Caring for Our Children (CFOC)

Chapter 1: Staffing

1.6 Consultants

1.6.0 Frequency of Child Care Health Consultation Visits

Content in the STANDARD was modified on 8/22/2013.

The child care health consultant (CCHC) should visit each facility as needed to review and give advice on the facility’s health component and review the overall health status of the children and staff (1-4). Early childhood programs that serve any child younger than three years of age should be visited at least once monthly by a health professional with general knowledge and skills in child health and safety and health consultation. Child care programs that serve children three to five years of age should be visited at least quarterly and programs serving school-age children should be visited at least twice annually. In all cases, the frequency of visits should meet the needs of the composite group of children and be based on the needs of the program for training, support, and monitoring of child health and safety needs, including (but not limited to) infectious disease, injury prevention, safe sleep, nutrition, oral health, physical activity and outdoor learning, emergency preparation, medication administration, and the care of children with special health care needs. Written documentation of CCHC visits should be maintained at the facility.
Almost everything that goes on in a facility and almost everything about the facility itself affects the health of the children, families, and staff. (1-4). Because infants are developing rapidly, environmental situations can quickly create harm. Their rapid changes in behavior make regular and frequent visits by the CCHC extremely important (2-4). More frequent visits should be arranged for those facilities that care for children with special health care needs and those programs that experience health and safety problems and high turnover rate to ensure that staff have adequate training and ongoing support (2). In one study, 84% of child care directors who were required to have weekly health consultation visits considered the visits critical for children’s health and program health and safety (2). Growing evidence suggests that frequent visits by a trained health consultant improves health policies and health and safety practices  and improves children’s immunization status, access to a medical home, enrollment in health insurance, timely screenings, and potentially reduces the prevalence of obesity with a targeted intervention (5-11). Furthermore, in one state, child care center medication administration regulatory compliance was associated with weekly visits by a trained nurse child care health consultant who delivered a standardized best practice curriculum (12).
State child care regulations display a wide range of frequency and recommendations in states that require CCHC visits (5,6,13), from as frequently as once a week for programs serving children under three years of age to twice a year for programs serving children three to five years of age (2,5,6,13).
Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home
RELATED STANDARDS Ratios for Facilities Serving Children with Special Health Care Needs and Disabilities Child Care Health Consultants Specialized Consultation for Facilities Serving Children with Disabilities Child Care Health Consultants for Facilities That Care for Children Who Are Ill Food Service Staff by Type of Facility and Food Service Nutritional Quality of Food Brought From Home Documentation of Child Care Health Consultation/Training Visits Support for Consultants to Provide Technical Assistance to Facilities Development of List of Providers of Services to Facilities
  1. Alkon, A., J. Bernzweig, K. To, J. K. Mackie, M. Wolff, J. Elman. 2008. Child care health consultation programs in California: Models, services, and facilitators. Public Health Nurs 25:126-39.
  2. Crowley, A. A. 2000. Child care health consultation: The Connecticut experience. Maternal Child Health J 4:67-75.
  3. Dellert, J. C., D. Gasalberti, K. Sternas, P. Lucarelli, J. Hall. 2006. Outcomes of child care health consultation services for child care providers in New Jersey: A pilot study. Pediatric Nursing 32:530-37.
  4. Gupta, R. S., S. Shuman, E. M. Taveras, M. Kulldorff, J. A. Finkelstein. 2005. Opportunities for health promotion education in child care. Pediatrics 116:499-505.
  5. Healthy Child Care Consultant Network Support Center, CHT Resource Group. 2006. The influence of child care health consultants in promoting children’s health and well-being: A report on selected resources.
  6. 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.
  7. Crowley, A. A. & Kulikowich, J. Impact of training on child care health consultant knowledge and practice. Pediatric Nursing.,2009, 35 (2): 93-100.
  8. Nurse Consultant Intervention Improves Nutrition and Physical Activity Knowledge, Policy, and Practice and Reduces Obesity in Child Care.  A. Crowley, A. Alkon, B Neelon, S. Hill, P. Yi, E. Savage, V. Ngyuen, J. Kotch. Head Start Research Conference, Washington, DC. June 20, 2012.
  9. Benjamin, S. E., A. Ammerman, J. Sommers, J. Dodds, B. Neelon, D. S. Ward. 2007. Nutrition and physical activity self-assessment for child care (NAP SACC): Results from a pilot intervention. Journal of Nutrition Education and Behavior 39(3):142-9.
  10. Bryant, D. “Quality Interventions for Early Care and Education.” Early Developments, Spring 2013,
  11. Isbell P, Kotch JB, Savage E, Gunn E, Lu LS, Weber DJ. Improvement of child care programs’ policies, practices, and children’s access to health care linked to child care health consultation. NHSA Dialog: A Research to Practice Journal 2013;16 (2):34-52 (ISSN:1930-1395).
  12. Crowley, A. A. & Rosenthal, M. S. IMPACT: Ensuring the health and safety of Connecticut’s early care and education programs. 2009. Farmington, CT: The Child Health and Development Institute of Connecticut.
  13. National Resource Center for Health and Safety in Child Care and Early Education. 2010. Child care health consultant requirements and profiles by state.

Content in the STANDARD was modified on 8/22/2013.