Chapter 3: Health Promotion and Protection
3.4 Health Protection in Child Care
126.96.36.199: Animals that Might Have Contact with Children and Adults
The following domestic animals may have contact with children and adults if they meet the criteria specified in this standard:
- Ungulate (e.g., cow, sheep, goat, pig, horse);
- Rodent (e.g., mice, rats, hamsters, gerbils, guinea pigs, chinchillas).
Fish are permissible but must be inaccessible to children.
Any animal present at the facility, indoors or outdoors, should be trained/adapted to be with young children, in good health, show no evidence of carrying any disease, fleas or ticks, be fully immunized, and be maintained on an intestinal parasite control program. A current (time-specified) certificate from each animal’s attending veterinarian should be on file in the facility, stating that all animals on the facility premises meet these conditions and meet local and state requirements.
Only animals that do not pose a health or safety risk will be allowed on the premises of the facility.
The caregiver/teacher should instruct children on the humane and safe procedures to follow when in close proximity to animals (for example, not to provoke or startle animals or touch them when they are near food).
All contact between animals and children should be supervised by a caregiver/teacher who is close enough to remove the child immediately if the animal shows signs of distress (e.g., growling, baring teeth, tail down, ears back) or the child shows signs of treating the animal inappropriately.
Children should not be allowed to feed animals directly from their hands.
No food and beverages should be allowed in animal areas. In addition, adults and children should not carry toys, use pacifiers, cups, and infant bottles in animal areas.
The animals should be housed within some “barrier” that protects them from competition by other animals while being fed which would also provide protection for the children yet they could still observe the animals eating. Animal food dishes should not be placed in areas accessible to children during hours when children are present.
Children should be discouraged from “kissing” animals or having them in close contact with their faces.
All children and caregivers/teachers who handle animals or animal-related equipment (e.g., leashes, dishes, toys, etc.) should be instructed to use hand hygiene immediately after handling.
Immunocompromised children, such as children with organ transplants, human immunodeficiency virus (HIV), acquired immunodeficiency syndrome (AIDS), or currently receiving cancer chemotherapy or radiation therapy, and/or children with allergies, should have an individualized health care plan in place that specifies if there are precautionary measures to be taken before the child has direct or indirect contact with animals or equipment.
Uncaged animals, such as dogs and cats, should wear a proper collar, harness, and/or leash when on the facility premises and the owner or responsible adult should stay with the animal at all times. Animals should not be permitted in food preparation or service areas at any time.
RATIONALEThe risk of injury, infection, and aggravation of allergy from contact between children and animals is significant. The staff must plan carefully when having an animal in the facility and when visiting a zoo or local pet store (5,9,10). Children should be brought into direct contact only with animals known to be friendly and comfortable in the company of children.
Dog bites to children under four years of age usually occur at home, and the most common injury sites are the head, face, and neck (1-4). Many human illnesses can be acquired from animals (5,7,8,11). Many allergic children have symptoms when they are around animals.
Special precautions may be needed to minimize the risk of disease transmission to immunocompromised children (13).
When animals are taken out of their natural environment and are in situations unusual to them, the stress that the animals experience may cause them to act aggressively or attempt to escape (the “flight or fight” phenomenon). Appropriate restraint devices will allow the holder to react quickly, prevent harm to children and/or the escape of the animal (9).
Pregnant women need to be aware of a potential risk associated with contact with cats’ feces (stool). Toxoplasmosis is an infection caused by a parasite called Toxoplasma gondii. This parasite is carried by cats and is passed in their feces. Toxoplasmosis can cause problems with pregnancy, including abortion (8). The CDC advises pregnant women to avoid pet rodents because of the risk of lymphocytic choriomeningitis virus (6,12).
COMMENTSBringing animals and children together has both risks and benefits. Animals teach children about how to be gentle and responsible, about life and death, and about unconditional love (9). Nevertheless, animals can pose serious health and safety risks.
Special accommodations for children with allergies may be necessary. Cleaning air filters more often if animals are in childcare areas may be helpful in reducing animal dander.
Some dogs complete training and are certified as part of “dog-assisted therapy programs.” Certification requires that dogs meet specific criteria, complete screening/training, and be a member of Therapy Dogs International for liability purposes. Although these programs are typically based in hospitals, certified therapy animals also help with disaster relief and other efforts. Facilities that want to offer educational information to staff or hands-on learning opportunities for children may find it helpful to contact their local hospital to identify a trainer for dog-assisted therapy programs. For more information on this program and resources, contact Therapy Dogs International at http://www.tdi-dog.org.
TYPE OF FACILITYCenter, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home
RELATED STANDARDS188.8.131.52 Situations that Require Hand Hygiene
184.108.40.206 Handwashing Procedure
220.127.116.11 Assisting Children with Hand Hygiene
18.104.22.168 Training and Monitoring for Hand Hygiene
22.214.171.124 Hand Sanitizers
126.96.36.199 Prohibited Animals
188.8.131.52 Care for Animals
- Gilchrist, J., J. J. Sacks, D. White, M. J. Kresnow. 2008. Dog bites: Still a problem? Injury Prevention 14:296-301.
- Reisner, I. R., F. S. Shofer. 2008. Effects of gender and parental status on knowledge and attitudes of dog owners regarding dog aggression toward children. J Am Vet Med Assoc 233:1412-19.
- Information from Your Family Doctor. 2004. Dog bites: Teaching your child to be safe. Am Family Physician 69:2653.
- Bernardo, L. M., M. J. Gardner, R. L. Rosenfield, B. Cohen, R. Pitetti. 2002. A comparison of dog bite injuries in younger and older children treated in a pediatric emergency department. Pediatric Emergency Care 18:247-49.
- National Association of State Public Health Veterinarians. 2007. Compendium of measures to prevent disease associated with animals in public settings. MMWR 56:1-13.
- U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. 2009. Appendix D: Guidelines for animals in school and child-care settings. MMWR 58:20-21.
- U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. 2000. Compendium of measures to control Chlamydia psittaci infection among humans (psittacosis) and pet birds (avian chlamydiosis). MMWR 49:3-17.
- U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. Pregnant women and Toxoplasmosis. http://www.cdc.gov/healthypets/pregnant.htm.
Hansen, G. R. 2004. Animals in Kansas schools: Guidelines for visiting and resident pets. Topeka, KS: Kansas Department of Health and Environment. http://www.kdheks.gov/pdf/hef/
Massachusetts Department of Public Health Division of Epidemiology and Immunization. 2001. Recommendations for petting zoos, petting farms, animal fairs, and other events and exhibits where contact between animals and people is permitted. http://www.mass.gov/Eeohhs2/docs/dph/cdc/rabies/reduce_zoos
- Pickering, L. K., N. Marano, J. A. Bocchini, F. J. Angulo. 2008. Exposure to nontraditional pets at home and to animals in public settings: risks to children. Pediatrics 122:876-86.
- Centers for Disease Control and Prevention. 2010. Lymphocytic choriomeningitis (LCMV). http://www.cdc.gov/ncidod/dvrd/spb/mnpages/dispages/lcmv.htm.
- Hemsworth, S., B. Pizer. 2006. Pet ownership in immunocompromised children – A review of the literature and survey of existing guidelines. Eur J Oncol Nurs 10:117-27.