (AAP) recommends:

Swimming lessons for children based on the child’s frequency of exposure to water, emotional maturity, physical limitations, and health concerns related to swimming pools;
“Touch supervision” of infants and young children through age four when they are in the bathtub or around other bodies of water;
Installation of four-sided fencing that completely separates homes from residential pools;
Use of approved personal flotation devices (PFDs) when riding on a boat or playing near a river, lake, pond, or ocean;
Teaching children never to swim alone or without adult supervision;
Stressing the need for parents/guardians and teens to learn first aid and cardiopulmonary resuscitation (CPR) (3).

Deaths and nonfatal injuries have been associated with infant bathtub “supporting ring” devices that are supposed to keep an infant safe in the tub. These rings usually contain three or four legs with suction cups that attach to the bottom of the tub. The suction cups, however, may release suddenly, allowing the bath ring and infant to tip over. An infant also may slip between the legs of the bath ring and become trapped under it. Caregivers/teachers must not rely on these devices to keep an infant safe in the bath and must never leave an infant alone in these bath support rings (1,6,7).

Thirty children under five years of age died from drowning in buckets, pails, and containers from 2003-2005 (10). Of all buckets, the five-gallon size presents the greatest hazard to young children because of its tall straight sides and its weight with even just a small amount of liquid. It is nearly impossible for top-heavy (their heads) infants and toddlers to free themselves when they fall into a five-gallon bucket head first (8).

The Centers for Disease Control (CDC) National Center for Injury Prevention and Control recommends that whenever young children are swimming, playing, or bathing in water, an adult should be watching them constantly. The supervising adult should not read, play cards, talk on the telephone, mow the lawn, or do any other distracting activity while watching children (1,9).

COMMENTS: “Touch supervision” means keeping swimming children within arm’s reach and in sight at all times. Flotation devices should never be used as a substitute for supervision. Knowing how to swim does not make a child drown-proof.

The need for constant supervision is of particular concern in dealing with very young children and children with significant motor dysfunction or developmental delays. Supervising adults should be CPR-trained and should have a telephone accessible to the pool and water area at all times should emergency services be required.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. U.S. Consumer Product Safety Commission. 2009. CPSC warns of in-home drowning dangers with bathtubs, bath seats, buckets. Release #10-008. Washington, DC: CPSC. http://www.cpsc.gov/cpscpub/prerel/prhtml10/10008.html.

2. U.S. Congress. 2007. Virginia Graeme Baker Pool and Spa Safety Act. 15 USC 8001. http://www.cpsc.gov/businfo/vgb/pssa.pdf.

3. American Academy of Pediatrics, Committee on Injury, Violence, and Poison Prevention. 2010. Policy statement-prevention of drowning. Pediatrics 126: 178-85.

4. U.S. Consumer Product Safety Commission. 2002. How to plan for the unexpected: Preventing child drownings. Publication #359. Washington, DC: CPSC. http://www.cpsc.gov/CPSCPUB/PUBS/359.pdf.

5. Centers for Disease Control and Prevention (CDC). 2010. Unintentional drowning: Fact sheet. http://www.cdc.gov/HomeandRecreationalSafety/Water-Safety/waterinjuries
-factsheet.html.

6. U.S. Consumer Product Safety Commission. 1994. Drowning hazard with baby “supporting ring” devices. Document #5084. Washington, DC: CPSC. http://www.cpsc.gov/cpscpub/pubs/
5084.html.

7. Rauchschwalbe, R., R. A. Brenner, S. Gordon. 1997. The role of bathtub seats and rings in infant drowning deaths. Pediatrics 100:e1.

8. U.S. Consumer Product Safety Commission. 1994. Infants and toddlers can drown in 5-gallon buckets: A hidden hazard in the home. Document #5006. Washington, DC: CPSC. http://www.cpsc
.gov/cpscpub/pubs/5006.html.

9. U.S. Consumer Product Safety Commission. 1997. CPSC reminds pool owners that barriers, supervision prevent drowning. Release #97-152. Washington, DC: CPSC. http://www.cpsc.gov/CPSCPUB/PREREL/PRHTML97/97152.html.

10. Gipson, K. 2008. Submersions related to non-pool and non-spa products, 2008 report. Washington, DC: U.S. Consumer Product Safety Commission. http://www.cpsc.gov/library/FOIA/FOIA09/OS/nonpoolsub2008.pdf.

11. American Academy of Pediatrics Committee on Injury, Violence, and Poison Prevention, J. Weiss. 2010. Technical report: Prevention of drowning. Pediatrics 126: e253-62.

STANDARD 2.2.0.5: Behavior Around a Pool

When children are in or around a pool, caregivers/teachers should teach age-appropriate behavior and safety skills including not pushing each other, holding each other under water, or running at the poolside. Children should be shown the depth of the water at different part of the pool. They should be taught that when going into a body of water, they should go in feet first the first time to check the depth. Children should be instructed what an emergency would be and to only call for help only in a real/genuine emergency. They should be taught to never dive in shallow water.

RATIONALE: Caregivers/teachers should take the opportunities to explain how certain behaviors could injure other children. Also such behavior can distract caregivers/teachers from supervising other children, thereby placing the other children at risk (1).

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. U.S. Department of Health and Human Services, Maternal and Child Health Bureau. 1999. Basic emergency lifesaving skills (BELS): A framework for teaching emergency lifesaving skills to children and adolescents. Newton, MA: Children’s Safety Network, Education Development Center. http://bolivia.hrsa.gov/emsc/Downloads/BELS/BELS.htm.

STANDARD 2.2.0.6: Discipline Measures

Reader’s Note: The word discipline means to teach and guide. Discipline is not punishment. The discipline standard therefore reflects an approach that focuses on preventing behavior problems by supporting children in learning appropriate social skills and emotional responses.

Caregivers/teachers should guide children to develop self-control and appropriate behaviors in the context of relationships with peers and adults. Caregivers/teachers should care for children without ever resorting to physical punishment or abusive language. When a child needs assistance to resolve a conflict, manage a transition, engage in a challenging situation, or express feelings, needs, and wants, the adult should help the child learn strategies for dealing with the situation. Discipline should be an ongoing process to help children learn to manage their own behavior in a socially acceptable manner, and should not just occur in response to a problem behavior. Rather, the adult’s guidance helps children respond to difficult situations using socially appropriate strategies. To develop self-control, children should receive adult support that is individual to the child and adapts as the child develops internal controls. This process should include:

Forming a positive relationship with the child. When children have a positive relationship with the adult, they are more likely to follow that person’s directions. This positive relationship occurs when the adult spends time talking to the child, listening to the child, following the child’s lead, playing with the child, and responding to the child’s needs;
Basing expectations on children’s developmental level;
Establishing simple rules children can understand (e.g., you can’t hurt others, our things, or yourself) and being proactive in teaching and supporting children in learning the rules;
Adapting the physical indoor and outdoor learning/play environment or family child care home to encourage positive behavior and self regulation by providing engaging materials based on children’s interests and ensuring that the learning environment promotes active participation of each child. Well-designed child care environments are ones that are supportive of appropriate behavior in children, and are designed to help children learn about what to expect in that environment and to promote positive interactions and engagement with others;
Modifying the learning/play environment (e.g., schedule, routine, activities, transitions) to support the child’s appropriate behavior;
Creating a predictable daily routine and schedule. When a routine is predictable, children are more likely to know what to do and what is expected of them. This may decrease anxiety in the child. When there is less anxiety, there may be less acting out. Reminders need to be given to the children so they can anticipate and prepare themselves for transitions within the schedule. Reminders should be individualized such that each child understands and anticipates the transition;
Using encouragement and descriptive praise. When clear encouragement and descriptive praise are used to give attention to appropriate behaviors, those behaviors are likely to be repeated. Encouragement and praise should be stated positively and descriptively. Encouragement and praise should provide information that the behavior the child engaged in was appropriate. Examples: “I can tell you are ready for circle time because you are sitting on your name and looking at me.” “Your friend looked so happy when you helped him clean up his toys.” “You must be so proud of yourself for putting on your coat all by yourself.” Encouragement and praise should label the behaviors, not the child (e.g., good listening, good eating, instead of good boy);
Using clear, direct, and simple commands. When clear commands are used with children, they are more likely to follow them. The caregiver/teacher should tell the child what to do rather than what NOT to do. The caregiver/teacher should limit the number of commands. The caregiver/teacher should use if/then and when/then statements with logical and natural consequences. These practices help children understand they can make choices and that choices have consequences;
Showing children positive alternatives rather than just telling children “no”;
Modeling desired behavior;
Using planned ignoring and redirection. Certain behaviors can be ignored while at the same time the adult is able to redirect the children to another activity. If the behavior cannot be ignored, the adult should prompt the child to use a more appropriate behavior and provide positive feedback when the child engages in the behavior;
Individualizing discipline based on the individual needs of children. For example, if a child has a hard time transitioning, the caregiver/teacher can identify strategies to help the child with the transition (individualized warning, job during transition, individual schedule, peer buddy to help, etc.) If a child has a difficult time during a large group activity, the child might be taught to ask for a break;
Using time-out for behaviors that are persistent and unacceptable. Time-out should only be used in combination with instructional approaches that teach children what to do in place of the behavior problem. (See guidance for time-outs below.)

Expectations for children’s behavior and the facility’s policies regarding their response to behaviors should be written and shared with families and children of appropriate age. Further, the policies should address proactive as well as reactive strategies. Programs should work with families to support their children’s appropriate behaviors before it becomes a problem.

RATIONALE: Common usage of the word “discipline” has corrupted the word so that many consider discipline as synonymous with punishment, most particularly corporal punishment (2,3). 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 harmful side effects (4-9). Children have to be taught expectations for their behavior if they are to develop internal control of their actions. The goal is to help children learn to control their own behavior.

COMMENTS: Children respond well when they receive descriptive praise/attention for behaviors that the caregiver/teacher wants to see again. It is best if caregivers/teachers are sincere and enthusiastic when using descriptive praise. On the contrary, children should not receive praise for undesirable behaviors, but instead be praised for honest efforts towards the behaviors the caregivers/teachers want to see repeated (1). Discipline is best received when it includes positive guidance, redirection, and setting clear-cut limits that foster the child’s ability to become self-disciplined. In order to respond effectively when children display challenging behavior, it is beneficial for caregivers/teachers to understand typical social and emotional development and behaviors. Discipline is an ongoing process to help children develop inner control so they can manage their own behavior in a socially approved manner. A comprehensive behavior plan is often based first on a positive, affectionate relationship between the child and the caregiver/teacher. Measures that prevent behavior problems often include developmentally appropriate environments, supervision, routines, and transitions. Children can benefit from receiving guidance and repeated instructions for navigating the various social interactions that take place in the child care setting such as friendship development, problem-solving, and conflict-resolution.

Time-out (also known as temporary separation) is one strategy to help children change their behavior and should be used in the context of a positive behavioral support approach which works to understand undesired behaviors and teach new skills to replace the behavior. Listed below are guidelines when using time-out (8):

Time-outs should be used for behaviors that are persistent and unacceptable, used infrequently and used only for children who are at least two years of age. Time-outs can be considered an extended ignore or a time-out from positive enforcement;
The caregiver/teacher should explain how time-out works to the child BEFORE s/he uses it the first time. The adult should be clear about the behavior that will lead to time-out;
When placing the child in time-out, the caregiver/teacher should stay calm;
While the child is in time-out, the caregiver/teacher should not talk to or look at the child (as an extended ignore). However, the adult should keep the child in sight. The child could 1) remain sitting quietly in a chair or on a pillow within the room or 2) participate in some activity that requires solitary pursuit (painting, coloring, puzzle, etc.) If the child cannot remain in the room, s/he will spend time in an alternate space, with supervision;
Time-outs do not need to be long. The caregiver/teacher should use the one minute of time-out for each year of the child’s age (e.g., three-years-old = three minutes of time-out);
The caregiver/teacher should end the time-out on a positive note and allow the child to feel good again. Discussions with the child to “explain WHY you were in time-out” are not usually effective;
If the child is unable to be distracted or consoled, parents/guardians should be contacted.

How to respond to failure to cooperate during time-out:

Caregivers/teachers should expect resistance from children who are new to the time-out procedure. If a child has never experienced time-out, s/he may respond by becoming very emotional. Time-out should not turn into a power struggle with the child. If the child is refusing to stay on time-out, the caregiver/teacher should give the child an if/then statement. For example, “if you cannot take your time-out, then you cannot join story time.” If the child continues to refuse the time-out, then the child cannot join story time. Note that children should not be restrained to keep them in time-out.

More resources for caregivers/teachers on discipline can be found at the following organizations’ Websites: a) Center on the Social and Emotional Foundations for Early Learning (CSEFEL) at http://csefel.vanderbilt.edu and b) Technical Assistance Center on Social Emotional Intervention (TACSIE) at http://www.challengingbehavior.org.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. Henderlong, J., M. Lepper. 2002 The effects of praise on children’s intrinsic motivation: A review and synthesis. Psychological Bulletin 128:774-95.

2. Hodgkin, R. 1997. Why the “gentle smack” should go: Policy review. Child Soc 11:201-4.

3. Fraiberg, S. H. 1959. The Magic Years. New York: Charles Scribner’s Sons.

4. Straus, M. A., et al. 1997. Spanking by parents and subsequent antisocial behavior of children. Arch Pediatric Adolescent Medicine 151:761-67.

5. Deater-Deckard, K., et al. 1996. Physical discipline among African American and European American mothers: Links to children’s externalizing behaviors. Dev Psychol 32:1065-72.

6. Weiss, B., et al. 1992. Some consequences of early harsh discipline: Child aggression and a maladaptive social information processing style. Child Dev 63:1321-35.

7. American Academy of Pediatrics, Committee on School Health. 2006. Policy statement: Corporal punishment in schools. Pediatrics 118:1266.

8. Dunlap, S., L. Fox, M. L. Hemmeter, P. Strain. 2004. The role of time-out in a comprehensive approach for addressing challenging behaviors of preschool children. CSEFEL What Works Series. http://csefel.vanderbilt.edu/briefs/wwb14.pdf.

9. Fiene, R. 2002. 13 indicators of quality child care: Research update. Washington, DC: U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation. http://aspe.hhs.gov/hsp/ccquality-ind02/.

ADDITIONAL READINGS:

Gross, D., C. Garvey, W. Julion, L. Fogg, S. Tucker, H. Mokos. 2009. Efficacy of the Chicago Parent Program with low-income multi-ethnic parents of young children. Preventions Science 10:54-65.

Breitenstein, S., D. Gross, I. Ordaz, W. Julion, C. Garvey, A. Ridge. 2007. Promoting mental health in early childhood programs serving families from low income neighborhoods. J Am Psychiatric Nurses Assoc 13:313-20.

Gross, D., C. Garvey, W. Julion, L. Fogg. 2007. Preventive parent training with low-income ethnic minority parents of preschoolers. In Handbook of parent training: Helping parents prevent and solve problem behaviors. Ed. J. M. Briesmeister, C. E. Schaefer. 3rd ed. Hoboken, NJ: Wiley.

Gartrell, D. 2007. He did it on purpose! Young Children 62:62-64.

Gartrell, D. 2004. The power of guidance: Teaching social-emotional skills in early childhood classrooms. Clifton Park, NY: Thomson Delmar Learning; Washington, DC: NAEYC.

Gartrell, D., K. Sonsteng. 2008. Promoting physical activity: It’s pro-active guidance. Young Children 63:51-53.

Shiller, V. M., J. C. O’Flynn. 2008. Using rewards in the early childhood classroom: A reexamination of the issues. Young Children 63:88, 90-93.

Reineke, J., K. Sonsteng, D. Gartrell. 2008. Nurturing mastery motivation: No need for rewards. Young Children 63:89, 93-97.

Ryan, R. M., E. L. Deci. 2000. When rewards compete with nature: The undermining of intrinsic motivation and self-regulation. In Intrinsic and extrinsic motivation: The search for optimal motivation and performance, ed. C. Sanstone, J. M. Harackiewicz, 13-54. San Diego, CA: Academic Press.

STANDARD 2.2.0.7: Handling Physical Aggression, Biting, and Hitting

Caregivers/teachers should intervene immediately when a child’s behavior is aggressive and endangers the safety of others. It is important that the child be clearly told verbally, “no hitting” or “no biting.” The caregiver/teacher should use age–appropriate interventions. For example, a toddler can be picked up and moved to another location in the room if s/he bites other children or adults. A preschool child can be invited to walk with you first but, if not compliant, taken by the hand and walked to another location in the room. The caregiver/teacher should remain calm and make eye contact with the child telling him/her the behavior is unacceptable. If the behavior persists, parents/guardians, caregivers/teachers, the child care health consultant and the early childhood mental health consultant should be involved to create a plan targeting this behavior. For example, a plan may be developed to recognize non-aggressive behavior. Children who might not have the social skills or language to communicate appropriately may use physical aggression to express themselves and the reason for and antecedents of the behavior must be considered when developing a plan for addressing the behavior.

RATIONALE: Caregiver/teacher intervention protects children and encourages children to exhibit more acceptable behavior (1).

COMMENTS: Biting is a phase. Here are some specific steps to deal with biting:

Step 1: If a child bites another child, the caregiver/teacher should comfort the child who was bitten and remind the biter that biting hurts and we do not bite. Children should be given some space from each other for an appropriate amount of time.

Step 2: The caregiver/teacher should follow first aid instructions (available from the American Academy of Pediatrics [AAP] and the American Red Cross) and use the Center for Disease Control and Prevention’s (CDC’s) Standard Precautions to handle potential exposure to blood.

Step 3: The caregiver/teacher should allow for “dignity of risk,” and let the children back in the same space with increased supervision. Interactions should be structured between children such that the child learns to use more appropriate social skills or language rather than biting. If there is another incident, caregivers/teachers should repeat step one. The biter can play with children they have not bitten.

Step 4: The adult needs to shadow the biter to ensure safety of the other children. This can be challenging but imperative for the biter.

Step 5: For all transitions when the biter would be in close contact, the caregiver/teacher should hold him/her on her/his hip or if possible hold hands, keep a close watch, and keep the biter from close proximity with peers.

Step 6: The child (biter) should play with one or two other children whom they have not bitten with a favored adult in a section separate from the other children. Sometimes, until a phase (biting is a phase) passes, the caregiver/teacher needs to extinguish the behavior by not allowing it to happen and thereby reducing the attention given to the behavior.

Step 7: Parents/guardians of both children of the incident should be informed.

Step 8: The caregiver/teacher should determine whether the incident necessitates documentation (see Standard 9.4.1.9). If so, s/he should complete a report form.

Caregivers/teachers need to consider why the child is biting and teach the child a more appropriate way to communicate the same need. Possible reasons why a child would bite include:

Lack of words (desire to stop the behavior of another child);
Teething;
Tired (is nap time too late?);
Hungry (is lunch time too late?);
Lack of toys – consider buying duplicates of popular items;
Lack of supervision – more staff should be added, staff are near children during transitions, and room is set up to ensure visibility;
Child is bored – too much sitting, activities are too frustrating;
Child has oral motor needs – teethers are offered;
Child is avoiding something, and biting gets him/her out of it;
Lack of attention – child receives attention when biting.

Other important strategies to consider:

The caregiver/teacher should point out the effect of the child’s biting on the victim: “Emma is crying. Biting hurts. Look at her face. See how sad she is?” Label feelings and give victims the words to respond. “Emma, you can say ‘No biting!’ to Josh”;
The child should help the victim feel better. He can get a wet paper towel, a blankie or favorite toy for the victim and sit near them until the other child is feeling better. This encourages children to take responsibility for their actions, briefly removes the child from other activities and also lets the child experience success as a helper.

Discussing aggressive behavior in group time with the children can be an effective way to gain and share understanding among the children about how it feels when aggressive behavior occurs. Although bullying has not been studied in the preschool population, it is a form of aggression (2). Here are some helpful Websites: http://stopbullying.gov and http://www.eyesonbullying.org/preschool.html.

For more helpful strategies for handling aggression, see Center on the Social and Emotional Foundations for Early Learning Website at http://csefel.vanderbilt.edu. In addition, a child care health consultant or child care mental health consultant can help when the biting behavior continues.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. Rush, K. L. 1999. Caregiver-child interactions and early literacy development of preschool children from low-income environments. Topics Early Child Special Education 19:3-14.

2. Ross, Scott W., Horner, Robert H. 2009. Bully prevention in positive behavior support. J Applied Behavior Analysis 42:747-59.

STANDARD 2.2.0.8: Preventing Expulsions, Suspensions, and Other Limitations in Services

Child care programs should not expel, suspend, or otherwise limit the amount of services (including denying outdoor time, withholding food, or using food as a reward/punishment) provided to a child or family on the basis of challenging behaviors or a health/safety condition or situation unless the condition or situation meets one of the two exceptions listed in this standard.

Expulsion refers to terminating the enrollment of a child or family in the regular group setting because of a challenging behavior or a health condition. Suspension and other limitations in services include all other reductions in the amount of time a child may be in attendance of the regular group setting, either by requiring the child to cease attendance for a particular period of time or reducing the number of days or amount of time that a child may attend. Requiring a child to attend the program in a special place away from the other children in the regular group setting is included in this definition.

Child care programs should have a comprehensive discipline policy that includes an explicit description of alternatives to expulsion for children exhibiting extreme levels of challenging behaviors, and should include the program’s protocol for preventing challenging behaviors. These policies should be in writing and clearly articulated and communicated to parents/guardians, staff and others. These policies should also explicitly state how the program plans to use any available internal mental health and other support staff during behavioral crises to eliminate to the degree possible any need for external supports (e.g., local police departments) during crises.

Staff should have access to in-service training on both a proactive and as-needed basis on how to reduce the likelihood of problem behaviors escalating to the level of risk for expulsion and how to more effectively manage behaviors throughout the entire class/group. Staff should also have access to in-service training, resources, and child care health consultation to manage children’s health conditions in collaboration with parents/guardians and the child’s primary care provider. Programs should attempt to obtain access to behavioral or mental health consultation to help establish and maintain environments that will support children’s mental well-being and social-emotional health, and have access to such a consultant when more targeted child-specific interventions are needed. Mental health consultation may be obtained from a variety of sources, as described in Standard 1.6.0.3.

When children exhibit or engage in challenging behaviors that cannot be resolved easily, as above, staff should:

Assess the health of the child and the adequacy of the curriculum in meeting the developmental and educational needs of the child;
Immediately engage the parents/guardians/family in a spirit of collaboration regarding how the child’s behaviors may be best handled, including appropriate solutions that have worked at home or in other settings;
Access an early childhood mental health consultant to assist in developing an effective plan to address the child’s challenging behaviors and to assist the child in developing age-appropriate, pro-social skills;
Facilitate, with the family’s assistance, a referral for an evaluation for either Part C (early intervention) or Part B (preschool special education), as well as any other appropriate community-based services (e.g., child mental health clinic);
Facilitate with the family communication with the child’s primary care provider (e.g., pediatrician, family medicine provider, etc.), so that the primary care provider can assess for any related health concerns and help facilitate appropriate referrals.

The only possible reasons for considering expelling, suspending or otherwise limiting services to a child on the basis of challenging behaviors are:

Continued placement in the class and/or program clearly jeopardizes the physical safety of the child and/or his/her classmates as assessed by a qualified early childhood mental health consultant AND all possible interventions and supports recommended by a qualified early childhood mental health consultant aimed at providing a physically safe environment have been exhausted; or
The family is unwilling to participate in mental health consultation that has been provided through the child care program or independently obtain and participate in child mental health assistance available in the community; or
Continued placement in this class and/or program clearly fails to meet the mental health and/or social-emotional needs of the child as agreed by both the staff and the family AND a different program that is better able to meet these needs has been identified and can immediately provide services to the child.

In either of the above three cases, a qualified early childhood mental health consultant, qualified special education staff, and/or qualified community-based mental health care provider should be consulted, referrals for special education services and other community-based services should be facilitated, and a detailed transition plan from this program to a more appropriate setting should be developed with the family and followed. This transition could include a different private or public-funded child care or early education program in the community that is better equipped to address the behavioral concerns (e.g., therapeutic preschool programs, Head Start or Early Head Start, prekindergarten programs in the public schools that have access to additional support staff, etc.), or public-funded special education services for infants and toddlers (i.e., Part C early intervention) or preschoolers (i.e., Part B preschool special education).

To the degree that safety can be maintained, the child should be transitioned directly to the receiving program. The program should assist parents/guardians in securing the more appropriate placement, perhaps using the services of a local child care resource and referral agency. With parent/guardian permission, the child’s primary care provider should be consulted and a referral for a comprehensive assessment by qualified mental health provider and the appropriate special education system should be initiated. If abuse or neglect is suspected, then appropriate child protection services should be informed. Finally, no child should ever be expelled or suspended from care without first conducting an assessment of the safety of alternative arrangements (e.g., Who will care for the child? Will the child be adequately and safely supervised at all times?) (1).

RATIONALE: The rate of expulsion in child care programs has been estimated to be as high as one in every thirty-six children enrolled, with 39% of all child care classes per year expelling at least one child. In state-funded prekindergarten programs, the rate has been estimated as one in every 149 children enrolled, with 10% of prekindergarten classes per year expelling at least one child. These expulsions prevent children from receiving potentially beneficial mental health services and deny the child the benefit of continuity of quality early education and child care services. Mental health consultation has been shown in rigorous research to help reduce the likelihood of behaviors leading to expulsion decisions. Also, research suggests that expulsion decisions may be related to teacher job stress and depression, large group sizes, and high child:staff ratios (1-6).

Mental health services should be available to staff to help address challenging behaviors in the program, to help improve the mental health climate of indoor and outdoor learning/play environments and child care systems, to better provide mental health services to families, and to address job stress and mental health needs of staff.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. American Academy of Pediatrics, Committee on School Health. 2008. Policy statement: Out-of-school suspension and expulsion. Pediatrics 122:450.

2. Gilliam, W. S. 2005. Prekindergarteners left behind: Expulsion rates in state prekindergarten programs. Foundation for Child Development, Policy Brief Series no. 3. http://medicine.yale.edu/childstudy/zigler/Images/National Prek Study_expulsion brief_tcm350-34775.pdf.

3. Gilliam, W. S., G. Shahar. 2006. Preschool and child care expulsion and suspension: Rates and predictors in one state. Infants Young Children 19:228-45.

4. Gilliam, W. S. 2008. Implementing policies to reduce the likelihood of preschool expulsion. Foundation for Child Development, Policy Brief Series no. 7. http://medicine.yale.edu/childstudy/zigler/Images/PreKExpulsionBrief2_tcm350-34772.pdf.

5. National Scientific Council on the Developing Child. 2008. Mental health problems in early childhood can impair learning and behavior for life. Working paper #6. http://developingchild.harvard.edu/library/reports_and_working_papers/working_papers/wp6/.

6. Perry, D. F., M. C. Dunne, L. McFadden, D. Campbell. 2008. Reducing the risk for preschool expulsion: Mental health consultation for young children with challenging behaviors. J Child Family Studies 17:44-54.

STANDARD 2.2.0.9: Prohibited Caregiver/Teacher Behaviors

The following behaviors should be prohibited in all child care settings and by all caregivers/teachers:

The use of corporal punishment. Corporal punishment means punishment inflicted directly on the body including, but not limited to:
1. Hitting, spanking (refers to striking a child with an open hand on the buttocks or extremities with the intention of modifying behavior without causing physical injury), shaking, slapping, twisting, pulling, squeezing, or biting;
2. Demanding excessive physical exercise, excessive rest, or strenuous or bizarre postures;
3. Compelling a child to eat or have in his/her mouth soap, food, spices, or foreign substances;
4. Exposing a child to extremes of temperature.
Isolating a child in an adjacent room, hallway, closet, darkened area, play area, or any other area where a child cannot be seen or supervised;
Binding or tying to restrict movement, such as in a car seat (except when travelling) or taping the mouth;
Using or withholding food as a punishment or reward;
Toilet learning/training methods that punish, demean, or humiliate a child;
Any form of emotional abuse, including rejecting, terrorizing, extended ignoring, isolating, or corrupting a child;
Any abuse or maltreatment of a child, either as an incident of discipline or otherwise. Any child care program must not tolerate, or in any manner condone, an act of abuse or neglect of a child by an older child, employee, volunteer, or any person employed by the facility or child’s family;
Abusive, profane, or sarcastic language or verbal abuse, threats, or derogatory remarks about the child or child’s family;
Any form of public or private humiliation, including threats of physical punishment (1);
Physical activity/outdoor time should not be taken away as punishment.

RATIONALE: Corporal punishment may be physical abuse or may easily become abusive. Corporal punishment is clearly prohibited in family child care homes and centers in the majority of states (2-4). Research links corporal punishment with negative effects such as later aggression (5) behavior problems in school (6,7), antisocial and criminal behavior, and impairment of learning (8-12).

Factors supporting prohibition of certain methods of discipline include current child development theory and practice, legal aspects (namely, that a caregiver/teacher does not foster a relationship with the child in place of the parents/guardians), and increasing liability suits. The American Academy of Pediatrics (AAP) is opposed to the use of corporal punishment (12). Physicians, educators, and caregivers/teachers should neither inflict nor sanction corporal punishment (11).

COMMENTS: Appropriate alternatives to corporal punishment vary as children grow and develop. As infants become more mobile, the caregiver/teacher must create a safe space and impose limitations by encouraging 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/teacher 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 (12). This standard covers any behaviors that threaten the safety and security of children. This would include behaviors that occur among or between staff. Children should not see hitting, ridicule, etc. among staff members. Even though adults may state that the behaviors are “playful,” children cannot distinguish this.

“In the wake of well-publicized allegations of child abuse in out-of-home settings and increased concerns regarding liability, some programs have instituted no-touch policies, either explicitly or implicitly. No-touch policies are misguided efforts that fail to recognize the importance of touch to children’s healthy development. Touch is especially important for infants and toddlers. Warm, responsive touches convey regard and concern for children of any age. Adults should be sensitive to ensuring that their touches (such as pats on the back, hugs, or ruffling the child’s hair) are welcomed by the children and appropriate to their individual characteristics and cultural experience. Careful, open communication between the program and families about the value of touch in children’s development can help to achieve consensus as to acceptable ways for adults to show their respect and support for children in the program” (13).

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. New York State Office of Children and Family Services. Child care forms, licensed/ registered provider. http://www.ocfs.state.ny.us/main/forms/day_care/.

2. The Children’s Foundation. Family child care licensing study. 2000. Washington, DC: The Children’s Foundation.

3. Azer, S., D. Eldred. 1998. Training requirements in child care licensing regulations. Boston, MA: Center for Career Development in Early Care and Education, Wheelock College.

4. Meadows, A., ed. 1991. Caring for America’s Children. Washington, DC: National Academy of Sciences and National Research Council.

5. Gershoff, E. T. 2002. Corporal punishment by parents and associated child behaviors and experiences: A meta-analytic and theoretical review. Psychological Bulletin 128:539-79.

6. Slade, E. P., L. S. Wissow. 2004. Spanking in early childhood and later behavior problems: A prospective study of infants and young toddlers. Pediatrics 113:1321-30.

7. Grogan-Kaylor, A. 2005. Corporal punishment and the growth trajectory of children’s antisocial behavior. Child Maltreatment 10:283-92.

8. Straus, M. A., et al. 1997. Spanking by parents and subsequent antisocial behavior of children. Arch Pediatric Adolescent Medicine 151:761-67.

9. Deater-Deckard, K., et al. 1996. Physical discipline among African American and European American mothers: Links to children’s externalizing behaviors. Dev Psychology 32:1065-72.

10. Weiss, B., et al. 1992. Some consequences of early harsh discipline: Child aggression and a maladaptive social information processing style. Child Dev 63:1321-35.

11. American Academy of Pediatrics, Committee on School Health. 2006. Policy statement: Corporal punishment in schools. Pediatrics 188:1266.

12. American Academy of Pediatrics, Committee on Psychological Aspects of Child and Family Health. 2004. Policy statement: Guidance for effective discipline. Pediatrics 114:1126.

13. National Association for the Education of Young Children. 1996. Position Statement. Prevention of child abuse in early childhood programs and the responsibilities of early childhood professionals to prevent child abuse.

STANDARD 2.2.0.10: Using Physical Restraint

Reader’s Note: It should never be necessary to physically restrain a typically developing child unless his/her safety and/or that of others are at risk.

When a child with special behavioral or mental health issues is enrolled who may frequently need the cautious use of restraint in the event of behavior that endangers his or her safety or the safety of others, a behavioral care plan should be developed with input from the child’s primary care provider, mental health provider, parents/guardians, center director/family child care home caregiver/teacher, child care health consultant, and possibly early childhood mental health consultant in order to address underlying issues and reduce the need for physical restraint.

That behavioral care plan should include:

An indication and documentation of the use of other behavioral strategies before the use of restraint and a precise definition of when the child could be restrained;
That the restraint be limited to holding the child as gently as possible to accomplish the restraint;
That such child restraint techniques do not violate the state’s mental health code;
That the amount of time the child is physically restrained should be the minimum necessary to control the situation and be age-appropriate; reevaluation and change of strategy should be used every few minutes;
That no bonds, ties, blankets, straps, car seats, heavy weights (such as adult body sitting on child), or abusive words should be used;
That a designated and trained staff person, who should be on the premises whenever this specific child is present, would be the only person to carry out the restraint.

RATIONALE: A child could be harmed if not restrained properly (1). Therefore, staff who are doing the restraining must be trained. A clear behavioral care plan needs to be in place. And, clear documentation with parent/guardian notification needs to be done after a restraining incident occurs in order to conform with the mental health code.

COMMENTS: If all strategies described in Standard 2.2.0.6 are followed and a child continues to behave in an unsafe manner, staff need to physically remove the child from the situation to a less stimulating environment. Physical removal of a child is defined according the development of the child. If the child is able to walk, staff should hold the child’s hand and walk him/her away from the situation. If the child is not ambulatory, staff should pick the child up and remove him/her to a quiet place where s/he cannot hurt themselves or others. Staff need to remain calm and use a calm voice when directing the child. Certain procedures described in Standard 2.2.0.6 can be used at this time, including not giving a lot of attention to the behavior, distracting the child and/or giving a time-out to the child. If the behavior persists, a plan needs to be made with parental/guardian involvement. This plan could include rewards or a sticker chart and/or praise and attention for appropriate behavior. Or, loss of privileges for inappropriate behavior can be implemented, if age-appropriate. Staff should request or agree to step out of the situation if they sense a loss of their own self-control and concern for the child.

The use of safe physical restraint should occur rarely and only for brief periods to protect the child and others. Staff should be alert to repeated instances of restraint for individual children or within a indoor and outdoor learning/play environment and seek consultation from health and mental health consultants in collaboration with families to develop more appropriate strategies.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. Safe and Responsive Schools. 2003. Effective responses: Physical restraint. http://www.unl.edu/srs/pdfs/physrest.pdf.

2.3 Parent/Guardian Relationships

2.3.1 General

STANDARD 2.3.1.1: Mutual Responsibility of Parents/Guardians and Staff

The quality of the relationship between parents/guardians and caregivers/teachers has an influence on the child. There should be a reciprocal responsibility of the family and caregivers/teachers to observe, participate, and be trained in the care that each child requires, and they should be encouraged to work together as partners in providing care.

During the enrollment process, caregivers/teachers should clarify who is/are the legal guardian(s) of the child. All relevant legal documents, court orders, etc., should also be collected and filed during the enrollment process (1). Caregivers/teachers should comply with court orders and written consent from the parent/guardian with legal authority, and not try to make the determination themselves regarding the best interests of the child.

All aspects of child care programs should be designed to facilitate parent/guardian input and involvement. Non-custodial parents should have access to the same developmental and behavioral information given to the custodial parent/guardian, if they have joint legal custody, permission by court order, or written consent from the custodial parent/guardian.

Caregivers/teachers should also clarify with whom the child spends significant time and with whom the child has primary relationships as they will be key informants for the caregivers/teachers about the child and his/her needs.

Parent/guardian involvement is needed at all levels of the program, including program planning for indoors and outdoors, provision of quality care, screening for children who are ill, and support for other parents/guardians. Communication between the administrator, caregiver/teacher and parent/guardian are essential to facilitate the involvement and commitment of parents/guardians. Parents/guardians should be invited to participate on the program board or planning meetings for the program. Parents/guardians should meet with their child’s caregiver/teacher or the director annually to discuss how their child is doing in the program. On a daily basis, parents/guardians and caregivers/teachers should share information about the child’s health, changes in drop-off or pick-up times, and changes in family routines or family events. Caregivers/teachers should communicate regularly with parents/guardians by providing injury report forms if their child sustains an injury, posting notices of exposures to infectious diseases, and greeting the parent/guardian at drop-off each day. Parents/guardians should receive a copy of the child care programs’ written policies, including health and safety policies.

Caregivers/teachers should informally share with parents/guardians daily information about their child’s needs and activities.

Transition reports on any symptoms that the child developed, differences in patterns of appetite or urinating, and activity level should be exchanged to keep parents/guardians informed.

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/guardians and caregivers/teachers 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. Especially for infants and toddlers, attention to consistency across settings will help minimize stress that can result from notable differences in routines across caregivers/teachers and settings.

Another 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/guardians and caregivers/teachers 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/guardians in the social and cognitive leaps of the child provides parents/guardians with the confidence vital to their sense of competence. Caregivers/teachers should be able to direct parents/guardians to sources of information and activities that support child’s development and learning and be able to assist them to obtain appropriate screening and assessment when there are concerns. Communication should be sensitive to ethnic and cultural practices. The parent/guardian/caregiver/teacher partnership models positive adult behavior for school-age children and demonstrates a mutual concern for the child’s well-being (2-16).

In families where the parents/guardians are separated, it is usually in the child’s best interest for both parents/guardians to be involved in the child’s care, and informed about the child’s progress and problems in care. However, it is up to the courts to decide who has legal custody of the child.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. Public Counsel Law Center in California. Guidelines for Releasing Children and Custody Issues. http://www.publiccounsel.org/publications/release.pdf.

2. Mayr, T., M. Ulich. 1999. Children’s well-being in day care centers: An exploratory empirical study. Int J Early Years Educ 7:229-39.

3. Marshall, N. L. 1991. Empowering low-income parents: The role of child care. Boston, MA: EDRS.

4. Greenman, J. 1998. Parent partnerships: What they don’t teach you can hurt. Child Care Infor Exch 124:78-82.

5. Shores, E. J. 1998. A call to action: Family involvement as a critical component of teacher education programs. Tallahassee, FL: Southeastern Regional Vision for Education.

6. Massachusetts State Office for Children. Establishing a successful family daycare home: A resource guide for providers. 1990. Boston: MA State Office for Children.

7. Tijus, C. A., et al. 1997. The impact of parental involvement on the quality of day care centers. Int J Early Years Educ 5:7-20.

8. Jones, R. 1996. Producing a school newsletter parents will read. Child Care Infor Exch 107:91-3.

9. O’Connor, S., et al. 1996. ASQ: Assessing school age child care quality. Wellesly, MA: Center for Research on Women.

10. Powell, D. R. 1998. Reweaving parents back into the fabric of early childhood programs: Research in review. Young Child 53:60-67.

11. Miller, S. H., et al. 1995. Family support in early education and child care settings: Making a case for both principles and practices. Child Today 23:26-29.

12. Dombro, A. L. 1995. Sharing the care: What every provider and parent needs to know. Child Today 23:22-5.

13. Larner, M. 1995. Linking family support and early childhood programs: Issues, experiences, opportunities: Best practices project, 1-40. Chicago, IL: Family Resource Coalition.

14. Endsley, R. C., et al. 1993. Parent involvement and quality day care in proprietary centers. J Res Child Educ 7:53-61.

15. Fagan, J. 1994. Mother and father involvement in day care centers serving infants and young toddlers. Early Child Dev Care 103:95-101.

16. Seibel, N. L., L. G. Gillespie, and T. Temple. 2008. The role of child care providers in child abuse prevention. Zero to Three 28:33-40.

STANDARD 2.3.1.2: Parent/Guardian Visits

Parents/guardians are welcome any time their child is in attendance.

Caregivers/teachers should inform all parents/guardians 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 should be part of the “admission agreement” or other contract between the parent/guardian and the facility/caregiver/teacher. Parents/guardians should be welcomed and encouraged to speak freely to staff about concerns and suggestions. Parents/guardians must be informed what appropriate and inappropriate parental/guardian behavior is and the consequences for inappropriate behavior.

Authorized family members and parents/guardians should check in with the facility staff every visit to ensure safety of the children in the facility.

RATIONALE: Requiring unrestricted access of parents/guardians to their children is essential to preventing the abuse and neglect of children in child care (1,2). When access is restricted, areas observable by the parents/guardians may not reflect the care the children actually receive.

COMMENTS: Caregivers/teachers should not release a child to a parent/guardian who appears impaired (see Standard 9.2.4.1). Caregivers/teachers should not attempt on their own to handle an unstable (e.g., intoxicated) parent/guardian who wants to be admitted but whose behavior poses a risk to the children. Caregivers/teachers should consult local police or the local child protection agency about their recommendations for how staff can obtain support from law enforcement authorities.

Parents/guardians can be interviewed to see if the open-door policy is consistently implemented.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. Koralek, D., U.S. Department of Health and Human Services. 1992. Caregivers of young children: Preventing and responding to child maltreatment. Rev ed. The user manual series. McLean, VA: Circle, Inc.

2. Baglin, C. A., M. Bender, eds. 1994. Handbook on quality child care for young children: Settings standards and resources. San Diego, CA: Singular Publishing Group.

2.3.2 Regular Communication

STANDARD 2.3.2.1: Parent/Guardian Conferences

Along with short informal daily conversations between parents/guardians and caregivers/teachers, and as a supplement to the collaborative relationships caregivers/teachers and parents/guardians form specifically to support infants and toddlers, periodic and regular planned communication (e.g., parent/guardian conferences) should be scheduled with at least one parent/guardian of every child in care:

To review the child’s adjustment to care and development over time;
To reach agreement on appropriate disciplinary measures;
To discuss the child’s strengths, specific health issues, special needs, and concerns;
To stay informed of family issues that may affect the child’s behavior in care;
To identify goals for the child;
To discuss resources that parents/guardians can access;
To discuss the results of developmental screening.

At these planned conferences a caregiver/teacher should review with the parent/guardian the child’s health report, and the health record and assessments of development and learning that the program may do to identify medical and developmental issues that require follow-up or adjustment by the facility.

Each review should be documented in the child’s health record with the signature of the parent/guardian and the staff reviewer. These planned conferences should occur:

As part of the intake process;
At each health update interval;
On a calendar basis, scheduled according to the child’s age:
1. Every six months for children under six years of age and for children with special health care needs;
2. Every year for children six years of age and older;
Whenever new information is added to the child’s facility health record.

Additional conferences should be scheduled if the parent/guardian or caregiver/teacher has a concern at any time about a particular child. Any concern about a child’s health or development should not be delayed until a scheduled conference date.

Notes about these planned communications should be maintained in each child’s record at the facility and should be available for review.

RATIONALE: Parents/guardians and caregivers/teachers alike should be aware of, and should have arrived at, an agreement concerning each other’s beliefs and knowledge about how to care for children. Reviewing the health record with parents/guardians ensures correct information and can be a valuable teaching and motivational tool (1). It can also be a staff learning experience, through insight gained from parents/guardians on a child’s special circumstances.

Studies have shown that parent–child interactions characterized as structured and responsive to the child’s needs and emotions were positively related to school readiness, social skills, and receptive communication skills development (2).

A health history is the basis for meeting the child’s health, mental, safety, and social needs in the child care setting (1). Review of the health record can be a valuable educational tool for parents/guardians, through better understanding of the health report and immunization requirements (1). A goal of out-of-home care of infants and children is to identify parents/guardians who are in need of instruction so they can provide preventive health/nutrition/physical activity 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/guardians about the child’s needs and progress. Parent/guardian support groups and parent/guardian involvement at every level of facility planning and delivery are usually beneficial to the children, parents/guardians, and staff. Communication among parents/guardians whose children attend the same facility helps the parents/guardians to share useful information and to be mutually supportive.

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 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/guardians 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. Especially for infants and toddlers, authentic relationships are crucial to the optimal development of the child. Compliance can be measured by interviewing parents/guardians and staff.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. Aronson, S. 2002. Model Child Care Health Policies. 4th ed. Bryn Mawr, PA: American Academy of Pediatrics, Pennsylvania Chapter.

2. Connell, C. M., R. J. Prinz. 2002. The impact of childcare and parent–child interactions on school readiness and social skills development for low-income African American children. J of School Psychology 40:177-93.

STANDARD 2.3.2.2: Seeking Parent/Guardian Input

At least twice a year, each caregiver/teacher should seek the views of parents/guardians about the strengths and needs of the indoor and outdoor learning/play environment and their satisfaction with the services offered. Caregivers/teachers should honor parents’/guardians’ requests for more frequent reviews. Anonymous surveys can be offered as a way to receive parent/guardian input without parents/guardians feeling concerned if they have negative comments or concerns about the facility or practices within a facility.

RATIONALE: Parents/guardians and caregiver/teacher alike recognize that parents/guardians have essential rights in helping to shape the kind of child care service their children receive (1).

COMMENTS: Asking parents/guardians about their concerns and observations is essential so they can share issues and engage with staff in collaborative problem-solving. Small and large family child care homes should have group meetings of all parents/guardians 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/guardian advisory council) for obtaining or offering parental/guardian input. Individual or group meetings with parents/guardians would suffice to meet this standard. Seeking consumer input is a cornerstone of facility planning and evaluation. Centers can offer parents/guardians the chance to respond in writing. Accreditation organizations such as the National Association for the Education of Young Children (NAEYC) or the National Association for Family Child Care (NAFCC) have guidance on conducting parent/guardian surveys.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. National Association of Child Care Resource and Referral Agencies. It’s a win-win situation: When parents and providers work together. Child Care Aware. http://ccaapps.childcareaware.org/en/subscriptions/dailyparent/volume.php?id=29.

STANDARD 2.3.2.3: Support Services for Parents/Guardians

Caregivers/teachers should establish parent/guardian groups and parent/guardian support services. Caregivers/teachers should have a regularly established means of communicating to parents/guardians the existence of these groups and support services. Caregivers/teachers should document these services and should include intra-agency activities or other community support group offerings. The caregiver/teacher should record parental/guardian participation in these on-site activities in the facility record.

One strategy for supporting parents/guardians is to facilitate communication among parents/guardians. The facility should give consenting parents/guardians a list of names and phone numbers of other consenting parents/guardians whose children attend the same facility. The list should include an annotation encouraging parents/guardians whose children attend the same facility to communicate with one another about the service. The facility should update the list at least annually.

RATIONALE: Parental/guardian involvement at every level of program planning and delivery and parent/guardian support groups are elements that are usually beneficial to the children, parents/guardians, and staff of the facility (1). The parent/guardian association group facilitates mutual understanding between the program and parents/guardians. Parental/guardian involvement also helps to broaden parents’/guardians’ knowledge of administration of the facility and develops and enhances advocacy efforts (1).

Encouraging parents’/guardians’ 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/guardians communicate with each other, they can share concerns about the behavior of a specific caregiver/teacher and can identify patterns of action suggestive of abuse/neglect. Parents/guardians can encourage each other to report all concerns to the director or owner of the program.

COMMENTS: Parent/guardian meetings within a facility are useful means of communication that supplement mailings and indirect contacts.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

STANDARD 2.3.2.4: Parent/Guardian Complaint Procedures

Facilities should have in place complaint resolution procedures to jointly resolve with parents/guardians any problems that may arise. Arrangements for hearing (or receiving) the complaint and the actions (or discussion) resulting in resolution should be documented along with dates and people involved. Facilities should develop mechanisms for holding formal and informal meetings between staff and groups of parents/guardians. Substantiated complaints and their resolution(s) should be posted in a prominent location. Facilities should post the complaint and resolution procedure where parents/guardians can easily see (or view) them.

RATIONALE: Coordination between the facility and the parents/guardians 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. Complaint and resolution documentation records can help program directors assess problem areas of the facility, staff, and services.

COMMENTS: Special meetings could identify facility needs, assist in developing resources, and recommend facility and policy changes to the governing body. 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 and at other venues.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

2.3.3 Health Information Sharing

STANDARD 2.3.3.1: Parents’/Guardians’ Provision of Information on Their Child’s Health and Behavior

The facility should ask parents/guardians for information regarding the child’s health, nutrition, level of physical activity, and behavioral status upon registration or when there has been an extended gap in the child’s attendance at the facility. The child’s health record should be updated if s/he have had any changes in their health or immunization status. Parents/guardians should be encouraged to sign a release of information/agreement so that child care workers can communicate directly with the child’s medical home/primary care provider.

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: It would be helpful to also have updated information about the health status of parents/guardians and siblings, noting any special conditions, circumstances, or stress that may be affecting the child in care. Some parents/guardians may resist providing this information. If so, the caregiver/teacher should invite them to view this exchange of information as an opportunity to express their own concerns about the facility (1).

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. Crowley, A. A., G. C. Whitney. 2005. Connecticut’s new comprehensive and universal early childhood health assessment form. J School Health 75:281-85.

STANDARD 2.3.3.2: Communication from Specialists

Health and safety, education, and other specialists/professionals who come into the facility to furnish special services to a child should communicate at each visit with the caregiver/teacher at the facility. The specialist/professional must also be certain that all communication shared with caregivers/teachers is shared directly with the parent/guardian. These specialists may include, but are not limited to, physicians, registered nurses, child care health consultants, behavioral consultants (e.g., psychologists, counselors, clinical social workers), occupational therapists, physical therapists, speech therapists, educational therapists, registered dietitians, and play facilitator. The discussions should be documented in the child’s Care Plan.

Specialists should use the facility’s sign in/sign out system for accurate tracking of their interactions with or on behalf of the child.

RATIONALE: Therapeutic services must be coordinated with the child’s general education program and with the parents/guardians and caregivers/teachers so everyone understands the child’s needs. To be most useful, the service providers must share the therapeutic techniques with the caregivers/teachers and parents/guardians and integrate them into the child’s daily routines, not just at therapy sessions. Parent/guardian consent to share information may be necessary. A child care health consultant can be helpful in coordinating these techniques and treatments.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

2.4 Health Education

2.4.1 Health Education for Children

STANDARD 2.4.1.1: Health and Safety Education Topics for Children

Health and safety education for children should include physical, oral, mental, emotional, nutritional, and social health and should be integrated daily into the program of activities, to include such topics as:

Body awareness and use of appropriate terms for body parts;
Families (including information that all families are different and have unique beliefs and cultural heritage);
Personal social skills such as sharing, being kind, helping others, and communicating appropriately;
Expression and identification of feelings;
Self-esteem;
Nutrition, healthy eating (preventing obesity);
Outdoor learning/play;
Fitness and age-appropriate physical activity;
Personal and dental hygiene including wiping, flushing, handwashing, cough and sneezing etiquette and toothbrushing;
Safety (such as home, vehicular car seats and safety belts, playground, bicycle, fire, and firearms, water safety, personal safety, what to do in an emergency, getting help and/or dialing 9-1-1 for emergencies);
Conflict management, violence prevention, and bullying prevention;
Age-appropriate first aid concepts;
Healthy and safe behaviors;
Poisoning prevention and poison safety;
Awareness of routine preventive and special health care needs;
Importance of rest and sleep;
Health risks of secondhand smoke;
Taking medications;
Handling food safely; and
Preventing choking and falls.

RATIONALE: For young children, health and safety education are inseparable from one another. 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; caregivers/teachers should integrate education to promote healthy and safe behaviors (1). Health and safety education does not have to be seen as a structured curriculum, but as a daily component of the planned program that is part of child development. Health and safety education supports and reinforces a healthy and safe lifestyle (1,2).

COMMENTS: Teaching children the appropriate names for their body parts is a good way to increase self esteem and personal safety. Learning about routine health maintenance practices such as receiving vaccines, having vision screening, blood pressure screening, oral health examinations, and blood tests helps children understand these activities and appreciate their value rather than fearing them. Similarly, learning about the importance of fitness choices helps children make responsible healthful decisions when facing abundant temptation to do otherwise.

Certified health education specialists (CHES) are good resources for this instruction. The American Association for Health Education (AAHE), the National Commission for Health Education Credentialing. (NCHEC), and the State and Territorial Injury Prevention Directors’ Association (STIPDA) provide information on this specialty.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. Gupta, R. S., S. Shuman, E. M. Taveras, M. Kulldorff, J. A. Finkelstein. 2005. Opportunities for health promotion education in child care. Pediatrics 116: e499-e505.

2. Hemmeter, M. L., L. Fox, S. Jack, L. Broyles. 2007. A program-wide model of positive behavior support in early childhood settings. J Early Intervention 29:337-55.

STANDARD 2.4.1.2: Staff Modeling of Healthy and Safe Behavior and Health and Safety Education Activities

The program should strongly encourage all staff members to model healthy and safe behaviors and attitudes in their contact with children in the indoor and outdoor learning/play environment, including, eating nutritious foods, drinking water or nutritious beverages when with the children, sitting with children during mealtime, and eating some of the same foods as the children. Caregivers/teachers should engage in daily movement and physical activity, limiting sedentary behaviors when in the outdoor learning/play environment (e.g., not sitting in structured chairs), not watching TV, and should comply with tobacco and drug use policies and handwashing protocols.

Caregivers/teachers should talk about and model healthy and safe behaviors while they carry out routine daily activities. Activities should be accompanied by words of encouragement and praise for achievement.

Facilities should encourage and support staff who wish to breastfeed their own infants and those who engage in gardening to enhance interest in healthy food, science, inquiries and learning. Staff are consistently a model for children and should be cognizant of the environmental information and print messages they bring into the indoor and outdoor learning/play environment. The labels and print messages that are present in the indoor and outdoor learning/play environment or family child care home should be in line with the healthy and safe behaviors and attitudes they wish to impart to the children.

Facilities should use developmentally appropriate health and safety education materials in the children’s activities and should also share these with the families whenever possible.

All health and safety education activities should be geared to the child’s developmental age and should take into account individual personalities and interests.

RATIONALE: Modeling is an effective way of confirming that a behavior is one to be imitated. Young children are particularly dependent on adults for their nutritional needs in both the home (1) and child care environment (2). Thus, modeling healthy and safe behaviors is an important way to demonstrate and reinforce healthy and safe behaviors of caregivers/teachers and children. Young children learn better through experiencing an activity and observing behavior than through didactic training (3,4). Learning and play have a reciprocal relationship; play experiences are closely related to learning (5).

Caregivers/teachers impact the nutrition habits of the children under their care, not only by making choices regarding the types of foods that are available but by influencing children’s attitudes and beliefs about that food as well as social interactions at mealtime. This provides a unique opportunity for programs to guide children’s choices by assigning parents/guardians and caregivers/teachers to the role of nutritional gatekeepers for the young children in their care. Such intervention is consistent with the USDA and U.S. Department of Health and Human Services (DHHS) recent release of 2010 Dietary Guidelines for Americans. The Dietary Guidelines focus on increased healthy eating and physical activity to reduce the current rate of overweight or obesity in American children (one in three in the nation) (6).

The effectiveness of health and safety education is enhanced when shared between the caregiver/teacher and the parents/guardians (7).

COMMENTS: Caregivers/teachers are important in the lives of the young children in their care. They should be educated and supported to be able to interact optimally with the children in their care. Compliance should be documented by observation. Consultation can be sought from a child care health consultant or certified health education specialist. The American Association for Health Education (AAHE) and the National Commission for Health Education Credentialing (NCHEC) provide information on this specialty.

An extensive education program to make such experiential learning possible indoors and outdoors should 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 (8). Examples include, but are not limited to, routine preventive care by health professionals, nutrition education and physical activity to prevent obesity, crossing streets safely, how to develop and use outdoor learning/play environments, car restraint safety, poison safety, latch key programs, health risks from secondhand smoke, personal hygiene, and oral health, including limiting sweets, rinsing the mouth with water after sweets, and regular tooth brushing. It can be helpful to place visual cues in the indoor and outdoor learning/play environments to serve as reminders (e.g., posters). “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 (9).

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. Lindsay, A. C., K. M. Sussner, J. Kim, S. Gortmaker. 2006. The role of parents in preventing childhood obesity. Future Child 16:169-86.

2. McBean, L. D., G. D. Miller. 1999. Enhancing the nutrition of America’s youth. J Am College of Nutrition 18:563-71.

3. Evaldsson, A., W. A. Corsaro. 1998. Play and games in the peer cultures of preschool and preadolescent children: An interpretative approach. Childhood 5:377-402.

4. Hemmeter, M. L., L. Fox, S. Jack, L. Broyles. 2007. A program-wide model of positive behavior support in early childhood settings. J Early Intervention 29:337-55.

5. Petersen, E. A. 1998. The amazing benefits of play. Child Fam 17:7-8.

6. U.S. Department of Agriculture, “USDA and HHS Announce New Dietary Guidelines to Help Americans Make Healthier Food Choices and Confront Obesity Epidemic,” press release June 2, 2011.

7. Holmes, M., et al. 1996. Promising partnerships: How to develop successful partnerships in your community. Alexandria, VA: National Head Start Association.

8. Gupta, R. S., S. Shuman, E. M. Taveras, M. Kulldorff, J. A. Finkelstein. 2005. Opportunities for health promotion education in child care. Pediatrics 116: e499-505.

9. Kendrick, D., L. Groom, J. Stewart, M. Watson, C. Mulvaney, R. Casterton. 2007. Risk Watch: Cluster randomized controlled trial evaluating an injury prevention program. Injury Prevention 13:93-99.

STANDARD 2.4.1.3: Gender and Body Awareness

The facility should prepare caregivers/teachers to appropriately discuss with the children anatomical facts related to gender identity and sex differences. When talking with parents/guardians, caregivers/teachers should take a general approach, while respecting cultural differences, acknowledging that all children engage in fantasy play, dressing up and trying out different roles (1). Caregivers/teachers should give children messages that contrast with stereotypes, such as men and women in non-traditional roles (2). Facilities should strive for developing common language and understanding among all the partners.

RATIONALE: Open discussions among adults concerning childhood sexuality increase their comfort with the subject. The adults’ comfort may reduce children’s anxiety about sexuality (3,4).

COMMENTS: Discussing sexuality and gender identity topics with young children is not always easy because the views of facility administrators, caregivers/teachers, parents/guardians, and community leaders on these topics may differ.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. Stein, M., K. Zuckert, S. Dixon. 2001. Sammy: Gender identity concerns in a six year old boy. Pediatrics 107:850-854.

2. National Association for the Education of Young Children (NAEYC). 1997. Teaching young children to resist bias. Early Years are Learning Years Series. Washington, DC: NAEYC.

3. Couchenour, D., K. Chrisman. 2002. Healthy sexuality development: A guide for early childhood educators and families. Washington, DC: National Association for the Education of Young Children.

4. Brill, S. A., R. Pepper. 2008. The transgender child: A handbook for families and professionals. San Francisco: Cleis.

2.4.2 Health Education for Staff

STANDARD 2.4.2.1: Health and Safety Education Topics for Staff

Health and safety education for staff should include physical, oral, mental, emotional, nutritional, physical activity, and social health of children. In addition to the health and safety topics for children in Standard 2.4.1.1, health education topics for staff should include:

Promoting healthy mind and brain development through child care;
Healthy indoor and outdoor learning/play environments;
Behavior/discipline;
Managing emergency situations;
Monitoring developmental abilities, including indicators of potential delays;
Nutrition (i.e., healthy eating to prevent obesity);
Food safety;
Water safety;
Safety/injury prevention;
Safe use, storage, and clean-up of chemicals;
Hearing, vision, and language problems;
Physical activity and outdoor play and learning;
Appropriate antibiotic use;
Immunizations;
Gaining access to community resources;
Maternal or parental/guardian depression;
Exclusion policies;
Tobacco use/smoking;
Safe sleep environments and SIDS prevention;
Breastfeeding support (1);
Environmental health and reducing exposures to environmental toxins;
Children with special needs;
Shaken baby syndrome and abusive head trauma;
Safe use, storage of firearms;
Safe medication administration.

RATIONALE: When child care staff are knowledgeable in health and safety practices, programs are more likely to be healthy and safe (2). Compliance with twenty hours per year of staff continuing education in the areas of health, safety, child development, and abuse identification was the most significant predictor for compliance with state child care health and safety regulations (3). Child care staff often receive their health and safety education from a child care health consultant. Data support the relationship between child care health consultation and the increased health and safety of a center (4,5).

COMMENTS: Community resources can provide written health- and safety-related materials. Consultation or training can be sought from a child care health consultant (CCHC) or certified health education specialist (CHES).

Child care programs should consider offering “credit” for health education classes or encourage staff members to attend accredited education programs that can give education credits.

The American Association for Health Education (AAHE), the National Commission for Health Education Credentialing (NCHEC), and the National Training Institute for Child Care Health Consultants (NTI) provide information on certified health education specialists.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. Gupta, R. S., S. Shuman, E. M. Taveras, M. Kulldorff, J. A. Finkelstein. 2005. Opportunities for health promotion education in child care. Pediatrics 116: e499-e505.

2. Alkon, A., J. Bernzweig, K. To, M. Wolff, J. F. Mackie. 2009. Child care health consultation improves health and safety policies and practices. Academic Pediatrics 9:366–70.

3. Crowley, A. A., M. S. Rosenthal. 2009. Ensuring the health and safety of Connecticut’s early care and education programs. Farmington, CT: The Child Health and Development Institute of Connecticut. http://www.chdi.org/admin/uploads/
3074013304b154ef428c1a.pdf.

4. Snohomish Health District: Child Care Health Program. Child care health consultation: Evidence based effectiveness. http://www
.napnap.org/docs/CCS_SIG_Evidence_ Based_ CCHP.pdf.

5. Rosenthal, M. S., A. A. Crowley, L. Curry. 2009. Promoting child development and behavioral health: Family child care providers’ perspectives. J Pediatric Health Care 23:289-97.

2.4.3 Health Education for Parents/Guardians

STANDARD 2.4.3.1: Opportunities for Communication and Modeling of Health and Safety Education for Parents/Guardians

Parents/guardians should be given opportunities to observe staff members modeling healthy and safe behavior and facilitating child development, both indoors and outdoors. Parents/guardians should also have opportunities to ask questions and to describe how effective the modeling has been. For parents/guardians who may not have the opportunity to visit their child or observe during the day, there should be alternate forms of communication between the staff and the parents/guardians. This can be handouts, written journals that would go between facility and home, newsletters, electronic communication, or events.

RATIONALE: Modeling and communication about healthy and safe behaviors that promote positive development can be an effective educational tool (1,2).

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. Lehman, G. R., E. S. Geller. 1990. Participative education for children: An effective approach to increase safety belt use. J Appl Behav Anal 23:219-25.

2. Lindsay, A. C., K. M. Sussner, J. Kim, S. Gortmaker. 2006. The role of parents in preventing childhood obesity. Future Child 16:169-86.

STANDARD 2.4.3.2: Parent/Guardian Education Plan

The content of a parent/guardian education plan should be individualized to meet each family’s needs and should be sensitive to cultural values and beliefs. Written material, at a minimum, should address the most important health and safety issues for all age groups served, should be in a language understood by families, and may include the topics listed in Standard 2.4.1.1, with special emphasis on the following:

Safety (such as home, community, playground, firearm, seat belts, safe medication administration procedures, poison awareness, vehicular, or bicycle, and awareness of environmental toxins and healthy choices to reduce exposure);
Value of developing healthy and safe lifestyle choices early in life and parental/guardian health (such as exercise and routine physical activity, nutrition, weight control, breastfeeding, avoidance of substance abuse and tobacco use, stress management, maternal depression, HIV/AIDS prevention);
Importance of outdoor play and learning;
Importance of role modeling;
Importance of well-child care (such as immunizations, hearing/vision screening, monitoring growth and development);
Child development and behavior including bonding and attachment;
Domestic and relational violence;
Conflict management and violence prevention;
Oral health promotion and disease prevention;
Effective toothbrushing, handwashing, diapering, and sanitation;
Positive discipline, effective communication, and behavior management;
Handling emergencies/first aid;
Child advocacy skills;
Special health care needs;
Information on how to access services such as the supplemental food and nutrition program (i.e., The Women, Infants and Children [WIC] Supplemental Food Program), Food Stamps (SNAP), food pantries, as well as access to medical/health care and services for developmental disabilities for children;
Handling loss, deployment, and divorce;
The importance of routines and traditions (including reading and early literacy) with a child.

Health and safety education for parents/guardians should utilize principles of adult learning to maximize the potential for parents/guardians to learn about key concepts. Facilities should utilize opportunities for learning, such as the case of an illness present in the facility, to inform parents/guardians about illness and prevention strategies.

The staff should introduce seasonal topics when they are relevant to the health and safety of parents/guardians 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/guardian attitudes, beliefs, fears, and educational and socioeconomic levels all should be given consideration in planning and conducting parent/guardian education (1,2). Parental/guardian behavior can be modified by education. Parents/guardians should be involved closely with the facility and be actively involved in planning parent/guardian education activities. If done well, adult learning activities can be effective for educating parents/guardians. If not done well, there is a danger of demeaning parents/guardians and making them feel less, rather than more, capable (1,2).

The concept of parent/guardian control and empowerment is key to successful parent/guardian education in the child care setting. Support and education for parents/guardians lead to better parenting skills and abilities.

Knowing the family will help the staff such as the health and safety advocate determine content of the parent/guardian education plan and method for delivery. Specific attention should be paid to the parents’/guardians’ need for support and consultation and help locating resources for their problems. If the facility suggests a referral or resource, this should be documented in the child’s record. Specifics of what the parent/guardian shared need not be recorded.

COMMENTS: Community resources can provide written health- and safety-related materials. School-age child care facilities may incorporate child health education into their programs as they can be integrated into their regular activities, (e.g., handwashing before snack, making healthful snack choices, pointing out why screen time limits are in place to promote physical activity, safe playground behaviors, and where possible, making an attempt to coordinate with formal health education enrollees receive in school).

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. Gonzalez-Mena, J. 1996. When values collide: Exploring a cross cultural issue. Child Care Infor Exch 108:30-32.

2. Hendricks, C., M. Russell, C. J. Smith. 1997. Staying healthy: Strategies for helping parents ensure their children’s health and well being. Child Fam 16:10-17.