Caring for Our Children (CFOC)

Chapter 9: Administration

9.2 Policies

9.2.1 Overview

9.2.1.1: Content of Policies

The facility should have policies to specify how the caregiver/teacher addresses the developmental functioning and individual or special health care needs of children of different ages and abilities who can be served by the facility, as well as other services and procedures. These policies should include, but not be limited to, the following:

Admissions criteria, enrollment procedures, and daily sign-in/sign-out policies, including authorized individuals for pick-up and allowing parent/guardian access whenever their child is in care;
Inclusion of children with special health care needs;
Nondiscrimination;
Payment of fees, deposits, and refunds;
Termination of enrollment and parent/guardian notification of termination;
Supervision;
Staffing, including caregivers/teachers, the use of volunteers, helpers, or substitute caregivers/teachers, and deployment of staff for different activities;
A written comprehensive and coordinated planned program based on a statement of principles;
Discipline;
Methods and schedules for conferences or other methods of communication between parents/guardians and staff;
Care of children and staff who are ill;
Temporary exclusion for children and staff who are ill and alternative care for children who are ill;
Health assessments and immunizations;
Handling urgent medical care or threatening incidents;
Medication administration;
Use of child care health consultants and education and mental health consultants;
Plan for health promotion and prevention (e.g., tracking routine child health care, health consultation, health education for children/staff/families, oral health, sun safety, safety surveillance, preventing obesity, etc.);
Disasters, emergency plan and drills, evacuation plan, and alternative shelter arrangements;
Security;
Confidentiality of records;
Transportation and field trips;
Physical activity (both outdoors and when children are kept indoors), play areas, screen time, and outdoor play policy;
Sleeping, safe sleep policy, areas used for sleeping/napping, sleep equipment, and bed linen;
Sanitation and hygiene;
Presence and care of any animals on the premises;
Food and nutrition including food handling, human milk, feeding and food brought from home, as well as a daily schedule of meals and snacks;
Evening and night care plan;
Smoking, tobacco use, alcohol, prohibited substances, and firearms;
Human resource management;
Staff health;
Maintenance of the facility and equipment;
Preventing and reporting child abuse and neglect;
Use of pesticides and other potentially toxic substances in or around the facility;
Review and revision of policies, plans, and procedures.

The facility should have specific strategies for implementing each policy. For centers, all of these items should be written. Facility policies should vary according to the ages and abilities of the children enrolled to accommodate individual or special health care needs. Program planning should precede, not follow the enrollment and care of children at different developmental levels and abilities and with different health care needs. Policies, plans, and procedures should generally be reviewed annually or when any changes are made. A child care health consultant can be very helpful in developing and implementing model policies.

RATIONALE

Neither plans nor policies affect quality unless the program has devised a way to implement the plan or policy. Children develop special health care needs and have developmental differences recognized while they are enrolled in child care (2). Effort should be made to facilitate accommodation as quickly as possible to minimize delay or interruption of care (1). For examples of policies see Model Child Care Health Policies at http://www.ecels-healthy
childcarepa.org/content/MHP4thEd Total.pdf and the California Childcare Health Program at http://www
.ucsfchildcarehealth.org. Nutrition and physical activity policies for child care developed by the NAP SACC Program, Center for Health Promotion and Disease Prevention, University of North Carolina are available at http://www
.center-trt.org.

COMMENTS

Reader’s note: Chapter 9 includes many standards containing additional information on specific policies noted above.

TYPE OF FACILITY

Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home

RELATED STANDARDS

1.8.2.1 Staff Familiarity with Facility Policies, Plans and Procedures

REFERENCES

Aronson, S. S., ed. 2002. Model child care health policies. 4th ed. Elk Grove Village, IL: American Academy of Pediatrics.
Child Care Law Center. 2009. Questions and answers about the Americans with Disabilities Act: A quick reference for child care providers. Updated Version. http://www.childcarelaw.org/docs/
ADA Q and A 2009 Final 3 09.pdf.

9.2.1.2: Review and Communication of Written Policies

All written policies should be reviewed and updated at least annually. The facility should provide copies of policies, which include pertinent plans and procedures, to all staff and parents/guardians at least annually, and two weeks before new policies or changes to existing policies go into effect. When a child enters a facility, when new policies are written, and when changes to existing policies have been made, parents/guardians should sign a statement that they have received a copy of the policy and read and/or understand the content of the policy.

Parents/guardians who are not able to read should have the policies presented orally to them. Parents/guardians who are not able to understand the policies because of a language barrier should have the policies presented to them in a language with which they are familiar (1).

RATIONALE

State of the art information changes. A yearly review encourages child care administrators to keep information and policies current. Current information on health and safety practices that is shared and developed cooperatively among caregivers/teachers and parents/guardians invites more participation and compliance with health and safety practices.

TYPE OF FACILITY

Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home

REFERENCES

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

9.2.1.3: Enrollment Information to Parents/Guardians and Caregivers/Teachers

At enrollment, and before assumption of supervision of children by caregivers/teachers at the facility, the facility should provide parents/guardians and caregivers/teachers with a statement of services, policies, and procedures, including, but not limited, to the following:

The licensed capacity, child:staff ratios, ages and number of children in care. If names of children and parents/guardians are made available, parental/guardian permission for any release to others should be obtained;
Services offered to children including a written daily activity plan, sleep positioning policies and arrangements, napping routines, guidance and discipline policies, diaper changing and toilet learning/training methods, child handwashing, medication administration policies, oral health, physical activity, health education, and willingness for special health or therapy services delivered at the program (special requirements for a child should be clearly defined in writing before enrollment);
Hours and days of operation;
Admissions criteria, enrollment procedures, and daily sign-in/sign-out policies, including authorized individuals for pick-up and allowing parent/guardian access whenever their child is in care;
Payment of fees, deposits, and refunds;
Methods and schedules for conferences or other methods of communication between parents/guardians and staff.

Policies on:

Staffing, including caregivers/teachers, the use of volunteers, helpers, or substitute caregivers/teachers, and deployment of staff for different activities;
Inclusion of children with special health care needs;
Nondiscrimination;
Termination and parent/guardian notification of termination;
Supervision;
Discipline;
Care of children and caregivers/teachers who are ill;
Temporary exclusion and alternative care for children who are ill;
Health assessments and immunizations;
Handling urgent medical care or threatening incidents;
Medication administration;
Use of child care health consultants, education and mental health consultants;
Plan for health promotion and prevention (tracking routine child health care, health consultation, health education for children/staff/families, oral health, sun safety, safety surveillance, etc.);
Disasters, emergency plan and drills, evacuation plan, and alternative shelter arrangements;
Security;
Confidentiality of records;
Transportation and field trips;
Physical activity (both outdoors and when children are kept indoors), play areas, screen time, and outdoor play policy;
Sleeping, safe sleep policy, areas used for sleeping/napping, sleep equipment, and bed linen;
Sanitation and hygiene;
Presence and care of any animals on the premises;
Food and nutrition including food handling, human milk, feeding and food brought from home, as well as a daily schedule of meals and snacks;
Evening and night care plan;
Smoking, tobacco use, alcohol, prohibited substances, and firearms;
Preventing and reporting child abuse and neglect;
Use of pesticides and other potentially toxic substances in or around the facility.

Parents/guardians and caregivers/teachers should sign that they have reviewed and accepted this statement of services, policies, and procedures. Policies, plans and procedures should generally be reviewed annually or when any changes are made.

RATIONALE

Model Child Care Health Policies, available at http://www.ecels-healthychildcarepa.org/content/MHP4thEd Total.pdf, has text to comply with many of the topics covered in this standard. Each policy has a place for the facility to fill in blanks to customize the policies for a specific site. The text of the policies can be edited to match individual program operations. Starting with a template such as the one in Model Child Care Health Policies can be helpful.

COMMENTS

For large and small family child care homes, a written statement of services, policies, and procedures is strongly recommended and should be added to the “Parent Handbook.” Conflict over policies can lead to termination of services and inconsistency in the child’s care arrangements. If the statement is provided orally, parents/guardians should sign a statement attesting to their acceptance of the statement of services, policies and procedures presented to them. Model Child Care Health Policies can be adapted to these smaller settings.

TYPE OF FACILITY

Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home

RELATED STANDARDS

1.1.1.1 Ratios for Small Family Child Care Homes
1.1.1.2 Ratios for Large Family Child Care Homes and Centers
1.1.1.3 Ratios for Facilities Serving Children with Special Health Care Needs and Disabilities
1.1.1.4 Ratios and Supervision During Transportation
1.1.1.5 Ratios and Supervision for Swimming, Wading, and Water Play
1.6.0.1 Child Care Health Consultants
2.1.1.1 Written Daily Activity Program and Statement of Principles
2.1.1.2 Health, Nutrition, Physical Activity, and Safety Awareness
2.1.1.3 Coordinated Child Care Health Program Model
2.1.1.4 Monitoring Children’s Development/Obtaining Consent for Screening
2.1.1.5 Helping Families Cope with Separation
2.1.1.6 Transitioning within Programs and Indoor and Outdoor Learning/Play Environments
2.1.1.7 Communication in Native Language Other Than English
2.1.1.8 Diversity in Enrollment and Curriculum
2.1.1.9 Verbal Interaction
2.1.2.1 Personal Caregiver/Teacher Relationships for Infants and Toddlers
2.1.2.2 Interactions with Infants and Toddlers
2.1.2.3 Space and Activity to Support Learning of Infants and Toddlers
2.1.2.4 Separation of Infants and Toddlers from Older Children
2.1.2.5 Toilet Learning/Training
2.1.3.1 Personal Caregiver/Teacher Relationships for Three- to Five-Year-Olds
2.1.3.2 Opportunities for Learning for Three- to Five-Year-Olds
2.1.3.3 Selection of Equipment for Three- to Five-Year-Olds
2.1.3.4 Expressive Activities for Three- to Five-Year-Olds
2.1.3.5 Fostering Cooperation of Three- to Five-Year-Olds
2.1.3.6 Fostering Language Development of Three- to Five-Year-Olds
2.1.3.7 Body Mastery for Three- to Five-Year-Olds
2.1.4.1 Supervised School-Age Activities
2.1.4.2 Space for School-Age Activity
2.1.4.3 Developing Relationships for School-Age Children
2.1.4.4 Planning Activities for School-Age Children
2.1.4.5 Community Outreach for School-Age Children
2.1.4.6 Communication Between Child Care and School
2.2.0.1 Methods of Supervision of Children
2.2.0.2 Limiting Infant/Toddler Time in Crib, High Chair, Car Seat, Etc.
2.2.0.3 Screen Time/Digital Media Use
2.2.0.4 Supervision Near Bodies of Water
2.2.0.5 Behavior Around a Pool
2.2.0.6 Discipline Measures
2.2.0.7 Handling Physical Aggression, Biting, and Hitting
2.2.0.8 Preventing Expulsions, Suspensions, and Other Limitations in Services
2.2.0.9 Prohibited Caregiver/Teacher Behaviors
2.2.0.10 Using Physical Restraint
2.4.1.2 Staff Modeling of Healthy and Safe Behavior and Health and Safety Education Activities
2.4.1.3 Gender and Body Awareness
2.4.2.1 Health and Safety Education Topics for Staff
2.4.3.1 Opportunities for Communication and Modeling of Health and Safety Education for Parents/Guardians
2.4.3.2 Parent/Guardian Education Plan
3.1.1.1 Conduct of Daily Health Check
3.1.1.2 Documentation of the Daily Health Check
3.1.2.1 Routine Health Supervision and Growth Monitoring
3.1.3.1 Active Opportunities for Physical Activity
3.1.3.2 Playing Outdoors
3.1.4.1 Safe Sleep Practices and Sudden Unexpected Infant Death (SUID)/SIDS Risk Reduction
3.1.5.1 Routine Oral Hygiene Activities
3.1.5.2 Toothbrushes and Toothpaste
3.1.5.3 Oral Health Education
3.2.1.1 Type of Diapers Worn
3.2.1.2 Handling Cloth Diapers
3.2.1.3 Checking For the Need to Change Diapers
3.2.1.4 Diaper Changing Procedure
3.2.1.5 Procedure for Changing Children’s Soiled Underwear, Disposable Training Pants and Clothing
3.2.2.1 Situations that Require Hand Hygiene
3.2.2.2 Handwashing Procedure
3.2.2.3 Assisting Children with Hand Hygiene
3.2.2.4 Training and Monitoring for Hand Hygiene
3.2.2.5 Hand Sanitizers
3.3.0.1 Routine Cleaning, Sanitizing, and Disinfecting
3.3.0.2 Cleaning and Sanitizing Toys
3.3.0.3 Cleaning and Sanitizing Objects Intended for the Mouth
3.3.0.4 Cleaning Individual Bedding
3.3.0.5 Cleaning Crib and Other Sleep Surfaces
3.4.1.1 Use of Tobacco, Electronic Cigarettes, Alcohol, and Drugs
3.4.2.1 Animals that Might Have Contact with Children and Adults
3.4.2.2 Prohibited Animals
3.4.2.3 Care for Animals
3.4.3.1 Medical Emergency Procedures
3.4.3.2 Use of Fire Extinguishers
3.4.3.3 Response to Fire and Burns
3.6.1.1 Inclusion/Exclusion/Dismissal of Ill Children
3.6.2.1 Exclusion and Alternative Care for Children Who Are Ill
3.6.2.2 Space Requirements for Care of Children Who Are Ill
3.6.2.3 Qualifications of Directors of Facilities That Care for Children Who Are Ill
3.6.2.4 Program Requirements for Facilities That Care for Children Who Are Ill
3.6.2.5 Caregiver/Teacher Qualifications for Facilities That Care for Children Who Are Ill
3.6.2.6 Child-Staff Ratios for Facilities That Care for Children Who Are Ill
3.6.2.7 Child Care Health Consultants for Facilities That Care for Children Who Are Ill
3.6.2.8 Licensing of Facilities That Care for Children Who Are Ill
3.6.2.9 Information Required for Children Who Are Ill
3.6.2.10 Inclusion and Exclusion of Children from Facilities That Serve Children Who Are Ill
3.6.3.1 Medication Administration
3.6.3.2 Labeling, Storage, and Disposal of Medications
3.6.3.3 Training of Caregivers/Teachers to Administer Medication
4.2.0.1 Written Nutrition Plan
4.2.0.2 Assessment and Planning of Nutrition for Individual Children
4.2.0.3 Use of US Department of Agriculture Child and Adult Care Food Program Guidelines
4.2.0.4 Categories of Foods
4.2.0.5 Meal and Snack Patterns
4.2.0.6 Availability of Drinking Water
4.2.0.7 100% Fruit Juice
4.2.0.8 Feeding Plans and Dietary Modifications
4.2.0.9 Written Menus and Introduction of New Foods
4.2.0.10 Care for Children with Food Allergies
4.2.0.11 Ingestion of Substances that Do Not Provide Nutrition
4.2.0.12 Vegetarian/Vegan Diets
4.3.1.1 General Plan for Feeding Infants
4.3.1.2 Responsive Feeding of Infants by a Consistent Caregiver/Teacher
4.3.1.3 Preparing, Feeding, and Storing Human Milk
4.3.1.4 Feeding Human Milk to Another Mother’s Child
4.3.1.5 Preparing, Feeding, and Storing Infant Formula
4.3.1.6 Use of Soy-Based Formula and Soy Milk
4.3.1.7 Feeding Cow’s Milk
4.3.1.8 Techniques for Bottle Feeding
4.3.1.9 Warming Bottles and Infant Foods
4.3.1.10 Cleaning and Sanitizing Equipment Used for Bottle Feeding
4.3.1.11 Introduction of Age-Appropriate Solid Foods to Infants
4.3.1.12 Feeding Age-Appropriate Solid Foods to Infants
4.3.2.1 Meal and Snack Patterns for Toddlers and Preschoolers
4.3.2.2 Serving Size for Toddlers and Preschoolers
4.3.2.3 Encouraging Self-Feeding by Older Infants and Toddlers
4.3.3.1 Meal and Snack Patterns for School-Age Children
4.6.0.1 Selection and Preparation of Food Brought From Home
4.6.0.2 Nutritional Quality of Food Brought From Home
6.4.2.2 Helmets
6.4.2.3 Bike Routes
6.5.1.1 Competence and Training of Transportation Staff
7.2.0.1 Immunization Documentation
7.2.0.2 Unimmunized/Underimmunized Children
7.2.0.3 Immunization of Staff
9.2.1.1 Content of Policies
9.2.3.2 Policy Development for Care of Children and Staff Who Are Ill
9.2.3.9 Written Policy on Use of Medications
9.2.3.11 Food and Nutrition Service Policies and Plans
9.2.3.12 Infant Feeding Policy
9.2.3.13 Plans for Evening and Nighttime Child Care
9.2.3.15 Policies Prohibiting Smoking, Tobacco, Alcohol, Illegal Drugs, and Toxic Substances
9.2.3.16 Policy Prohibiting Firearms
9.2.4.1 Written Plan and Training for Handling Urgent Medical or Threatening Incidents
9.2.4.2 Review of Written Plan for Urgent Care and Threatening Incidents
9.2.4.3 Disaster Planning, Training, and Communication
9.2.4.4 Written Plan for Seasonal and Pandemic Influenza
9.2.4.5 Emergency and Evacuation Drills Policy
9.2.4.6 Use of Daily Roster During Evacuation Drills
9.2.4.7 Sign-In/Sign-Out System
9.2.4.8 Authorized Persons to Pick Up Child
9.2.4.9 Policy on Actions to Be Followed When No Authorized Person Arrives to Pick Up a Child
9.2.4.10 Documentation of Drop-Off, Pick-Up, Daily Attendance of Child, and Parent/Provider Communication
9.4.1.3 Written Policy on Confidentiality of Records
9.4.2.3 Contents of Admission Agreement Between Child Care Program and Parent/Guardian

9.2.1.4: Exchange of Information Upon Enrollment

Arrangements for enrollment of children should be made in person by the parents/guardians. The facility should advise the parents/guardians of their responsibility to provide information to the facility regarding their children and inform them of the facility’s confidentiality guidelines.

RATIONALE

Parents/guardians should be fully informed about the facility’s services before delegating responsibility for care of the child. The facility and parents/guardians should exchange information necessary for the safety and health of the child.

TYPE OF FACILITY

Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home

9.2.1.5: Nondiscriminatory Policy

The facility’s written admission policy should be nondiscriminatory in regard to race, culture, sex, religion, national origin, ancestry, sexual preference, or disability. A copy of the policy and definitions of eligibility should be available for review on demand.

RATIONALE

Nondiscriminatory policies advocate for quality child care services for all children regardless of the child’s citizenship, residency status, financial resources, and language differences (1).

COMMENTS

Facilities should be able to accommodate all children except those whose needs require extreme modifications beyond the capability of the facility’s resources. Facilities should not have blanket policies against admitting children with disabilities. Instead, a facility should make an individual assessment of a child’s needs and the facility’s ability to meet those needs. Federal laws (e.g., Americans with Disabilities Act) do not permit discrimination based on disability. Inclusion of children with special health care needs and disabilities in all child care and early childhood educational programs is strongly encouraged.

TYPE OF FACILITY

Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home

REFERENCES

U.S. Department of Justice, Civil Rights Division, Disability Rights Section. 1997. Commonly asked questions about child care centers and the Americans with Disabilities Act. http://www.ada.gov/childq%26a.htm.

9.2.1.6: Written Discipline Policies

Each facility should have a written discipline policy reflective of the positive methods of guidance appropriate to the ages of the children enrolled outlined in Standard 2.2.0.6 and prohibited caregiver behaviors as outlined in Standard 2.2.0.9.

The facility should have policies for dealing with biting, hitting, and other undesired behavior by children and written protocol reflective guidance outlined in Standard 2.2.0.7.

Policies should explicitly prohibit corporal punishment, psychological abuse, humiliation, abusive language, binding or tying to restrict movement, restriction of access to large motor physical activities, and the withdrawal or forcing of food and other basic needs.

All caregivers/teachers should sign an agreement to implement the facility’s discipline policies. A policy explicitly stating the consequence for staff who do not follow the discipline policies should be reviewed and signed by each staff member prior to hiring.

RATIONALE

Caregivers/teachers are more likely to avoid abusive practices if they are well-informed about effective, non-abusive methods for managing children’s behaviors. Positive methods of discipline create a constructive and supportive social group and reduce incidents of aggression.

Corporal punishment may be physical abuse or may become abusive very easily. Research links corporal punishment with negative effects such as later criminal behavior and impairment of learning (1-3). Primary factors supporting the prohibition of certain methods of punishment include current child development theory and practice, legal aspects (namely that a caregiver/teacher is not acting in place of parents/guardians with regard to the child), and increasing liability suits. According to the NARA 2008 Child Care Licensing Study, forty-eight states prohibit corporal punishment in centers; forty-three of forty-four states that license small family child care homes prohibit corporal punishment and only one state does not prohibit corporal punishment in large family child care homes (4).

COMMENTS

Parents/guardians should be encouraged to utilize similar positive discipline methods at home in order to encourage these practices and to provide a more consistent discipline approach for the child.

TYPE OF FACILITY

Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home

RELATED STANDARDS

2.2.0.6 Discipline Measures
2.2.0.7 Handling Physical Aggression, Biting, and Hitting
2.2.0.8 Preventing Expulsions, Suspensions, and Other Limitations in Services
2.2.0.9 Prohibited Caregiver/Teacher Behaviors

REFERENCES

Paintal, S. 1999. Banning corporal punishment of children: A position paper. Child Educ 76:36-39.
American Academy of Pediatrics, Committee on School Health. 2006. Policy statement: Corporal punishment in the schools. Pediatrics 106:343.
Education Commission of the States. 1999. Collection of clearinghouse notes, 1998-1999. Denver, CO: ECS.

9.2.2 Transitions

9.2.2.1: Planning for Child’s Transition to New Services

If a parent/guardian requests assistance with the transition process from the facility to a public school or another program, the designated care or service coordinator at the facility should review the child’s records, including needs, learning style, supports, progress, and recommendations. The designated care or service coordinator should obtain written informed consent from the parent/guardian prior to sharing information at a transition meeting, in a written summary, or in some other verbal or written format.

The process for the child’s departure should also involve sharing and the exchange of progress reports with other care providers for the child and the parents/guardians of the child within the realm of confidentiality guidelines.

Any special health care need of the child and successful strategies that have been employed while at child care should be shared. For children who are receiving services under Part C of IDEA 2004, a transition plan is required, usually at least ninety days prior to the time that the child will leave the facility or program.

In the case of a child who may be eligible for preschool services, with approval of the family of the child, a conference should be convened among the lead agency, the family, and the local educational agency not less than ninety days (and at the discretion of all such parties, not more than nine months) before the child is eligible for the preschool services, to discuss any such services that the child may receive. In the case of a child who may not be eligible for such preschool services, with the approval of the family, reasonable efforts should be made to convene a conference among the lead agency, the family, and providers of other appropriate services, to discuss the appropriate services that the child may receive; to review the child’s program options; for the period from the child’s third birthday through the remainder of the school year; and to establish a transition plan, including as appropriate, steps to exit from the program. A plan also requires description of efforts to promote collaboration among Early Head Start programs under section 645A of the Head Start Act, early education and child care programs.

The facility should determine in what form and for how long archival records of transitioned children should be maintained by the facility.

RATIONALE

All children and their families will experience one or more program transitions during early childhood. One of the most common transitions is from preschool to kindergarten. Families in transition benefit when support and advocacy are available from a facility representative who is aware of their needs and of the community’s resources (1). This process is essential in planning the child’s departure or transition to another program. Information regarding successful behavior strategies, motivational strategies, and similar information may be helpful to staff in the setting to which the child is transitioning.

COMMENTS

Some families are capable of advocating effectively for themselves and their children; others require help negotiating the system outside of the facility. An interdisciplinary process is encouraged. Though coordinating and evaluating health and therapeutic services for children with special health care needs is primarily the responsibility of the school district or regional center, staff from the child care facility (one of many service providers) should participate, as staff members have had a unique opportunity to observe the child. In small and large family child care homes where an interdisciplinary team is not present, the caregivers/teachers should participate in the planning and preparation along with other care or treatment providers, with parent/guardian written consent.

It is important for all providers of care to coordinate their activities and referrals; otherwise the family may not be well informed. If records are shared electronically, providers should ensure that the records are encrypted for security and confidentiality.

TYPE OF FACILITY

Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home

RELATED STANDARDS

9.2.2.2 Format for the Transition Plan
9.4.1.3 Written Policy on Confidentiality of Records
9.4.1.4 Access to Facility Records
9.4.1.5 Availability of Records to Licensing Agency
9.4.1.6 Availability of Documents to Parents/Guardians

REFERENCES

Harbin, G., B. Rous, N. Peeler, J. Schuster, K. McCormick. 2007. Research brief: Desired family outcomes of the early childhood transition process. http://community.fpg.unc.edu/connect/

9.2.2.2: Format for the Transition Plan

Each service agency or primary care provider should have a format and timeline for the process of developing a transition plan for children with special health care needs to be followed when each child leaves the facility. The plan should include the following components:

Review and final preparation of the child’s records;
A child and family needs assessment;
Identification of potential child care, educational, or programmatic arrangements;
Summary of any special health care needs and successful strategies that were employed in child care.

RATIONALE

Many factors contribute to the success or failure of a transition. These concerns can be monitored effectively when a written plan is developed and followed to ensure that all steps in a transition are included and are undertaken in a timely, responsive manner (1).

COMMENTS

Though the child care provider can and should offer support in this process, child care is a free-market system where the parent/guardian is the consumer and decision-maker.

It is best if the process of planning begins at least nine months prior to the child turning three and an anticipated transition, since finding the proper facility for a child can be a complex and time consuming process in some communities. Each state is required to develop transition guidelines that implement the federal guidelines in respect to timelines, procedural due process expectations, and the required representation at the various meetings. Each agency can adapt the format to its own needs. However, consistent formats for planning and information exchange, requiring written parental/guardian consent, would be useful to both caregivers/teachers and families in both localities when children with special health care needs are involved. The use of outside consultants for small and large family child care homes is especially important in meeting this type of standard.

TYPE OF FACILITY

Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home

RELATED STANDARDS

9.2.2.1 Planning for Child’s Transition to New Services

REFERENCES

Harbin, G., B. Rous, N. Peeler, J. Schuster, K. McCormick. 2007. Research brief: Desired family outcomes of the early childhood transition process. http://community.fpg.unc.edu/connect/Desired-Family-Outcomes-of-the-Early-Childhood-Transition-Process-1.pdf.

9.2.2.3: Exchange of Information at Transitions

A written communication policy should be in place to describe needed communication between parents/guardians and caregivers/teachers during transitions that occur at times when children are being dropped off or picked up and other interactions with parents/guardians. When several staff shifts are involved, information about the child should be exchanged between caregivers/teachers assigned to each shift.

RATIONALE

Personal contact on a daily basis between the child care staff and parents/guardians is essential to ensure the transfer of information required to provide for the child’s needs. Information about the child’s experiences and health during the interval when an adult other than the parent/guardian is in charge should be provided to parents/guardians because they may need such information to understand the child’s later behavior.

COMMENTS

A sample of issues that should be communicated and exchanged include change in routine at home/program, change in child’s health status, recent problems sleeping/eating, or change in family routines or family health.

TYPE OF FACILITY

Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home

RELATED STANDARDS

2.3.1.1 Mutual Responsibility of Parents/Guardians and Staff
2.3.3.1 Parents’/Guardians’ Provision of Information on Their Child’s Health and Behavior

9.2.3 Health Policies

9.2.3.1: Policies and Practices that Promote Physical Activity

Content in the Standard was modified on 08/25/2016 and 05/30/2018.

The facility should have written policies for the promotion of indoor and outdoor physical activity and the removal of potential barriers to physical activity participation. Policies should cover the following areas:

a. Benefits: benefits of physical activity and outdoor play.

b. Duration: Children will spend 60 to 120 minutes each day outdoors depending on their age, weather permitting. Policies will describe what will be done to ensure physical activity

and provisions for gross motor activities indoors on days with more extreme conditions (ie, very wet, very hot, or very cold).

c. Type: Structured (caregiver/teacher-initiated) versus unstructured activity.

d. Setting: provision of covered areas for shade and shelter on playgrounds, if feasible (1).

e. Clothing: Clothing should protect children from sun exposure and permit easy movement (not too loose and not too tight) that enables full participation in active play; footwear

should provide support for running and climbing. Hats and sunglasses should be worn to protect children from sun exposure.

Examples of appropriate clothing/footwear include:

a. Gym shoes or sturdy gym shoe equivalent.

b. Clothes for the weather, including heavy coat, hat, and mittens in the winter/snow; raincoat and boots for the rain; and layered clothes for climates in which the temperature can

vary dramatically on a daily basis. Lightweight, breathable clothing, without any hood and neck strings, should be worn when temperatures are hot to protect children from sun

exposure.

Examples of inappropriate clothing/footwear include:

a. Footwear that can come off while running or that provides insufficient support for climbing (2)

b. Clothing that can catch on playground equipment (eg, those with drawstrings or loops)

If children wear “dress clothes” or special outfits that cannot be easily laundered, caregivers/teachers should talk with the children’s parents/guardians about the program’s goals in providing physical activity during the program day and encourage them to provide a set of clothes that can be used during physical activities.

Facilities should discuss the importance of this policy with parents/guardians on enrollment and periodically thereafter.

RATIONALE

If appropriately dressed, children can safely play outdoors in most weather conditions. Children can learn math, science, and language concepts through games involving movement (3,4).

Having a policy on outdoor physical activity that will take place on days when there are adverse weather conditions informs all caregivers/teachers and families about the facility’s expectations. The policy can make clear that outdoor activity may require special clothing in colder weather or arrangements for cooling off when it is warm. By having such a policy, the facility encourages caregivers/teachers and families to anticipate and prepare for outdoor activity when cold, hot, or wet weather prevails.

The inappropriate dress of a child is often a barrier in reaching recommended amounts of physical activity in child care centers. Sometimes, children cannot participate in physical activity because of their inappropriate clothes. Caregivers/teachers can be helpful by having extra clean clothing on hand (5). Children can play in the rain and snow and in low temperatures when wearing clothing that keeps them dry and warm. When it is very warm, children can play outdoors, if they play in shady areas, and wear sunscreen, sun-protective clothing, and insect repellent, if necessary (6). Caregivers/teachers should have water available for children to mist, sprinkle, and drink while in warmer weather.

COMMENTS

For assistance in creating and writing physical activity policies, Nemours provides several resources and best practice advice on program implementation. Information is available at https://www.nemours.org/service/health/growuphealthy/activity/educators.html.

TYPE OF FACILITY

Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home

RELATED STANDARDS

3.1.3.1 Active Opportunities for Physical Activity
3.1.3.2 Playing Outdoors
3.1.3.4 Caregivers’/Teachers’ Encouragement of Physical Activity
3.4.5.1 Sun Safety Including Sunscreen
3.4.5.2 Insect Repellent and Protection from Vector-Borne Diseases
3.4.6.1 Strangulation Hazards
5.3.1.1 Indoor and Outdoor Equipment, Materials, and Furnishing
6.1.0.2 Size and Requirements of Indoor Play Area
9.2.6.1 Policy on Use and Maintenance of Play Areas
Appendix S: Physical Activity: How Much Is Needed?

REFERENCES

Weinberger N, Butler, AG, Schumacher P. Looking inside and out: perceptions of physical activity in childcare spaces. Early Child Development and Care. 2014;184(2):194-210
Tandon PS, Walters KM, Igoe BM, Payne EC, Johnson DB. Physical activity practices, policies and environments in Washington state child care settings: results of a statewide survey. Matern Child Health J. 2017;21(3):571–582
Bento G, Dias G. The importance of outdoor play for young children’s healthy development. Porto Biomed J. 2017;2(5):157–160. http://dx.doi.org/10.1016/j.pbj.2017.03.003. Accessed January 11, 2018
Jayasuriya A, Williams M, Edwards T, Tandon P. Parents’ perceptions of preschool activities: exploring outdoor play. Early Educ Dev. 2016;27(7):1004–1017
Henderson KE, Grode GM, O’Connell ML, Schwartz MB. Environmental factors associated with physical activity in childcare centers. Int J Behav Nutr Phys Act. 2015;12:43
American Academy of Pediatrics. Choosing an insect repellent for your child. HealthyChildren.org Web site. https://www.healthychildren.org/English/safety-prevention/at-play/Pages/Insect-Repellents.aspx. Updated March 1, 2017. Accessed January 11, 2018

NOTES

Content in the Standard was modified on 08/25/2016 and 05/30/2018.

9.2.3.2: Policy Development for Care of Children and Staff Who Are Ill

Content in the STANDARD was modified on 02/25/2022.

All early care and education programs should develop written policies for the management and care of children and staff who are ill. It is important to meet the needs of the individual who is ill while also protecting the health and well-being of others in the program. The policy should be developed in consultation with the program’s child care health consultant and should include:

Procedures for obtaining urgent and/or emergency healthcare
Seasonal and pandemic infectious disease procedures
Procedures for obtaining and maintaining updated individual care plans for children with special health care needs
Inclusion/exclusion and re-entry policies for children and staff
A description of common childhood illnesses, their management, illness-related precautions, and information to protect the health of other children and staff
Medication administration procedures
Circumstances and procedures for separating ill children while awaiting family/guardian pickup (taking into account the physical facility and availability of staff to monitor ill children)
Procedures for reaching the child’s emergency contact(s) when a child becomes ill
Procedures for documenting illnesses in the program including name of person(s) affected, date and time of illness, description of symptoms, the response of the staff person to these symptoms, and who was notified (such as a family/guardian, health care professional, or health department) and the response

RATIONALE

Early care and education programs should develop policies and procedures because children and staff can become ill frequently and at unpredictable times. Children and staff come into close and frequent contact with one another in group settings, increasing the risk for spreading infectious diseases.¹ Additionally, staff may have known health conditions (e.g., pregnancy, immunocompromised) that may make them more vulnerable to common childhood illnesses. Documenting the occurrence of illness in a program, and the response, can help identify outbreaks of infectious disease in the program and larger community.

COMMENTS

It is important to develop policies and procedures in consultation with a child care health consultant who is knowledgeable in appropriate response and reporting for common childhood illnesses. A model policy can be found in the current edition of Managing Infectious Diseases in Child Care and Schools, a publication of the American Academy of Pediatrics (AAP). This publication includes handouts and resources for families/guardians and staff about managing infectious diseases in early care and education programs. Other model policies can be found in Model Child Care Health Policies.²For more resources, contact your state or local health department.

TYPE OF FACILITY

Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home

RELATED STANDARDS

1.6.0.1 Child Care Health Consultants
3.2.3.4 Prevention of Exposure to Blood and Body Fluids
3.4.3.1 Medical Emergency Procedures
3.4.3.3 Response to Fire and Burns
3.6.1.1 Inclusion/Exclusion/Dismissal of Ill Children
3.6.1.2 Staff Exclusion for Illness
3.6.3.1 Medication Administration
3.6.3.2 Labeling, Storage, and Disposal of Medications
3.6.3.3 Training of Caregivers/Teachers to Administer Medication
3.6.4.1 Procedure for Parent/Guardian Notification About Exposure of Children to Infectious Disease
3.6.4.2 Infectious Diseases That Require Parent/Guardian Notification
3.6.4.4 List of Excludable and Reportable Conditions for Parents/Guardians
5.6.0.1 First Aid and Emergency Supplies
7.2.0.3 Immunization of Staff
9.2.3.9 Written Policy on Use of Medications
9.2.4.3 Disaster Planning, Training, and Communication
9.2.4.4 Written Plan for Seasonal and Pandemic Influenza
9.4.2.1 Contents of Child’s Records
9.4.2.6 Contents of Medication Record
Appendix F: Enrollment/Attendance/Symptom Record
Appendix AA: Medication Administration Packet

REFERENCES

American Academy of Pediatrics. Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide. Aronson SS, Shope TR, eds. 5th ed. Itasca, IL: American Academy of Pediatrics; 2020
Pennsylvania chapter of the American Academy of Pediatrics. Model Child Care Health Polices. Aronson SS, ed. 5th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2014.

NOTES

Content in the STANDARD was modified on 02/25/2022.

9.2.3.3: Written Policy for Reporting Notifiable Diseases to the Health Department

The facility should have a written policy that complies with the state’s reporting requirements for children who are ill. All notifiable diseases should be reported to the health department. The facility should have the telephone number of the responsible health authority to whom confirmed or suspected cases of these diseases, or outbreaks of other infectious diseases, should be reported, and should designate a staff member as responsible for reporting the disease.

RATIONALE

Reporting to the health department provides the department with knowledge of illnesses within the community and ability to offer preventive measures to children and families exposed to the outbreak of a disease. In some states, caregivers/teachers may not be a mandatory reporter. In those states, caregivers/teachers are encouraged to report any infectious disease to the responsible health authority.

TYPE OF FACILITY

Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home

9.2.3.4: Written Policy for Obtaining Preventive Health Service Information

Each facility should develop and follow a written policy for obtaining necessary medical information including immunizations (see Appendix G: Recommended Childhood Immunization Schedule) and periodic preventive health assessments (see Appendix I: Recommendations for Preventive Pediatric Health Care) as recommended by the American Academy of Pediatrics (AAP) in Bright Futures Guidelines for Health Supervision of Infants, Children, and Adolescents (1-3). Facility staff should encourage parents/guardians to schedule these preventive health services in a timely fashion.

Documentation of an age-appropriate health assessment that includes current immunizations and health screenings should be filed in the child’s record at the facility. Immunization records should be provided at the time of enrollment. The health assessment should be provided within two weeks of admission or indication that an appointment has been made with the health care provider. Updates of the health record should be maintained according to the American Academy of Pediatrics’ (AAP’s) periodicity schedule, Appendix I: Recommendations for Preventive Pediatric Health Care. Health record information should be reviewed by the staff of the facility and information sharing between the staff, the parents/guardians, and the child’s health care professional should be encouraged and facilitated in order to provide better care for the child in the child care setting.

Centers should have written procedures for the verification of compliance with recommended immunizations and periodic health assessments of children. Centers should maintain confidential records of immunizations, periodic health assessments, including Body Mass Index (BMI) for children age two and older, and any special health considerations.

RATIONALE

Health assessments are important to ensure prevention, early detection of remediable problems, and planning for adaptations needed so that all children can reach their potential. When age-appropriate health assessments and use of health insurance benefits are promoted by caregivers/teachers, children enrolled in child care will have increased access to immunizations and other preventive services (4). With the expansion of eligibility for medical assistance and the federal subsidy of state child health insurance plans (SCHIP), the numbers of children who lack insurance for routine preventive health care should lessen.

Requiring facilities to maintain a current health record encourages and supports discussion of a child’s health needs between parents/guardians, caregivers/teachers, and the child’s primary care provider. It also encourages parents/guardians to seek preventive and primary care services in a timely fashion for their child.

The facility should have accurate, current information regarding the medical status and treatment of each child so it will be able to determine and adjust its capability to provide needed services. This documentation should consist of more than a statement from the child’s primary care provider that the child is up-to-date. Because of the administrative burden posed by requests to fill out forms, unless the specifics of services rendered are requested, the information may not reflect the child’s actual receipt of services according to the nationally recommended schedule. Instead, it may only represent that the child has a current health record in the primary care provider’s office. Until tracking systems become more widespread and effective in health care settings, a joint effort by the education system, family and primary care provider is required to ensure that children receive the preventive health services that ensure they are healthy and ready to learn.

COMMENTS

Assistance for caregivers/teachers and low income parents/guardians can be obtained through the Medicaid Early Periodic Screening and Diagnostic Treatment (EPSDT) program (Title XIX) and the state’s version of the federal Child Health Insurance Program (SCHIP) (5).

Most states require that caregivers/teachers document that the child’s health records are up-to-date to protect the child and other children whom the unimmunized child would expose to increased risk of vaccine-preventable disease. State regulations regarding immunization requirements for children may differ, but the child care facility should strive to comply with the national, annually published, “Recommended Childhood Immunization Schedule,” available at http://www.cispimmunize.org from the AAP, Centers for Disease Control and Prevention (CDC), and the American Academy of Family Physicians (AAFP).

A child’s entrance into the facility need not be delayed if an appointment for health supervision is scheduled. Often appointments for well-child care must be scheduled several weeks in advance. In such cases, the child care facility should obtain a health history report from the parents/guardians and documentation of an appointment for routine health supervision, as a minimum requirement for the child to attend the facility on a routine basis. The child should receive immunizations on admission or provide evidence of an immunization plan to prevent an increased exposure to vaccine-preventable diseases.

Local public health staff (such as the staff of immunization units, EPSDT programs) should provide assistance to caregivers/teachers in the form of record-keeping materials, educational materials, and on-site visits for education and help with surveillance activities. A copy of a form to use for documentation of routine health supervision services is available from Model Child Care Health Policies at http://www.ecelshealthychildcarepa.org/content/MHP4thEd Total.pdf.

TYPE OF FACILITY

Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home

RELATED STANDARDS

2.1.1.4 Monitoring Children’s Development/Obtaining Consent for Screening
9.4.1.3 Written Policy on Confidentiality of Records
Appendix I: Recommendations for Preventive Pediatric Health Care
Appendix FF: Child Health Assessment

REFERENCES

American Academy of Pediatrics. 2008. Recommendations for preventive pediatric health care. http://practice.aap.org/content
.aspx?aid=1599&nodeID=4000.
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.
Haskins, R., J. Kotch. 1986. Day care and illness: Evidence, costs, and public policy. Pediatrics 77:951-82.
U.S. Department of Health and Human Services, Centers for Medicare and Medicaid. Children’s health insurance program. http://www.cms.hhs.gov/home/chip.asp.
American Academy of Pediatrics. Recomended childhood immunization schedules. http://www2.aap.org/immunization/izschedule.html.

9.2.3.5: Documentation of Exemptions and Exclusion of Children Who Lack Immunizations

For children who have been exempted from required, up-to-date immunizations, these exemptions should be documented in the child’s health record as a cross reference, (acceptable documentation includes a statement from the child’s primary provider, a legal exemption with notarization, waiver, or other state-specific required documentation signed by the parent/guardian). See Standard 7.2.0.2 for more information.

Within two weeks of enrollment the parent/guardian should provide documentation to the child care program regarding progress in obtaining immunizations. The parent/guardian should receive written notice of exclusion if noncompliance or lack of progress is evident. If more than one immunization is needed in a series, time should be allowed for the immunizations to be obtained at the appropriate intervals. Exemptions from the requirement related to compliance with the federal McKinney-Vento Homeless Assistance Act for children experiencing homelessness are documented and include a plan for obtaining available documents within a reasonable period of time.

RATIONALE

National surveys document that child care has a positive influence on protection from vaccine-preventable illness (1). Immunizations should be required for all children in child care and early education settings. Facilities must consider the consequences if they accept responsibility for exposing a child who cannot be fully immunized (because of immaturity) to an unimmunized child who may bring disease to the facility. Although up to two weeks after the child starts to participate in child care may be allowed for the acquisition of immunizations for which the child is eligible, parents/guardians should maintain their child’s immunization status according to the nationally recommended schedule to avoid potential exposure of other children in the facility to vaccine-preventable disease.

COMMENTS

An updated immunization schedule is published annually near the beginning of the calendar year in the AAP’s Pediatrics journal and in the CDC’s MMWR and should be consulted for current information. In addition to print versions of the recommended childhood immunization schedule, the “Recommended Immunization Schedules for Persons Aged 0 through 18 Years – United States” is posted on the Websites of the CDC at http://www.cdc.gov/vaccines/schedules/index.html and the AAP at https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/immunization/Pages/Immunization-Schedule.aspx.

When a child who has a medical exemption from immunization is included in child care, reasonable accommodation of that child requires planning to exclude such a child in the event of an outbreak. Caregivers/teachers should check the Website http://www.immunize.org/laws/ for specific state-mandated immunization requirements and exemptions.

TYPE OF FACILITY

Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home

RELATED STANDARDS

7.2.0.2 Unimmunized/Underimmunized Children

REFERENCES

Aronson, S. S. 1986. Maintaining health in child care settings. In Group care for young children, ed. N. Gunzenhauser, B. M. Caldwell. New Brunswick, NJ: Johnson and Johnson Baby Products Company.

9.2.3.6: Identification of Child’s Medical Home and Parental Consent for Information Exchange

As part of the enrollment of a child, the caregiver/teacher should ask the family to identify the child’s primary care provider, his or her medical home, and other specialty health care professionals. The parent/guardian should provide written consent to enable the caregiver/teacher to establish communication with those providers. The family should always be informed prior to the use of the permission unless it is an emergency. The providers with whom the facility should exchange information (with parental consent) should include:

Sources of regular medical and dental care (such as the child’s primary care provider, dentist, and medical facility);
Special clinics the child may attend, including sessions with medical specialists and registered dietitians;
Special therapists for the child (e.g., occupational, physical, speech, and nutritional), along with written documentation of the services rendered provided by the special therapist;
Counselors, therapists, or mental health service providers for parents/guardians (e.g., social workers, psychologists, or psychiatrists);
Pharmacists for children who take prescription medication on a regular basis or have emergency medications for specific conditions.

RATIONALE

Primary care providers are involved not only in the medical care of the child but also involved in supporting the child’s emotional and developmental needs (1-3). A major barrier to productive working relationships between child care and health care professionals is inadequate communication (1,2).

Knowing who is treating the child and coordinating services with these sources of service is vital to the ability of the caregivers/teachers to offer appropriate care to the child. Every child should have a medical home and those with special health care needs may have additional specialists and therapists (4-7). The primary care provider and needed specialists will create the Care Plan which will be the blueprint for healthy and safe inclusion into child care for the child with special health care needs.

COMMENTS

A source of health care may be a community or specialty clinic, a public health department, specialist, or a private primary care provider. Families should also know the location of the hospital emergency room departments nearest to their home and child care facility.

The California Childcare Health Program has developed a form to help facilitate the exchange of information between the health professionals and the parents/guardians and caregivers/teachers at http://ucsfchildcarehealth.org/pdfs/forms/CForm_ExchangeofInfo.pdf. They also release an information form at http://ucsfchildcarehealth.org/pdfs/forms/CF_ReferralRel.pdf. For more information on the medical home concept, see the American Academy of Pediatrics’ (AAP) Medical Home Website at http://www.medicalhome
info.org.

TYPE OF FACILITY

Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home

RELATED STANDARDS

2.3.3.1 Parents’/Guardians’ Provision of Information on Their Child’s Health and Behavior
3.5.0.1 Care Plan for Children with Special Health Care Needs
9.4.1.3 Written Policy on Confidentiality of Records
9.4.1.4 Access to Facility Records
9.4.1.5 Availability of Records to Licensing Agency
9.4.1.6 Availability of Documents to Parents/Guardians
Appendix AA: Medication Administration Packet
Appendix FF: Child Health Assessment
Appendix O: Care Plan for Children with Special Health Care Needs

REFERENCES

American Academy of Pediatrics (AAP). 2001. The pediatrician’s role in promoting health and safety in child care. Elk Grove Village, IL: AAP.
Murph, J. R., S. D. Palmer, D. Glassy, eds. 2005. Health in child care: A manual for health professionals. 4th ed. Elk Grove Village, IL: American Academy of Pediatrics.
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.
Starfield, B., L. Shi. 2004. The medical home, access to care, and insurance: A review of evidence. Pediatrics 113:1493-98.
Homer, C. J., K. Klatka, D. Romm, K. Kuhlthau, S. Bloom, P. Newacheck, J. Van Cleave, J. M. Perrin. 2008. A review of the evidence for the medical home for children with special health care needs. Pediatrics 122:e922–37.
Inkelas, M., M. Regolado, N. Halfon. 2005. Stategies for integrating developmental services and promoting medical homes. Los Angeles: National Center for Infant and Early Childhood Health Policy.
Nowak, A. J., P. S. Casamassimo. 2002. The dental home: A primary care concept. JADA 133:93-98.

9.2.3.7: Information Sharing on Therapies and Treatments Needed

The person at the child care facility who is responsible for planning care for the child with special therapies or treatments should obtain an individualized care plan, developed by the child’s primary care provider or specialist on allergies, medications, therapies, and treatments being provided to the child that are directly relevant to the health and safety of the child in the child care facility. The written consent of the child’s parents/guardians and, where appropriate, the child’s primary care provider should be obtained before this confidential information is sought from outside sources. Therapies and treatments need to meet the criteria for evidenced based practices.

RATIONALE

The facility must have accurate, current information regarding the health status and treatment of the child so it will be able to determine the facility’s capability to provide needed services or to obtain them elsewhere.

Medicines can be crucial to the health and wellness of children. They can also be very dangerous if the wrong type or wrong amount is given to the wrong person or at the wrong time.

Parents/guardians should always be notified in every instance when medication is used. Telephone instructions from a primary care provider are acceptable if the caregiver/teacher fully documents them and if the parent/guardian initiates the request for primary care provider or child care health consultant instruction. In the event medication for a child becomes necessary during the day or in the event of an emergency, administration instructions from a parent/guardian and the child’s primary care provider are required before a caregiver/teacher may administer medication.

TYPE OF FACILITY

Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home

RELATED STANDARDS

3.5.0.1 Care Plan for Children with Special Health Care Needs
3.6.3.1 Medication Administration
9.4.1.3 Written Policy on Confidentiality of Records
9.4.1.4 Access to Facility Records
9.4.1.5 Availability of Records to Licensing Agency
9.4.1.6 Availability of Documents to Parents/Guardians
Appendix AA: Medication Administration Packet
Appendix O: Care Plan for Children with Special Health Care Needs

9.2.3.8: Information Sharing on Family Health

Families should be asked to share information about family health (such as chronic diseases) that might affect the child’s health. Families should be guaranteed that all information will be kept confidential.

RATIONALE

A family history of chronic disease helps caregivers/teachers understand family stress and experiences of the child within the family.

COMMENTS

Information on family health can be gathered by asking parents/guardians to tell the caregiver/teacher about any chronic health problems that the child’s parents/guardians, siblings, or household members have that might affect the child’s health. This information could also be obtained from the child’s primary care provider with permission from the parent/guardian.

TYPE OF FACILITY

Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home

9.2.3.9: Written Policy on Use of Medications

The facility should have a written policy for the administration of any prescription or non-prescription (over-the-counter [OTC]) medication. The policy should address at least the following:

The use of written parental/guardian consent forms for each prescription and OTC medication to be administered at the child care facility. The consent form should include:
1. The child’s name;
2. The name of the medication;
3. The date(s) and times the medication is to be given;
4. The dose or amount of medication to be given;
5. How the medication is to be administered;
6. The period of time the consent form is valid, which may not exceed the length of time the medication is prescribed for, the expiration date of the medication or one year, whichever is less.
The use of the prescribing health professional’s authorization forms for each prescription and OTC medication to be administered at the child care facility.
The circumstances under which the facility will agree to administer medication. This may include the administration of:
1. Topical medications such as non-medicated diaper creams, insect repellants, and sun screens;
2. OTC medicines for fever including acetaminophen and ibuprofen;
3. Long-term medications that are administered daily for children with chronic health conditions that are managed with medications;
4. Controlled substances, such as psychotropic medications;
5. Emergency medications for children with health conditions that may become life-threatening such as asthma, diabetes, and severe allergies;
6. One-time medications to prevent conditions such as febrile seizures.
The circumstances under which the facility will not administer medication. This should include:
1. No authorization from parent/guardian and/or prescribing health professional;
2. Prohibition of administering OTC cough and cold medication;
3. Not administering a new medication for the first time to a child while he or she is in child care;
4. If the instructions are unclear or the supplies needed to measure doses or administer the medication are not available or not in good working condition;
5. The medication has expired;
6. If a staff person or his/her backup who has been trained to give that particular medication is not present (in the case of training for medications that require specific skills to administer properly, such as inhalers, injections, or feeding tubes/ports).
The process of accepting medication from parents/guardians. This should include:
1. Verifying the consent form;
2. Verifying the medication matches what is on the consent form;
3. Accepting authorization for prescription medications from the child’s prescribing health professional only if the medications are in their original container and have the child’s name, the name of the medication, the dose and directions for giving the medication, the expiration date of the medication, and a list of warnings and possible side effects;
4. Accepting authorization for OTC medications from the child’s prescribing health professional only if the authorization indicates the purpose of the medication and time intervals of administration, and if the medications are in their original container and include the child’s name, the name of the medication, dose and directions for use, an expiration date for the medication, and a list of warnings and possible side effects;
5. Verifying that a valid Care Plan accompanies all long-term medications (i.e., medications that are to be given routinely or available routinely for chronic conditions such as asthma, allergies, and seizures);
6. Verifying any special storage requirements and any precautions to take while the child is on the prescription or OTC medication.
The proper handling and storage of medications, including:
1. Emergency medications – totally inaccessible to children but readily available to supervising caregivers/teachers trained to give them;
2. Medications that require refrigeration;
3. Controlled substances;
4. Expired medications;
5. A policy to insure confidentiality;
6. Storing and preparing distribution in a quiet area completely out of access to children;
7. Keeping all medication at all times totally inaccessible to children (e.g., locked storage);
8. Whether to require even short-term medications be kept at the facility overnight.
The procedures to follow when administering medications. These should include:
1. Assigning administration only to an adequately trained, designated staff;
2. Checking the written consent form;
3. Adhering to the “six rights” of safe medication administration (child, medication, time/date, dose, route, and documentation) (1);
4. Documenting and reporting any medication errors;
5. Documenting and reporting and adverse effects of the medication;
6. Documenting and reporting whether the child vomited or spit up the medication.
The procedures to follow when returning medication to the family, including:
1. An accurate account of controlled substances being administered and the amount being returned to the family;
2. When disposing of unused medication, the remainder of a medication, including controlled substances.
The disposal of medications that cannot be returned to the parent/guardian.

A medication administration record should be maintained on an ongoing basis by designated staff and should include the following:

Specific, signed parental/guardian consent for the caregiver/teacher to administer medication including documentation of receiving controlled substances and verification of the amount received;
Specific, signed authorization from the child’s prescribing health professional, prescribing the medication, including medical need, medication, dosage, and length of time to give medication.
Information about the medication including warnings and possible side effects;
Written documentation of administration of medication and any side effects;
Medication errors log.

The facility should consult with the State Board of Nursing, other interested organizations and their child care health consultant about required training and documentation for medication administration. Based on the information, the facility should develop and implement a plan regarding medication administration training (9).

RATIONALE

Administering medication requires skill, knowledge and careful attention to detail. Parents/guardians and prescribing health professionals must give a caregiver/teacher written authorization to administer medication to the child (12). Caregivers/teachers must be diligent in their adherence to the medication administration policy and procedures to prevent any inadvertent medication errors, which may be harmful to the child (11). There is always a risk that a child may have a negative reaction to a medication, and children should be monitored for serious side effects that may require an emergency response. Because children twenty-four months of age and younger are in a period of rapid development and are more vulnerable to the possible side effects of medications, extra care should be given to the circumstances under which medications will be administered to this population. A child may have a negative reaction to a medication that was given at home or to one administered while attending child care. For these reasons caregivers/teachers need to be aware of each of the medications a child received at child care as well as at home. They should know the names of the medication(s), when each was given, who prescribed them, and what the known reactions or side effects may be in the event that a child has a negative reaction to the medicine (2,10).

OTC medicines are often assumed to be safe and not afforded the proper diligence. Even common drugs such as acetaminophen and ibuprofen can result in significant toxicity for infants and small children. Inaccurate dosing from the use of inaccurate measuring tools can result in illness or even death (2,3).

Cough and cold medications (CCM) are readily available OTC in the United States and are widely used to treat upper respiratory infection. These products are not safe for infants and young children and were withdrawn by the Consumer Healthcare Products Association for children less than two years of age in 2007 (4-6,8). The Food and Drug Administration (FDA) issued a public health advisory in 2008 stating these medications should not be used in children less than two years of age. The American Academy of Pediatrics (AAP) states that CCMs are not effective for children less than six years of age and their use can result in serious, adverse effects (7).

The medication record protects the person administering medication by documenting the process. The medication errors log can be reviewed and will point out what kind of intervention, if any, will be helpful in reducing the number of medication errors. Accounting for medications administered and thrown away is important for several reasons. It may assist a health professional in determining whether the child is actually getting the medicine, especially when the child is not getting better from treatment. Some medications are “controlled substances,” meaning that the medication is regulated by the federal government due to potential for abuse. Controlled substances include narcotic pain medicine, some behavior medications for ADHD, and some seizure medications. A prescribing health professional may need proper accounting for these types of medications to assure that requests for refills are because the medication was given to the patient and not used/abused by adults. Some medications, (i.e., antibiotics), can have a harmful affect on the environment if not disposed of properly.

For children with chronic health conditions or special health care needs, administering medications while the child is attending child care may be part of the child’s individualized family service plan (IFSP) or individualized education plan (IEP). Child care facilities must comply with the Americans with Disabilities Act.

COMMENTS

When a child care facility cannot return unused medication to the parent/guardian, the facility needs to dispose of the medication. An example of when medication cannot be returned is when a parent/guardian has removed the child from care and the facility cannot reach the parent/guardian to return the medication. Herbal and folk medicines and home remedies are not regulated and should not be given at child cares without a prescribing health professional’s order and complete pharmaceutical labeling. If they are given at home, the caregiver/teacher should be aware of their use and possible side effects.

A curriculum for child care providers on safe administration of medications in child care is available from the AAP at http://www.healthychildcare.org/HealthyFutures.html. A sample medication administration policy is located in Appendix AA: Medication Administration Packet.

TYPE OF FACILITY

Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home

RELATED STANDARDS

3.6.3.1 Medication Administration
3.6.3.2 Labeling, Storage, and Disposal of Medications
3.6.3.3 Training of Caregivers/Teachers to Administer Medication
9.4.2.6 Contents of Medication Record
Appendix AA: Medication Administration Packet

REFERENCES

North Carolina Child Care Health & Safety Resource Center. 2007. Steps to administering medication. http://www.healthychild
carenc.org/PDFs/steps_admin_medication.pdf.
American Academy of Pediatrics. 2009. Healthy futures: Medication administration in early education and child care settings. http://www.healthychildcare.org/HealthyFutures.html.
American Academy of Pediatrics, Council on School Health. 2009. Policy statement: Guidance for the administration of medication in school. Pediatrics 124:1244-51.
American Academy of Pediatrics, Committee on Drugs. 2009. Policy statement: Acetaminophen toxicity in children. Pediatrics 123:1421-22.
Vernacchio, L., J. Kelly, D. Kaufman, A. Mitchell. 2008. Cough and cold medication use by U.S. children, 1999-2006: Results from the Sloan Survey. Pediatrics 122:e323-29.
Schaefer, M. K., N. Shehab, A. Cohen, D. S. Budnitz. 2008. Adverse events from cough and cold medicines in children. Pediatrics 121:783-87.
Centers for Disease Control and Prevention. 2007. Infant deaths associated with cough and cold medications: Two states. MMWR 56:1-4.
U.S. Food and Drug Administration. 2007. Nonperscription cough and cold medicine use in children. http://www.fda.gov/Safety/
MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm152691.htm.
Consumer Healthcare Products Association. Makers of OTC cough and cold medicines announce voluntary withdrawal of oral infant medicines. http://www.chpa-info.org/pressroom/10_11_07_OralInfantMedicines.aspx.
Heschel, R. T., A. A. Crowley, S. S. Cohen. 2005. State policies regarding nursing delegation and medication administration in child care setttings: A case study. Policy, Politics, and Nurs Prac 6:86-98.
Friedman, J. F., G. M. Lee, K. P. Kleinman, J. A. Finkelstein. 2004. Child care center policies and practices for management of ill children. Ambulatory Pediatrics 4:455-60.
Sinkovits, H. S., M. W. Kelly, M. E. Ernst. 2003. Medication administration in day care centers for children. J Am Pharm Assoc 43:379-82.

9.2.3.10: Sanitation Policies and Procedures

*STANDARD UNDERGOING FULL REVISION*

The child care facility should have written sanitation policies and procedures for the following items:

Maintaining equipment used for hand hygiene, toilet use, and toilet learning/training in a sanitary condition;
Maintaining diaper changing areas and equipment in a sanitary condition;
Maintaining toys in a sanitary condition;
Managing animals in a safe and sanitary manner;
Practicing proper handwashing and diapering procedures (the facility should display proper handwashing instruction signs conspicuously);
Practicing proper personal hygiene of caregivers/teachers and children;
Practicing environmental sanitation policies and procedures, such as sanitary disposal of soiled diapers;
Maintaining sanitation for food preparation and food service.

RATIONALE

Many infectious diseases can be prevented through appropriate hygiene and sanitation practices. Bacterial cultures of environmental surfaces in facilities, which are used to gauge the adequacy of sanitation and hygiene practices, have demonstrated evidence of fecal contamination. Contamination of hands, toys, and other equipment in the room has appeared to play a role in the transmission of diseases in child care settings (1). Regular and thorough cleaning of toys, equipment, and rooms helps to prevent transmission of illness (1).

Animals can be a source of illness for people, and people may be a source of illness for animals (1).

The steps involved in effective handwashing (to reduce the amount of bacterial contamination) can be easily forgotten. Posted signs provide frequent reminders to staff and orientation for new staff. Education of caregivers/teachers regarding handwashing, cleaning, and other sanitation procedures can reduce the occurrence of illness in the group of children with whom they work (2).

Illnesses may be spread by way of:

Human waste (such as urine and feces);
Body fluids (such as saliva, nasal discharge, eye discharge, open skin sores, and blood);
Direct skin-to-skin contact;
Touching a contaminated object;
The air (by droplets that result from sneezes and coughs).

Since many infected people carry communicable diseases without symptoms, and many are contagious before they experience a symptom, caregivers/teachers need to protect themselves and the children they serve by carrying out, on a routine basis, standard precautions and sanitation procedures that approach every potential illness-spreading condition in the same way.

Handling food in a safe and careful manner prevents the spread of bacteria, viruses, and fungi. Outbreaks of foodborne illness have occurred in many settings, including child care facilities.

COMMENTS

State health department rules and regulations may also guide the child care provider.

TYPE OF FACILITY

Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home

RELATED STANDARDS

3.2.1.1 Type of Diapers Worn
3.2.1.2 Handling Cloth Diapers
3.2.1.3 Checking For the Need to Change Diapers
3.2.1.4 Diaper Changing Procedure
3.2.1.5 Procedure for Changing Children’s Soiled Underwear, Disposable Training Pants and Clothing
3.2.2.1 Situations that Require Hand Hygiene
3.2.2.2 Handwashing Procedure
3.2.2.3 Assisting Children with Hand Hygiene
3.2.2.4 Training and Monitoring for Hand Hygiene
3.2.2.5 Hand Sanitizers
3.3.0.2 Cleaning and Sanitizing Toys
3.3.0.3 Cleaning and Sanitizing Objects Intended for the Mouth
3.4.2.1 Animals that Might Have Contact with Children and Adults
3.4.2.2 Prohibited Animals
3.4.2.3 Care for Animals
4.8.0.1 Food Preparation Area
4.8.0.2 Design of Food Service Equipment
4.8.0.3 Maintenance of Food Service Surfaces and Equipment
4.8.0.4 Food Preparation Sinks
4.8.0.5 Handwashing Sinks in Food Preparation Areas
4.8.0.6 Maintaining Safe Food Temperatures
4.8.0.7 Ventilation Over Cooking Surfaces
4.8.0.8 Microwave Ovens
4.9.0.1 Compliance with U.S. Food and Drug Administration Food Sanitation Standards, State and Local Rules
4.9.0.2 Staff Restricted from Food Preparation and Handling
4.9.0.3 Precautions for a Safe Food Supply
4.9.0.4 Leftovers
4.9.0.5 Preparation for and Storage of Food in the Refrigerator
4.9.0.6 Storage of Foods Not Requiring Refrigeration
4.9.0.7 Storage of Dry Bulk Foods
4.9.0.9 Cleaning Food Areas and Equipment
4.9.0.10 Cutting Boards
4.9.0.11 Dishwashing in Centers
4.9.0.12 Dishwashing in Small and Large Family Child Care Homes
4.9.0.13 Method for Washing Dishes by Hand
5.4.1.1 General Requirements for Toilet and Handwashing Areas
5.4.1.2 Location of Toilets and Privacy Issues
5.4.1.3 Ability to Open Toilet Room Doors
5.4.1.4 Preventing Entry to Toilet Rooms by Infants and Toddlers
5.4.1.5 Chemical Toilets
5.4.1.6 Ratios of Toilets, Urinals, and Hand Sinks to Children
5.4.1.7 Toilet Learning and Training Equipment
5.4.1.8 Cleaning and Disinfecting Toileting Equipment
5.4.1.9 Waste Receptacles in the Child Care Facility and in Child Care Facility Toilet Room(s)
5.4.1.10 Handwashing Sinks
5.4.1.11 Handwashing Sinks Prohibited Uses
5.4.1.12 Mop Sinks
5.4.2.1 Diaper Changing Tables
5.4.2.2 Handwashing Sinks for Diaper Changing Areas in Centers
5.4.2.3 Handwashing Sinks for Diaper Changing Areas in Homes
5.4.2.4 Use, Location, and Setup of Diaper Changing Areas
5.4.2.5 Changing Table Requirements
5.4.2.6 Maintenance of Changing Tables
5.4.3.1 Ratio and Location of Bathtubs and Showers
5.4.3.2 Safety of Bathtubs and Showers
5.7.0.6 Storage Area Maintenance and Ventilation
5.7.0.7 Structure Maintenance
5.7.0.8 Electrical Fixtures and Outlets Maintenance
5.7.0.9 Plumbing and Gas Maintenance
5.7.0.10 Cleaning of Humidifiers and Related Equipment
Appendix K: Routine Schedule for Cleaning, Sanitizing, and Disinfecting

REFERENCES

Chin, J., ed. 2000. Control of communicable diseases manual. Washington, DC: American Public Health Association.
Kotch, J., P. Isbell, D. J. Weber, et al. 2007. Hand-washing and diapering equipment reduces disease among children in out-of-home child care centers. Pediatrics 120:e29-36.

9.2.3.11: Food and Nutrition Service Policies and Plans

Content in the STANDARD was modified on 05/21/2019.

Early care and education programs should have food handling, feeding, and written nutrition policies and plans under the direction of the administration that address the following items:

Age-appropriate eating utensils and tableware
Age-appropriate portion sizes to meet nutritional needs
Emergency preparedness for water and nutrition services
Food allergies and special dietary restrictions, including family/cultural food preferences
Food brought from home, including food brought for celebrations
Food budget
Food safety, sanitation, preparation, and service
Food procurement and storage
Kitchen and meal service staffing
Kitchen layout
Menu and meal planning
Nutrition education for children, staff, and parents/guardians
Promotion of breastfeeding and provision of community resources to support mothers

A nutritionist/registered dietitian and a food service expert should provide input for and facilitate the development and implementation of a written nutrition plan for the early care and education program.¹

RATIONALE

Children spend a significant amount of time in out-of-home care; this requires 1 or 2 meals to be served during the day.² Having a plan that clearly assigns responsibility and that encompasses the pertinent nutrition elements will promote the optimal health of all children and staff in early care and education settings. Centers following safe steps in food handling, cooking, and storage safeguard against foodborne illness.³

TYPE OF FACILITY

Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home

RELATED STANDARDS

4.2.0.1 Written Nutrition Plan
4.2.0.9 Written Menus and Introduction of New Foods
4.3.1.1 General Plan for Feeding Infants
4.3.1.2 Responsive Feeding of Infants by a Consistent Caregiver/Teacher
4.3.1.3 Preparing, Feeding, and Storing Human Milk
4.3.2.2 Serving Size for Toddlers and Preschoolers
4.4.0.2 Use of Nutritionist/Registered Dietitian
4.6.0.1 Selection and Preparation of Food Brought From Home
4.6.0.2 Nutritional Quality of Food Brought From Home
4.7.0.1 Nutrition Learning Experiences for Children
4.7.0.2 Nutrition Education for Parents/Guardians
4.9.0.8 Supply of Food and Water for Disasters
5.2.6.5 Emergency Safe Drinking Water and Bottled Water
Appendix C: Nutrition Specialist, Registered Dietitian, Licensed Nutritionist, Consultant, and Food Service Staff Qualifications
Appendix JJ: Breastfeeding/Chestfeeding Support in Early Care and Education Programs

REFERENCES

School Nutrition Association. School nutrition professionals: roles & responsibilities. https://schoolnutrition.org/AboutSchoolMeals/SNPRolesResponsibilities. Accessed December 20, 2018
Swindle T, Sigman-Grant M, Branen LJ, Fletcher J, Johnson SL. About feeding children: factor structure and internal reliability of a survey to assess mealtime strategies and beliefs of early childhood education teachers. Int J Behav Nutr Phys Act. 2018;15(1):85
US Department of Agriculture, Food Safety and Inspection Service. Basics for handling food safely. https://www.fsis.usda.gov/wps/portal/fsis/topics/food-safety-education/get-answers/food-safety-fact-sheets/safe-food-handling/basics-for-handling-food-safely/ct_index. Modified March 24, 2015. Accessed December 20, 2018

NOTES

Content in the STANDARD was modified on 05/21/2019.

9.2.3.12: Infant Feeding Policy

A policy about infant feeding should be developed with the input and approval from the nutritionist/registered dietitian and should include the following:

Storage and handling of expressed human milk;
Determination of the kind and amount of commercially prepared formula to be prepared for infants as appropriate;
Preparation, storage, and handling of infant formula;
Proper handwashing of the caregiver/teacher and the children;
Use and proper sanitizing of feeding chairs and of mechanical food preparation and feeding devices, including blenders, feeding bottles, and food warmers;
Whether expressed human milk, formula, or infant food should be provided from home, and if so, how much food preparation and use of feeding devices, including blenders, feeding bottles, and food warmers, should be the responsibility of the caregiver/teacher;
Holding infants during bottle-feeding or feeding them sitting up;
Prohibiting bottle propping during feeding or prolonging feeding;
Responding to infants’ need for food in a flexible fashion to allow cue feedings in a manner that is consistent with the developmental abilities of the child (policy acknowledges that feeding infants on cue rather than on a schedule may help prevent obesity) (1,2);
Introduction and feeding of age-appropriate solid foods (complementary foods);
Specification of the number of children who can be fed by one adult at one time;
Handling of food intolerance or allergies (e.g., cow’s milk, peanuts, orange juice, eggs, wheat).

Individual written infant feeding plans regarding feeding needs and feeding schedule should be developed for each infant in consultation with the infant’s primary care provider and parents/guardians.

RATIONALE

Growth and development during infancy require that nourishing, wholesome, and developmentally appropriate food be provided, using safe approaches to feeding. Because individual needs must be accommodated and improper practices can have dire consequences for the child’s health and safety, the policy for infant feeding should be developed with professional nutritionists/registered dietitians. The infant feeding plans should be developed with each infant’s parents/guardians and, when appropriate, in collaboration with the child’s primary care provider.

TYPE OF FACILITY

Center, Early Head Start, Large Family Child Care Home, Small Family Child Care Home

RELATED STANDARDS

4.3.1.1 General Plan for Feeding Infants
4.3.1.2 Responsive Feeding of Infants by a Consistent Caregiver/Teacher
4.3.1.3 Preparing, Feeding, and Storing Human Milk
4.3.1.4 Feeding Human Milk to Another Mother’s Child
4.3.1.5 Preparing, Feeding, and Storing Infant Formula
4.3.1.8 Techniques for Bottle Feeding
4.3.1.9 Warming Bottles and Infant Foods
4.3.1.11 Introduction of Age-Appropriate Solid Foods to Infants
4.3.1.12 Feeding Age-Appropriate Solid Foods to Infants
4.8.0.8 Microwave Ovens
Appendix JJ: Breastfeeding/Chestfeeding Support in Early Care and Education Programs

REFERENCES

Birch, L., W. Dietz. 2008. Eating behaviors of young child: Prenatal and postnatal influences on healthy eating, 59-93. Elk Grove Village, IL: American Academy of Pediatrics.
Taveras, E. M., S. L. Rifas-Shiman, K. S. Scanlon, L. M. Grummer-Strawn, B. Sherry, M. W. Gillman. 2006. To what extent is the protective effect of breastfeeding on future overweight explained by decreased maternal feeding restriction? Pediatrics 118:2341-48.

9.2.3.13: Plans for Evening and Nighttime Child Care

Facilities that provide evening and nighttime care should have plans for such care that include the supervision of sleeping children and the management and maintenance of sleep equipment including their sanitation and disinfection. Evacuation drills should occur during hours children are in care. Centers should have these plans in writing.

RATIONALE

Evening child care routines are similar to those required for daytime child care with the exception of sleep routines. Evening and nighttime child care requires special attention to sleep routines, safe sleep environment, supervision of sleeping children, and personal care routines, including bathing and tooth brushing. Nighttime child care must meet the nutritional needs of the children and address morning personal care routines such as toileting/diapering, hygiene, and dressing for the day. Children and staff must be familiar with evacuation procedures in case a natural or human generated disaster occurs during evening child care and nighttime child care hours.

COMMENTS

Sleeping time is a very sensitive time for infants and young children. Attention should be paid to individual needs, transitional objects, lighting preferences, and bedtime routines.

TYPE OF FACILITY

Center, Large Family Child Care Home, Small Family Child Care Home

RELATED STANDARDS

2.2.0.1 Methods of Supervision of Children
3.3.0.4 Cleaning Individual Bedding
3.3.0.5 Cleaning Crib and Other Sleep Surfaces
5.4.5.1 Sleeping Equipment and Supplies
5.4.5.2 Cribs
5.4.5.3 Stackable Cribs
5.4.5.4 Futons
5.4.5.5 Bunk Beds
9.2.4.3 Disaster Planning, Training, and Communication
9.2.4.4 Written Plan for Seasonal and Pandemic Influenza
9.2.4.5 Emergency and Evacuation Drills Policy

9.2.3.14: Oral Health Policy

The program should have an oral health policy that includes the following:

Information about fluoride content of water at the facility;
Contact information for each child’s dentist;
Resource list for children without a dentist;
Implementation of daily tooth brushing or rinsing the mouth with water after eating;
Use of sippy cups and bottles only at mealtimes during the day, not at naptimes;
Prohibition of serving sweetened food products;
Promotion of healthy foods per the USDA’s Child and Adult Care Food Program (CACFP);
Early identification of tooth decay;
Age-appropriate oral health educational activities;
Plan for handling dental emergencies.

RATIONALE

Good oral hygiene is as important for a six-month-old child with one tooth as it is for a six-year-old with many teeth (1). Tooth brushing and activities at home may not suffice to develop the skill of proper tooth brushing or accomplish the necessary plaque removal, especially when children eat most of their meals and snacks during a full day in child care.

TYPE OF FACILITY

Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home

RELATED STANDARDS

3.1.5.1 Routine Oral Hygiene Activities
3.1.5.2 Toothbrushes and Toothpaste
3.1.5.3 Oral Health Education
5.5.0.1 Storage and Labeling of Personal Articles

REFERENCES

American Academy of Pediatric Dentistry. 2009. Clinical guideline on periodicity of examination, preventive dental services, anticipatory guidance, and oral treatment for children. Pediatric Dentistry 30:112-18.

9.2.3.15: Policies Prohibiting Smoking, Tobacco, Alcohol, Illegal Drugs, and Toxic Substances

Content in the STANDARD was modified on 1/12/2017.

Facilities should have written policies addressing the use and possession of tobacco and electronic cigarette (e-cigarette) products, alcohol, illegal drugs, legal drugs (e.g. medicinal/recreational marijuana, prescribed narcotics, etc.) that have side effects that diminish the ability to properly supervise and care for children or safely drive program vehicles, and other potentially toxic substances. Policies should include that all of these substances are prohibited inside the facility, on facility grounds, and in any vehicles that transport children at all times. Policies should specify that smoking and vaping is prohibited at all times and in all areas (indoor and outdoor) of the program. This includes any vehicles that are used to transport children.

Policies must also specify that use and possession of all substances referred to above are prohibited during all times when caregivers/teachers are responsible for the supervision of children, including times when children are transported, when playing in outdoor play areas not attached to the facility, and during field trips and staff breaks.

Child care centers and large family child care homes should provide information to employees about available drug, alcohol, and tobacco counseling and rehabilitation, and any available employee assistance programs.

RATIONALE

The age, defenselessness, and lack of discretion of the child under care make this prohibition an absolute requirement.

The hazards of second-hand and third-hand smoke exposure warrant the prohibition of smoking in proximity of child care areas at any time (1-10). Third-hand smoke refers to gases and particles clinging to smokers’ hair and clothing, cushions, carpeting and outdoor equipment after visible tobacco smoke has dissipated (9). The residue includes heavy metals, carcinogens, and even radioactive materials that young children can get on their hands and ingest, especially if they’re crawling or playing on the floor. Residual toxins from smoking at times when the children are not using the space can trigger asthma and allergies when the children do use the space (10).

Safe child care necessitates sober caregivers/teachers. Alcohol and drug use, including the misuse of prescription, over-the-counter (OTC), or recreational drugs, prevent caregivers/teachers from providing appropriate care to infants and children by impairing motor coordination, judgment, and response time. Off-site use prior to or during work, of alcohol and illegal drugs is prohibited. OTC medications or prescription medications that have not been prescribed for the user or that could impair motor coordination, judgment, and response time is prohibited.

The use of alcoholic beverages and legal drugs in family child care homes when children are not in care is not prohibited, but these items should be stored safely at all times.

COMMENTS

The policies related to smoking and use of prohibited substances should be discussed with staff and parents/guardians. Educational material such as handouts could include information on the health risks and dangers of these prohibited substances and referrals to services for counseling or rehabilitation programs.

It is strongly recommended that, whenever possible, all caregivers/teachers should be non-tobacco and non-electronic cigarette (e-cigarette) users. Family child care homes should be kept smoke-free at all times to prevent exposure of the children who are cared for in these spaces.

In states that permit recreational and/or medicinal use of marijuana, special care is needed to store edible marijuana products securely and apart from other foods. State regulations typically required that these products be clearly labeled as containing an intoxicating substance and stored in the original packaging that is tamper-proof and child-proof. Any legal edible marijuana products in a family child care home should be helpy in a locked and child-resistant storage device.

TYPE OF FACILITY

Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home

RELATED STANDARDS

3.4.1.1 Use of Tobacco, Electronic Cigarettes, Alcohol, and Drugs
5.2.9.1 Use and Storage of Toxic Substances
6.5.1.2 Qualifications for Drivers

REFERENCES

U.S. Environmental Protection Agency. Secondhand tobacco smoke and smoke-free homes. 2016. https://www.epa.gov/indoor-air-quality-iaq/secondhand-tobacco-smoke-and-smoke-free-homes.
American Academy of Pediatrics. Healthychildren.org. 2015. The dangers of secondhand smoke. https://www.healthychildren.org/English/health-issues/conditions/tobacco/Pages/Dangers-of-Secondhand-Smoke.aspx.
U.S. Department of Health and Human Services. 2007. Children and secondhand smoke exposure. Excerpts from the health consequences of involuntary exposure to tobacco smoke: A report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health.
Dreyfuss, J.H. Thirdhand smoke identified as potent, enduring carcinogen. CA Cancer J Clin. 2010;60(4):203-204. https://www.ncbi.nlm.nih.gov/pubmed/20530799.
U.S. Department of Health and Human Services. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General. Secondhand Smoke What It Means to You. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2006. http://www.surgeongeneral.gov/library/reports/secondhand-smoke-consumer.pdf.
Hang, B., Sarker, A.H., Havel, C., et al. Thirdhand smoke causes DNA damage in human cells. Mutagenesis. 2013;28(4):381-391. https://www.ncbi.nlm.nih.gov/pubmed/23462851.
Winickoff, J. P., J. Friebely, S. E. Tanski, C. Sherrod, G. E. Matt, M. F. Hovell, R. C. McMillen. 2009. Beliefs about the health effects of “thirdhand” smoke and home smoking bans. Pediatrics 123: e74-e79.
Dale, L. 2014. What is thirdhand smoke, and why is it a concern? http://www.mayoclinic.org/healthy-lifestyle/adult-health/expert-answers/third-hand-smoke/faq-20057791.
Centers for Disease Control and Prevention. 2016. Health effects of secondhand smoke. http://www.cdc.gov/tobacco/data_statistics/fact_sheets/secondhand_smoke/health_effects/.
Campaign for Tobacco-Free Kids. Secondhand smoke, kids and cars. 2016. http://www.tobaccofreekids.org/research/factsheets/pdf/0334.pdf.
ADDITIONAL REFERENCES

U.S. Fire Administration. Electronic cigarette fires and explosions. 2014. https://www.usfa.fema.gov/downloads/pdf/publications/electronic_cigarettes.pdf.

Campbell. R. Electronic Cigarette Explosions and Fires: The 2015 Experience. 2016. http://www.nfpa.org/news-and-research/fire-statistics-and-reports/fire-statistics/fire-causes/electrical-and-consumer-electronics/electronic-cigarette-explosions-and-fires-the-2015-experience.

National Institute on Drug Abuse. 2016. What is marijuana? https://www.drugabuse.gov/publications/drugfacts/marijuana.

Rapoport, M.J., Lanctôt, K.L., Streiner, D.L., Bédard, M., Vingilis, E., Murray, B., Schaffer, A., Shulman, K.I., Herrmann, N. Benzodiazepine use and driving: A meta-analysis. J Clin Psychiatry. 2009;70(5):663-73. doi:10.4088/JCP.08m04325.

Sansone, R.A., Sansome, L.A. Driving on Antidepressants: Cruising for a crash?. Psychiatry (Edgmont). 2009:6(9): 13–16. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2766284/.

Volkow, N.D., Baler, R.D., Compton, W.M., R.B. Weiss, S.R.B. Adverse health effects of marijuana use. N Engl J Med 2014:370:2219-2227. DOI: 10.1056/NEJMra1402309.

Lenné MG, Dietze PM, Triggs TJ, Walmsley S, Murphy B, Redman JR. The effects of cannabis and alcohol on simulated arterial driving: Influences of driving experience and task demand. Accid Anal Prev. 2010;42(3):859-866. doi:10.1016/j.aap.2009.04.021.

Hartman RL, Huestis MA. Cannabis effects on driving skills.Clin Chem. 2013;59(3):478-492. doi:10.1373/clinchem.2012.194381.

Verster, J. C., D. S. Veldhuijzen, E. R. Volkerts. 2005. Is it safe to drive a car when treated with anxiolytics? Evidence from on the road driving studies during normal traffic. Current Psychiatry Reviews1:215-25.

Centers for Disease Control and Prevention. 2009. Facts: Preventing residential fire injuries. http://www.cdc.gov/injury/pdfs/Fires2009CDCFactSheet-FINAL-a.pdf.

American Lung Association. E-cigarettes and Lung Health. 2016. http://www.lung.org/stop-smoking/smoking-facts/e-cigarettes-and-lung-health.html?referrer=https://www.google.com/.

Children’s Hospital Colorado. 2016. Acute marijuana intoxication. https://www.childrenscolorado.org/conditions-and-advice/conditions-and-symptoms/conditions/acute-marijuana-intoxication/.

NOTES

Content in the STANDARD was modified on 1/12/2017.

9.2.3.16: Policy Prohibiting Firearms

Centers should have a written policy prohibiting firearms, ammunition, and ammunition supplies.

Large or small family homes should have a written policy that if firearms and other weapons are present, they should:

Have child protective devices;
Be unloaded or disarmed;
Be kept under lock and key;
Be inaccessible to children.

For large and small family homes the policy should include that ammunition and ammunition supplies should be:

Placed in locked storage;
Separate from firearms;
Inaccessible to children.

Parents/guardians should be notified that firearms and other weapons are on the premises.

RATIONALE

The potential for injury to and death of young children due to firearms is apparent (1-3). These items should not be accessible to children in a facility (2,3).

TYPE OF FACILITY

Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home

REFERENCES

American Academy of Pediatrics, Committee on Injury and Poison Prevention. 2004. Policy statement: Firearm-related injuries affecting the pediatric population. Pediatrics 114:1126.
DiScala, C., R. Sege. 2004. Outcomes in children and young adults who are hospitalized for firearms-related injuries. Pediatrics 113:1306-12.
Grossman, D. C., B. A. Mueller, C. Riedy, et al. 2005. Gun storage practices and risk of youth suicide and unintentional firearm injuries. JAMA 296:707-14.

9.2.3.17: Child Care Health Consultant’s Review of Health Policies

At least annually, after an incident or injury has occurred, or when changes are made in the health policies, the facility should obtain input and a review of the policies from a child care health consultant.

RATIONALE

Changes in health information may require changes in the health policies of a child care facility. These changes are best known to health professionals who stay in touch with sources of updated information and can suggest how the new information applies to the operation of the child care program (1,2). For example, when the information on the importance of back-positioning for putting infants down to sleep became available, it needed to be added to child care policies. Frequent changes in recommended immunization schedules offer another example of the need for review and modification of health policies.

TYPE OF FACILITY

Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home

RELATED STANDARDS

1.6.0.1 Child Care Health Consultants

REFERENCES

Alkon, A., J. Farrer, J. Bernzweig. 2004. Child care health consultants’ roles and responsibilities: Focus group findings. Pediatric Nursing 30:315-21.
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.

9.2.4 Emergency/Security Policies and Plans

9.2.4.1: Written Plan and Training for Handling Urgent Medical or Threatening Incidents

Content in the standard was modified on 03/22/22.

Early care and education programs should have a written plan for urgent incidents that threaten the health or safety of children, staff, or volunteers. The plan should include policies and procedures for training staff to manage, document, and report these incidents.

Developing a Written Plan

A written plan will cover these types of incidents:¹

Lost or missing child
Suspected sexual, physical or emotional abuse or neglect of a child
Staff members not reporting their suspicion, although they are mandated reporters
Suspected sexual, physical, or emotional abuse of staff, volunteers, or family members that takes place on site
Illness or injury needing urgent or emergency medical care or dental care
Mental health emergencies
Health and safety emergencies involving parents/guardians and visitors
Death of a child or staff member-including death from a serious illness or injury that happened on site, even if the person died outside of regular program hours
An unauthorized, threatening, or violent person who tries to enter-or who does enter-the program
Violence in the community

The written plan should include a policy for debriefing staff after an incident has occurred.

A written plan for illness or injuries that need urgent or emergency care should clearly state:

Where the closest urgent care is
- Hospital emergency department
- Medical or dental clinic that is open during the program’s operating hours and is acceptable to families
Which supplies and equipment to have on site. For example:
- First aid kit
- Car and car seat to accompany a child to a health care facility
Standard safety precautions if exposed to body fluids
How staff must stay with the child until the family arrives and takes responsibility for them
Emergency information for medical personnel including:
- A signed emergency medical care authorization form
- A signed informed consent form that allows the program to share medical information with medical staff
- Additional information for children with special health care needs or disabilities
How backup staff members will step in to help maintain child-to-staff ratios
How to alert others in the building about a medical urgency
Communication procedures for promptly notifying parent/guardian, or family emergency contact
A procedure to regularly update and verify emergency contact and health information²
How to complete an incident/injury report and the program’s response to the emergency
Using and restocking first aid kits, which includes checking their content, condition, and expiration dates every month.
The policy for regular reviews of staff’s ability to perform first aid

A written plan for threatening incidents should include:

How to control access to buildings and outdoor play areas
How to report a lost child or child abuse
How to alert others in the building that a threatening person is on site
How to alert police/emergency services³
How to alert a parent, guardian, or family emergency contact if an unauthorized or threatening person tries to make contact with or remove a child, staff member, or volunteer
What to document (e.g., all possible descriptions of a person; a car’s color or license plate number)²
How to complete an incident/injury report and the program’s response to the emergency

Staff Training on Drills

Policies and procedures for staff training on emergency drills should include:

Frequency, timing, and documentation of drills²
A system for notifying families, staff, and children about planned drills
Preparing children to participate in drills by letting them know:
- When the drill will happen
- What to wear
- What they will practice
When to exclude children from drills
- They should not practice some drills until they are developmentally ready.
- They should only practice drills that will help, not harm, them.
A policy for debriefing staff and children after a drill

RATIONALE

Medical urgencies are common in early care and education settings. Also, threatening intrusions can happen and sometimes involve violence, injury, and death. Having written plans, staff training, and regular drills help programs prepare for emergencies. They are a guide for making responsible decisions while under stress. Drills can help ease tension and build confidence in the staff’s ability to respond calmly during a real incident.

Careful planning means having written plans, policies, and procedures, and keeping accurate records. All this is needed to keep the program safe and to handle medical emergencies or threatening incidents consistently, even if the staff is different. For example, checking first aid kits regularly will make sure supplies are always available. Careful planning also helps families understand what the staff will do to keep their children safe.

Having children practice drills that are very intense (e.g., drills that use fake gunfire to simulate an attack by a shooter) is inappropriate. The intensity may distress and psychologically harm children who are not developmentally ready.⁴

However, programs can still prepare for violent or threatening incidences, with advice from health care providers, mental health consultants, child care health consultants, and first responders.⁵ These experts can:

Help programs prepare for and reduce potential harm
Help programs prepare children, staff and families
Make sure that emergency response and recovery plans consider children’s developmental needs.⁵

ADDITIONAL RESOURCES

The National Center on Early Childhood Health and Wellness, U.S. Department of Health and Human Services Administration for Children and Families Office of Head Start’s Emergency Preparedness Manual for Early Childhood Programs has detailed explanations and examples of procedures for emergency situations.

https://eclkc.ohs.acf.hhs.gov/sites/default/files/pdf/emergency-preparedness-manual-early-childhood-programs.pdf

The Emergency Medical Services for Children Innovation & Improvement Center has educational materials and disaster planning resources.

https://emscimprovement.center/domains/planning

TYPE OF FACILITY

Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home

RELATED STANDARDS

1.4.3.1 First Aid and Cardiopulmonary Resuscitation Training for Staff
1.4.3.2 Topics Covered in Pediatric First Aid Training
1.4.5.3 Training on Occupational Risk Related to Handling Body Fluids
1.5.0.1 Employment of Substitutes
1.5.0.2 Orientation of Substitutes
3.2.3.4 Prevention of Exposure to Blood and Body Fluids
3.6.4.5 Death
5.6.0.1 First Aid and Emergency Supplies
9.2.4.2 Review of Written Plan for Urgent Care and Threatening Incidents
9.2.4.3 Disaster Planning, Training, and Communication
9.2.4.5 Emergency and Evacuation Drills Policy
9.2.4.8 Authorized Persons to Pick Up Child
9.4.1.9 Records of Injury
9.4.1.10 Documentation of Parent/Guardian Notification of Injury, Illness, or Death in Program
9.4.1.11 Review and Accessibility of Injury and Illness Reports
9.4.2.1 Contents of Child’s Records

REFERENCES

Illinois Department of Public Health, Illinois Emergency Medical Services for Children. Emergency Preparedness Planning Guide for Child Care Centers & Child Care Homes. Published January 2016. LurieChildrens.org Web site. https://www.luriechildrens.org/en/emergency-medical-services-for-children/disaster/child-care-centers/. Accessed February 15, 2021.
Pennsylvania chapter of the American Academy of Pediatrics. Model Child Care Health Polices. Aronson SS, ed. 5th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2014.
Schonfeld DJ, Rossen E, Woodard D. Deception in schools — when crisis preparedness efforts go too far. JAMA Pediatr. 2017;171(11):1033–1034.
Schonfeld DJ, Hashikawa AN, Melzer-Lange M, Gorski PA; AAP Council on Children and Disasters; Council on Injury, Violence, and Poison Prevention; Council on School Health. Participation of children and adolescents in live crisis drills and exercises. Pediatrics. 2020;146(3):e2020015503
Needle S, Wright J, Disaster Preparedness Advisory Council, Committee on Pediatric Emergency Medicine. Ensuring the health of children in disasters. Pediatrics. 2015;136(5). https://publications.aap.org/pediatrics/article/136/5/e1407/33847/Ensuring-the-Health-of-Children-in-Disasters

NOTES

Content in the standard was modified on 03/22/22.

9.2.4.2: Review of Written Plan for Urgent Care and Threatening Incidents

Content in the STANDARD was modified on 08/27/2020.

The early care and education program written plan(s) for urgent medical care and threatening incidents should be reviewed and updated annually or as needed. It should be reviewed with each employee on employment and yearly thereafter to ensure that policies and procedures are understood and followed in the event of such an occurrence. The plan(s) and associated procedures should be reviewed with a child care health consultant once a year, signed, and dated.

In the event that there is an urgent medical care or threatening incident, the facility should plan to review the process within 1 to 2 months after the incident to determine opportunities for improvement and any changes that need to be made to the plan for future incidents.

The care plan for a child with special health care needs should cover emergency care needs and be shared with and discussed between parents/guardians and caregivers/teachers prior to an emergency situation.¹

RATIONALE

Emergency situations are not conducive to calm and composed thinking. Developing a written plan and reviewing it in preservice meetings with new employees, and annually thereafter, provides the opportunity to prepare and to provide guidance for good decision-making under the stress of an emergency. An organized, comprehensive approach to urgent care response and control based on current practice and evidence is necessary to ensure that a safe environment is provided to children in child care. Such an approach requires written plans, policies, procedures, and record keeping so that there is consistency over time and across staff. It also promotes understanding between parents/guardians and caregivers/teachers about concerns for, and attention to, the safety of children.

TYPE OF FACILITY

Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home

RELATED STANDARDS

3.4.3.1 Medical Emergency Procedures
3.4.3.2 Use of Fire Extinguishers
3.4.3.3 Response to Fire and Burns
3.5.0.1 Care Plan for Children with Special Health Care Needs
9.2.4.1 Written Plan and Training for Handling Urgent Medical or Threatening Incidents
9.2.4.3 Disaster Planning, Training, and Communication
Appendix KK: Authorization for Emergency Medical/Dental Care
Appendix CC: Incident Report Form
Appendix O: Care Plan for Children with Special Health Care Needs
Appendix P: Situations that Require Medical Attention Right Away

REFERENCES

American Academy of Pediatrics. Managing Chronic Health Needs in Child Care and Schools: A Quick Reference Guide. Donoghue EA, Kraft CA, eds. 2nd ed. Itasca, IL: American Academy of Pediatrics; 2019

NOTES

Content in the STANDARD was modified on 08/27/2020.

9.2.4.3: Disaster Planning, Training, and Communication

Content in the STANDARD was modified on 02/27/2020.

Early care and education programs should develop written action plans to prepare for and respond to emergency or natural disaster situations. These written action plans should include preparation/response practices and procedures for hazards/disasters that could occur in any location, including acts of violence, biological or chemical terrorism, exposure to hazardous agents, facility damage, fire, missing child, power outage, and other situations that may require evacuation, relocation, lockdown, lockout, or shelter in place. All early care and education programs should have procedures in place to address natural disasters relevant to their location (eg, earthquakes, tornados, tsunamis, floods/flash floods, storms, volcanoes).

If a facility is unsure of what to do, the first point of contact in any situation should be the local public health authority.¹ The local public health authority, in partnership with emergency personnel and other officials, will know how to engage the appropriate public health and other professionals for the situation.

Certain emergency/disaster situations may result in exceptions being made regarding state or local regulations (either in existing facilities or in temporary facilities). In these situations, facilities should make every effort to meet or exceed the temporary requirements.

Written Emergency/Disaster Action Plan

Facilities should develop and implement a written plan that describes the practices and procedures they will use to prepare for and respond to emergency or disaster situations. This emergency/disaster plan should include

Information on disasters likely to occur in or near the facility, county, state, or region that require advance preparation and/or contingency planning
Plans (and a timeline) to conduct regularly scheduled practice drills within the facility and in collaboration with community or other exercises
Mechanisms for notifying and communicating with parents/guardians in various situations (eg, website postings; use of social media platforms; email notifications; recorded message on central telephone number, telephone calls, use of telephone tree, or cellular phone texts; posting of flyers at the facility and other community locations)
Mechanisms for notifying and communicating with emergency management and public health officials (advance connections with these officials will be helpful to identify times when it would be important to notify others)
Information on crisis management (decision-making and practices) related to sheltering in place; lockdown; relocating to another facility; evacuation procedures, including how nonmobile children and adults will be evacuated; safe transportation of children, including children with special health care needs; transporting necessary medical equipment; obtaining emergency medical care; and responding to an intruder or threatening individual
Identification of primary and secondary meeting places and plans for reunification of parents/guardians with their children in the event of an evacuation
Details on collaborative planning with other groups and representatives (eg, other early care and education facilities; schools; state child care licensing personnel; law enforcement and fire officials; emergency management personnel and first responders; pediatricians and other health professionals; public health agencies; clinics; hospitals; volunteer agencies, including Red Cross and other known groups likely to provide shelter and related services)
Continuity of operations planning, including backing up or retrieving health and other key records/files and managing financial issues such as paying employees and bills during the aftermath of the disaster
Contingency plans for various situations that address

Emergency contact information and related procedures to maintain in contact with staff, families, community contacts, vendors, etc
How the facility will care for children and account for them, until the parent/guardian or other authorized adult has been appropriately identified and has accepted responsibility for their care
Acquiring, stockpiling, storing, and cycling provisions to keep updated emergency food/water and supplies that might be needed to care for children and staff for a minimum of 3 days and up to 7 days if sheltering in place is required or when removal to an alternate location is required
Administering medicine and implementing other instructions as described in individual special care plans
Procedures that might be implemented in the event of an infectious disease outbreak, epidemic, or other infectious disease emergency (eg, reviewing relevant immunization records, conducting daily health checks, keeping symptom records, implementing tracking procedures and corrective actions, modifying exclusion and isolation guidelines, coordinating with schools, reporting or responding to notices about public health emergencies)
Procedures for staff to follow in the event that they are on a field trip or are in the midst of transporting children when an emergency or disaster situation arises
Staff responsibilities and assignment of tasks (facilities should recognize that staff can and should be utilized to assist in facility preparedness and response efforts; however, they should not be hindered in addressing their own personal or family preparedness efforts, including evacuation)
Actions to be followed when no authorized person arrives to pick up a child

Specific Written Emergency/Disaster Action Plans

The following are emergency/disaster action plans currently used in early care and education programs. Caregivers/teachers should be aware of the differences between each action plan and when to implement the appropriate actions.

Evacuation
An evacuation is carried out to move students and staff out of the building. These drills often accompany fire drills and require students and staff to leave and move to a nearby, predetermined location.²

An evacuation plan should include all the following components³:

Information, diagrams, and/or maps on classroom and building locations, including locations of all exits, doors, and stairways
Maps of evacuation routes in each classroom, including
1. Primary and secondary evacuation routes
2. Locations of the primary and secondary assembly areas
3. Locations of fire alarm manual pull stations, fire extinguishers, smoke detectors, sprinkler heads, and sprinkler control valves
Directions for how staff will be notified and what they will do when they need to immediately evacuate the building and proceed to assembly areas (staff and children should be advised to evacuate as quickly and as safely as possible and should not attempt to secure or collect personal items during an evacuation, if it would compromise their safety or the safety of the children they care for)
Recommendation that (when feasible) each classroom should take their portable first aid kit with emergency information, medications, and other documents
Description of how staff will monitor/track children, including a requirement that attendance should be taken immediately before evacuating and once at the assembly area
Steps to notify parents in an emergency

Shelter in Place

A shelter in place is carried out during severe weather and other environmental hazard/threat situations with the goal of keeping people safe while remaining indoors.^2,4 Early care and education programs should have students, staff, and visitors take shelter in predetermined rooms with access to a telephone, stored disaster supplies, and, ideally, a bathroom. Facility and classroom doors should all remain shut and locked, depending on the situation.

A shelter-in-place plan should include all the following components⁵:

Details on how to notify staff and children that a shelter-in-place drill (or another code word) is occurring, such as verbally announce “shelter-in-place” or other communication term.
Recommendations for staff as to whether they should bring children inside or relocate to another nearby facility.
Instructions to bring children and staff to the predetermined area(s) within the building/home.
1. Depending on the nature of the emergency, when outside air quality is compromised, select interior room(s) without windows or vents that has adequate space to accommodate all children and staff.
2. Close and lock all windows and doors.
3. If necessary, staff should shut off the building’s heating systems, gas, air conditioners, and exhaust fans and switch valves to the closed position.
4. If necessary, seal all cracks around the doors and any vents into the room with duct tape or plastic sheeting.
Attendance should be taken to ensure everyone is present and accounted for in the area.
No outside access is permitted, but early care and education programs may allow activities within the predetermined area to continue.
Early care and education staff should follow established procedures for assisting children and/or staff with special health care needs. Bring medications, special health care plans, and assistive devices for communication and mobility.
Early care and education staff should follow established procedures for addressing children’s (especially infants and toddlers) nutrition and hygiene needs.
Provide developmentally appropriate activities (a list of ideas can be determined in advance and included in the written plan).
Continue the shelter-in-place drill until the early care and education program director or designee announces the end of the drill.

Lockdown

A lockdown is used when there is a perceived threat/danger inside the building.² A lockdown is carried out to secure all children and staff within their classrooms by locking the doors, directing people to hide or stay away from windows and doors, and sometimes asking people to remain calm and quiet. No children or staff members should be in the hallways during a lockdown. The plan should include protocols on when to unlock/open doors and should be developed in collaboration with local law enforcement officials.

A lockdown plan should include all the following components⁶:

Notify children that a lockdown is occurring by verbally announce “lockdown” or other communication term.
If children are outside, bring them inside.
Instruct people to go to the nearest room or the designated location away from danger and bring first aid/disaster and emergency supply kits.
Lock the classroom doors and windows, cover the windows, and turn off lights and audio equipment. Use tables, cabinets, or other heavy furniture to block doors/windows, if needed.
Children should be asked to remain seated on the floor, away from doors and windows.
Attendance should be taken to ensure all children are accounted for and remain inside the room.
If relevant, instruct staff and children that everyone will ignore any fire alarm activation.
Set cell phones to silent or vibrate.
Activate the emergency communication/notification plan, contact outside staff and families, inform them of the situation, and explain that they cannot enter the building right now and if they are nearby, they may need to find a safe location.
Staff should follow established procedures to remain calm and help children stay quiet. Examples include holding hands, gently rocking back and forth, using modified hand gestures that relate to a song without singing (eg, heads, shoulders, knees, and toes; eensy-weensy spider), making eye contact with each child, or offering pacifiers to infants.
Staff should follow established procedures for assisting children and/or staff with special health care needs. Bring medications, care plans, and assistive devices for communication and mobility into the area where people are located.
Staff should follow established procedures for addressing children’s (especially infants and toddlers) nutrition and hygiene needs.
Remain in the room until the early care and education program director or designee announces the end of the lockdown.

Details in the emergency/disaster plans should be reviewed and updated biannually and immediately after any relevant event to incorporate any best practices or lessons learned into the document.

Facilities should identify which agency or agencies would be the primary contact for early care and education regulations, evacuation instructions, and other directives that might be communicated in various emergency or disaster situations.

Staff Support/Training

Staff should receive training on emergency/disaster planning and response. Training can be provided by individual groups or people such as emergency management agencies, educators, child care health consultants (CCHCs), health professionals, hospital or health care coalition personnel, law enforcement or fire officials, or emergency personnel qualified and experienced in disaster preparedness and response. Training could also be developed with a community team identified to assist the program with these efforts. The training should address

Why it is important for early care and education programs to prepare for disasters and to have an emergency/disaster plan
Different types of emergency and disaster situations and when and how they may occur

Natural disasters
Exposure to agents (ie, biological, chemical, radiological, nuclear, or explosive) that may be intentional (terrorism) or accidental
Outbreaks, epidemics, or other infectious disease emergencies

The special and unique needs of children at various ages and developmental stages and appropriate responses to children’s physical and emotional needs during and after the disaster, including information on consulting with pediatric disaster experts
How to obtain support for staff members in coping/adjusting after a disaster/emergency
Providing first aid and medications and accessing emergency health care in situations in which there are not enough available resources
Contingency planning, including the ability to be flexible, to improvise, and to adapt to ever-changing situations
Developing personal and family preparedness plans
Strategies for supporting and communicating with families
Floor plan/layout and appropriate safety considerations
Location of emergency documents, supplies, medications, and equipment needed by children and staff with special health care needs
Typical community, county, and state emergency procedures (including information on state disaster and pandemic influenza plans, emergency operation centers, and the incident command structure)
Community resources for post-event support, such as agencies with mental health consultants, counselors, and safety consultants
Which individuals or agency representatives have the authority to close early care and education programs and schools and when and why this might occur
Insurance and liability issues
New advances in technology, communication efforts, and disaster preparedness strategies customized to meet children’s needs

Facilities should determine how often they will conduct drills/tests, or “practice use” of an evacuation, shelter in place, or lockdown, as well as the communication options/planning mechanisms that are selected. These drills/tests should be held at least annually, but some could also be held on a biannual or quarterly basis. After an event or practice drill, the staff should meet to review what happened and identify any needed changes to the written plan or protocols.

Communicating With Parents/Guardians

Facilities should share detailed information about facility disaster planning and preparedness with parents/guardians when they enroll their children in the program, including

Portions of the emergency/disaster plan relevant to parents/guardians or the public
Procedures and instructions for what parents/guardians can expect if something happens at the facility
Description of how parents/guardians will receive information and updates during or after a potential emergency or disaster situation
Situations that might require parents/guardians to have a contingency plan regarding how their children will be cared for in the unlikely event of a facility closure

Recovery After a Disaster

In the recovery time frame after a disaster, early childhood professionals, early care and education health and safety experts, CCHCs, health care professionals, and researchers with expertise in child development or early care and education may be asked to support the development of or help to implement emergency, temporary, or respite child care. These individuals may also be asked to assist with caring for children in shelters or other temporary housing situations. Disaster recovery can take months or even years, so it is wise to plan for how the program will address any ongoing support needs of the children, families, and staff in these situations. Refer to Standard 5.1.1.5: Environmental Audit of Site Location for more information on assessing building safety following a disaster.

RATIONALE

The only way to prepare for disasters is to consider various worst case or unique scenarios and to develop contingency plans. By brainstorming and thinking through a variety of what-if situations and developing records, protocols/procedures, and checklists (and testing/practicing these), facilities will be better able to respond to an unusual emergency or disaster situation.

Providing clear, accurate, and helpful information to parents/guardians as soon as possible is crucial. Sharing written policies with parents/guardians when they enroll their child, informing them of routine practices, and letting them know how they will receive information and updates, on a daily basis as well as during a disaster or emergency, will help them understand what to expect. Notifying parents/guardians about emergencies or disaster situations without causing alarm or prompting inappropriate action is challenging. The content of such communications will depend on the situation. Sometimes, it will be necessary to provide information to parents/guardians while a situation is evolving and before all details are known. In a serious situation, the federal government, the governor, or the state or county health official may announce or declare a state of emergency, a public health emergency, or a disaster.

Ignoring fire alarm activation during a lockdown or lockdown drill is used to protect children from an intruder either in or outside of the building, as the fire alarm could trigger everyone to leave the building, which would perhaps put them in the path of the intruder. Explaining this up front will help adults and children comply with this approach in an emergency.

Identifying and connecting with the appropriate key contact(s) before a disaster strikes is crucial for many reasons but particularly because the identified official may not know how to contact or connect with individual early care and education programs. In addition, representatives within the local school system (especially school administrators and school nurses) may have effective and more direct connections to the state emergency management or disaster preparedness and response system. If early care and education programs do not typically communicate with the schools in their area on a regular basis, staff can consider establishing a direct link to and partnership with school representatives already involved in disaster planning and response efforts.

Early care and education programs, as well as pediatricians, are rarely considered or included in disaster planning or preparedness efforts; unfortunately, the needs of children are, therefore, often overlooked. Children have important physical, physiological, developmental, and psychological differences from adults that can and must be anticipated in disaster planning, response, and recovery processes. Including considerations for children in state plans is a requirement beginning to be implemented in 2019. Caregivers/teachers, pediatricians, health care professionals, and child advocates can prepare to assume a primary mission of advocating for children before, during, and after a disaster.⁷

COMMENTS

Disaster planning and response protocols are unique and typically customized to the type of emergency or disaster; geographical area; identified needs and available resources; applicable federal, state, and local regulations; and the incident command structure in place at the time. The US Department of Homeland Security and the Federal Emergency Management Agency (FEMA) operate under a set of principles and authorities described in various laws and the National Planning Frameworks (https://www.fema.gov/national-planning-frameworks). Each state is required to maintain a state disaster preparedness plan and a separate plan for responding to a pandemic influenza. These plans may be developed by separate agencies, and the point person or the key contact for an early care and education program can be the state emergency coordinator, a representative in the state department of health, an individual associated with the agency that licenses child care facilities for that state, or another official. The state child care administrator is a key contact for any facility that receives federal support.

ADDITIONAL RESOURCES

Ready.gov. Plan ahead for disasters. www.ready.gov. Accessed August 21, 2019

US Office of Human Services, Emergency Preparedness and Response. https://www.acf.hhs.gov/ohsepr. Accessed August 21, 2019

Centers for Disease Control and Prevention, Center for Preparedness and Response. Ready Wrigley. https://www.cdc.gov/cpr/readywrigley/. Reviewed October 15, 2018. Accessed August 21, 2019

TYPE OF FACILITY

Center, Early Head Start, Early Head Start, Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home

RELATED STANDARDS

3.4.3.1 Medical Emergency Procedures
3.4.3.2 Use of Fire Extinguishers
3.4.3.3 Response to Fire and Burns
3.6.4.5 Death
4.9.0.8 Supply of Food and Water for Disasters
5.1.1.5 Assessment of the Environment at the Site Location
5.6.0.1 First Aid and Emergency Supplies
9.2.4.4 Written Plan for Seasonal and Pandemic Influenza
9.2.4.9 Policy on Actions to Be Followed When No Authorized Person Arrives to Pick Up a Child
Appendix NN: First Aid and Emergency Supply Lists

REFERENCES

American Academy of Pediatrics. PedFACTs: Pediatric First Aid for Caregivers and Teachers. 2nd ed. Burlington, MA: Jones & Bartlett Learning; 2014
American Academy of Pediatrics. School safety during emergencies: what parents need to know. HealthyChildren.org website. https://www.healthychildren.org/English/safety-prevention/all-around/Pages/Actions-Schools-Are-Taking-to-Make-Themselves-Safer.aspx. Updated June 7, 2015. Accessed August 21, 2019
US General Services Administration. Sample child care evacuation plan. https://www.gsa.gov/resources-for/citizens-consumers/child-care/child-care-services/for-professionals-providers/emergency-management/sample-child-care-evacuation-plan. Reviewed October 11, 2018. Accessed August 21, 2019
National Center on Early Childhood Health and Wellness, US Department of Health and Human Services Administration for Children and Families Office of Head Start. Emergency Preparedness Manual for Early Childhood Programs. https://eclkc.ohs.acf.hhs.gov/sites/default/files/pdf/emergency-preparedness-manual-early-childhood-programs.pdf. Accessed August 21, 2019
University of California San Francisco California Childcare Health Program. Sample announced shelter-in-place drill. https://cchp.ucsf.edu/sites/cchp.ucsf.edu/files/Sample-Drill-Shelter-in-Place.pdf. Published 2016. Accessed August 21, 2019
University of California San Francisco California Childcare Health Program. Sample announced lockdown drill. https://cchp.ucsf.edu/sites/cchp.ucsf.edu/files/Sample-Drill-Lockdown.pdf. Published 2016. Accessed August 21, 2019
Quinn M, Gillooly D, Kelly S, Kolassa J, Davis E, Jankowski S. Evaluation of identified stressors in children and adolescents after Super Storm Sandy. Pediatr Nurs. 2016;42(5):235–241

NOTES

Content in the STANDARD was modified on 02/27/2020.

9.2.4.4: Written Plan for Seasonal and Pandemic Influenza

The facility should have a written plan for seasonal and pandemic influenza (flu) to limit and contain influenza-related health hazards to the staff, children, their families and the general public. The plan should include information on:

Planning and coordination:
1. Forming a committee of staff members, parents/guardians, and the child care health consultant to produce/review a plan for dealing with the flu each year including specific plans if there is a flu pandemic;
2. Reviewing the seasonal flu plan during and after flu season so that key staff could discuss how the program would plan for a more serious outbreak or pandemic;
3. Assigning one person to identify reliable sources of information regarding the seasonal flu strain or pandemic flu outbreak considering local, state and national resources, monitor public health department announcements and other guidance, and forward key information to staff and parents/guardians as needed (the child care health consultant can be especially helpful with this);
4. Including the infection control policy and procedure (see below) and a communication plan (see below) in the seasonal flu plan;
5. Including a communication plan (see below), the infection control policy and procedure (see below), and the child learning and program operations plan (see below) in the pandemic flu plan. In addition the pandemic flu plan should include:
6. Identification of who in the program’s community has legal authority to close child care programs if there is a public health emergency or pandemic;
7. A list of key contacts such as representatives at the local/state health departments and agencies that regulate child care and their plans to combat or address seasonal or pandemic influenza (programs can extend an invitation for consultation from these departments when formulating the plan).
8. Development of a plan of action for addressing key business continuity and programmatic issues relevant to pandemic flu;
9. Communication to parents/guardians encouraging them to have a back-up plan for care for their children if the program must be closed;
10. Collaboration with those in charge of the community’s planning to find other sources of meals for low-income children who receive subsidized meals in child care in case of a closure;
11. Knowledge of services in the community that can help staff, children, and their families deal with stress and other problems caused by a flu pandemic;
12. Communicate with other child care programs in the area to share information and possibly share expertise and resources.
Communications plan:
1. Developing a plan for keeping in touch during the flu and/or pandemic with staff members and children’s families;
2. Ensuring staff and families have read and understand the flu and/or pandemic plan and understand why it’s needed;
3. Communicating reliable information to staff and children’s families on the issues listed below in their languages and at their reading levels:
4. How to help control the spread of flu by handwashing/cleansing and covering the mouth when coughing or sneezing (see http://www.cdc.gov/flu/school/);
5. How to recognize a person that may have the flu, and what to do if they think they have the flu (see http://www.pandemicflu.gov);
6. How to care for family members who are ill (see https://www.cdc.gov/flu/pdf/freeresources/general/influenza_flu_homecare_guide.pdf);
7. How to develop a family plan for dealing with a flu pandemic (see https://www.cdc.gov/flu/pandemic-resources/index.htm).
Infection control policy and procedures:
1. Developing a plan for keeping children who become ill at the child care facility away from other children until the family arrives, such as a fixed place for holding children who are ill in an area of their usual caregiving room or in a separate room where interactions with unexposed children and staff will be limited;
2. Establishing and enforcing guidelines for excluding children with infectious diseases from attending the child care facility (1);
3. Teaching staff, children, and their parents/guardians how to limit the spread of infection (see http://www.cdc.gov/flu/school);
4. Maintaining adequate supplies of items to control the spread of infection;
5. Educating families about the influenza vaccine, including that experts recommend yearly influenza vaccine (and an influenza-specific vaccine, for example H1N1, if necessary) for everyone, however, if there is a vaccine shortage, priority should be given to children and adolescents six months through eighteen years of age, caregivers/teachers of all children younger than five years of age, and health care professionals (see http://www.cdc.gov/flu/);
6. Staff caring for all children should receive annual vaccination against influenza (and an influenza-specific vaccine such as what was used during the 2009 H1N1 pandemic, if necessary) each year, preferably before the start of the influenza season (as early as August or September) and as long as influenza is circulating in the community, immunization should continue through March or April;
7. Maintaining accurate records when children or staff are ill with details regarding their symptoms and/or the kind of illness (especially when influenza was verified through testing);
8. Practicing daily health checks of children and adults each day for illness;
9. Determining guidelines to support staff members to remain home if they think they might be ill and a mechanism to provide paid sick leave so they can stay home until completely well without losing wages.
Child learning and program operations:
1. Plan how to deal with program closings and staff absences;
2. Support families in continuing their child’s learning if the child care program or preschool is closed;
3. Plan ways to continue basic functions (meeting payroll, maintaining communication with staff, children, and families) if modifications to program planning are necessary or the program is closed.

The facility should also include procedures for staff and parent/guardian training on this plan.

Some of the above plan components may be beyond the scope of ability in a small family child care home. In this case, the caregiver/teacher should work closely with a child care health consultant to determine what specific procedures can be implemented and/or adapted to best meet the needs of the caregiver/teacher and the families s/he serves.

RATIONALE

Yearly or seasonal influenza is a serious illness that requires specific management to keep children healthy. A pandemic flu is a flu virus that spreads rapidly across the globe because most of the population lacks immunity (1,2). The goals of planning for an influenza pandemic are to save lives and to reduce adverse personal, social, and economic consequences of a pandemic. Pandemics, while rare, are not new. In the twentieth century, three flu pandemics were responsible for more than fifty million deaths worldwide, including more than 20 million deaths in the United States (2).
The 2009 influenza A (H1N1) pandemic was the first in the 21^st century that resulted in between 151,700 and 575,400 deaths worldwide (2). As it is not possible to predict with certainty when the next flu pandemic will occur or how severe it will be, seasonal flu management and preparation is essential to minimize the potentially devastating effects (1-4).

COMMENTS

The Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP) recommend annual influenza vaccination for children and caregivers/teachers in child care settings (1,2,5,6). Vaccination is the best method for preventing flu and its potentially severe complications in children (1,2,5,6). The CDC and AAP recommend children and adolescents six months through eighteen years of age, for all adults including household contacts, caregivers/teachers of all children younger than five years of age, and health care professionals get the flu vaccine. Certain groups of children are at increased risk for flu complications. Child care health consultants are very helpful with finding and coordinating the local resources for this planning. In addition most state and/or local health departments have resources for pandemic flu planning.

For additional resources, see:

Centers for Disease Control and Prevention Influenza (Flu): https://www.cdc.gov/flu/
Children, the Flu and the Flu Vaccine: http://www.cdc.gov/flu/protect/children.htm
Protecting Against Influenza (Flu): Advice for Caregivers of Young Children: http://www.cdc.gov/flu/protect/infantcare.htm

TYPE OF FACILITY

Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home

RELATED STANDARDS

3.1.1.1 Conduct of Daily Health Check
3.2.2.2 Handwashing Procedure
3.2.3.2 Cough and Sneeze Etiquette
3.6.1.1 Inclusion/Exclusion/Dismissal of Ill Children
3.6.1.2 Staff Exclusion for Illness
3.6.1.4 Infectious Disease Outbreak Control
3.6.2.1 Exclusion and Alternative Care for Children Who Are Ill
7.3.3.1 Influenza Immunizations for Children and Staff
9.2.4.3 Disaster Planning, Training, and Communication
9.4.1.2 Maintenance of Records
Appendix A: Signs and Symptoms Chart
Appendix G: Recommended Childhood Immunization Schedule
Appendix H: Recommended Adult Immunization Schedule

REFERENCES

Aronson, S. S., T. R. Shope, eds. 2017. Managing infectious diseases in child care and schools: A quick reference guide, pp. 43-48. 4^th Edition. Elk Grove Village, IL: American Academy of Pediatrics.
American Academy of Pediatrics. Influenza In: Kimberlin DW, Brady MT, Jackson MA, Long SS, eds. Red Book: 2018 Report of the Committee on Infectious Diseases. 31st Edition. Itasca, IL: American Academy of Pediatrics; 2018: 476-477
Centers for Disease Control and Prevention. 2016. Preventing the flu: Good habits can help stop germs. https://www.cdc.gov/flu/protect/habits.htm.
American Academy of Pediatrics. 2017. Influenza/pandemics. https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/Children-and-Disasters/Pages/Influenza-Pandemics.aspx.
Centers for Disease Control and Prevention. 2016. Children, the flu, and the flu vaccine. https://www.aap.org/en-us/Documents/disasters_dpac_InfluenzaHandout.pdf.
American Academy of Pediatrics. 2015. Influenza prevention and control. Strategies for early education and child care programs. https://www.aap.org/en-us/Documents/disasters_dpac_InfluenzaHandout.pdf.

9.2.4.5: Emergency and Evacuation Drills Policy

Content in the STANDARD was modified on 03/22/2022.

Early care and education programs should have a written policy listing the drills they’ll practice in case of natural disasters, and emergencies caused by people. Programs should practice drills that are relevant to their local region or based on recently reported emergencies. The drills should prepare staff and children to respond appropriately to:^1–4

Evacuation emergencies: a perceived or real hazard or threat (e.g., bomb threat, fire, flood, gas leak, chemical spill) requires leaving the building or area
Shelter-in-place emergencies: a perceived or real hazard or threat (e.g., tornado, earthquake) requires finding a safe place to stay temporarily
Lockdown emergencies: a perceived or real hazard or threat in the building (e.g., violent or hostile intruder) requires being locked inside classrooms
Lockout emergencies: a perceived or real hazard or threat outside the building (e.g., dangerous person reported in the area; threatening animals) requires children and staff who are outside to be brought inside (which is known as a reverse evacuation) and the building to be secured

Teachers and staff should practice these plans and drills on a set schedule. Programs should not include children in drills that are very intense or frightening, such as those acting out injuries or an intrusion. To develop their policies, programs should follow local and state licensing regulations for drills. Programs also should ask experts in the community about preparing for emergencies (e.g., how to plan drills). These experts include fire officials, law enforcement officials, emergency response personnel, health care providers, and infant and early childhood mental health and child care health consultants.

The written policy should include:

The types of emergencies the program is likely to have and suitable drills for each emergency (including instructions for that type of drill)
How often to practice these drills
- Drills are a priority and should be practiced often.
Limiting children to drills they are developmentally ready for (e.g., excluding them from very intense drills that realistically simulate hostile or harmful events)
Including children with special health care needs and disabilities in drills to determine if accommodations are needed
- Each child’s individual health plan, medications, and equipment should be evacuated with them.
The importance of practicing drills at different times, including nap time and during different activities, and from all exits
Using the daily roster during the drill to account for all children. Refer to Standard 9.2.4.6: Use of Daily Roster During Evacuation Drills.
- Plans for moving children, including infants and children with special health care needs or disabilities, from areas of potential danger⁵
How to notify staff, children, and families before a drill⁶
Importance of:
- The staff being alert to signs of psychological distress in children during and after drills
- The staff modeling calm behavior during drills
- Children learning safety skills (e.g., how to stay quiet and how to follow instructions)
Documenting all drill practices, as described in Standard 9.4.1.16: Evacuation and Shelter-In-Place Drill Record

RATIONALE

Written policies that require practicing routine drills will help early care and education programs respond well to natural disasters or events caused by people, and remain safe.7 Some drills for emergencies caused by natural disasters (e.g., coastal flooding, wildfires) may need more frequent practice. Also, the turnover of staff and children, and children’s changing developmental abilities, require scheduling regular drills. When conducted with care and notice, drills increase skills and minimize unnecessary, but significant, distress and psychological harm.¹ For example, it is not appropriate to include children in very intense drills, such as drills with:

An injured adult
A shooter and real weapons
Simulated gunfire, or blanks
Realistic images of wounds or injuries
Aggressive re-enactments; or other simulations of attacks^1,6

However, it may be appropriate for only staff to participate in these types of drills.⁸

In developing written policies and plans, it is important to get help from first responders, and local fire and police departments. These public safety experts not only advise programs, but they can observe drills. Plans will be different depending on the emergency (i.e., natural and environmental disasters, shooters, chemical exposures, etc.) and can include locking doors, turning off lights, keeping quiet, turning off ventilation systems, gathering in rooms that are windowless or in the basement, etc.

Emergency personnel also get to know the program and its plans in case they must respond to the site. Fire department officials and inspectors may advise, improve, and certify a safe evacuation plan, including routes, specific number of minutes, and other procedures. For example, in family child care homes, the infant rooms or napping areas might be on levels other than the main level. This makes it especially important that the fire inspector or fire department representative approve (in writing) the program’s evacuation plan.

Health and mental health professionals can help staff remain calm during drills. They also may help staff prepare for and lessen psychological effects, encourage children and families to be prepared and resilient, and ensure that children’s needs (including infant, mobility, and special health care needs) are addressed.⁹ Advice from these professionals can make sure accommodations are based on children’s unique vulnerabilities and the program’s environment and layout.¹ For example, they may advise programs to use wheeled cribs or other equipment to evacuate infants, children who are immobile, and other children with special health care needs or disabilities, if rolling is possible on the evacuation route(s).⁶

ADDITIONAL RESOURCES

California Childcare Health Program, Sample Emergency Disaster Drills

https://cchp.ucsf.edu/content/sample-emergency-disaster-drills

National Association of School Psychologists. National Association of School Resource Officers.

Best Practice Considerations for Armed Assailant Drills

TYPE OF FACILITY

Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home

RELATED STANDARDS

5.4.5.2 Cribs
9.2.4.1 Written Plan and Training for Handling Urgent Medical or Threatening Incidents
9.2.4.3 Disaster Planning, Training, and Communication
9.2.4.6 Use of Daily Roster During Evacuation Drills
9.4.1.16 Evacuation and Shelter-In-Place Drill Record

REFERENCES

Schonfeld DJ, Hashikawa AN, Melzer-Lange M, Gorski PA; AAP Council on Children and Disasters; Council on Injury, Violence, and Poison Prevention; Council on School Health. Participation of children and adolescents in live crisis drills and exercises. Pediatrics. 2020;146(3):e2020015503
American Academy of Pediatrics. School Safety During an Emergency or Crisis: What Parents Need to Know. HealthyChildren.org Web site. https://www.healthychildren.org/English/safety-prevention/all-around/Pages/Actions-Schools-Are-Taking-to-Make-Themselves-Safer.aspx. Updated April 2021. Accessed February 15, 2022.
North Dakota Department of Public Instruction. Lockdown Drills. ED.gov Web site. https://files.eric.ed.gov/fulltext/ED524982.pdf. Accessed February 15, 2022.
Department of Homeland Security. Planning Considerations: Evacuation and Shelter-in-Place Guidance for State, Local, Tribal, and Territorial Partners. Published July 2019. FEMA.gov Web site. https://www.fema.gov/sites/default/files/2020-07/planning-considerations-evacuation-and-shelter-in-place.pdf. Accessed February 15, 2022.
U.S. General Services Administration. Sample Child Care Evacuation Plan. Reviewed October 11, 2018. GSA.gov Web site. https://www.gsa.gov/resources-for/citizens-consumers/child-care/child-care-services/for-professionals-providers/emergency-management/sample-child-care-evacuation-plan. Accessed February 15, 2022.
Schonfeld DJ, Rossen E, Woodard D. Deception in schools — when crisis preparedness efforts go too far. JAMA Pediatr. 2017;171(11):1033–1034.
State Capacity Building Center, Office of Child Care, U.S. Department of Health and Human Services Administration for Children and Families. Emergency Preparedness, Response, and Recovery: Hostile Intruders. How Do States and Territories Plan For and Respond to Hostile Intruder Incidents? HHS.gov Web site. https://childcareta.acf.hhs.gov/sites/default/files/public/hostile_intruder_0.pdf. Published September 2017. Accessed February 15, 2022.
National Center on Early Childhood Health and Wellness, U.S. Department of Health and Human Services Administration for Children and Families Office of Head Start. Emergency Preparedness Manual for Early Childhood Programs. 2020 Edition. HHS.gov Web site. https://eclkc.ohs.acf.hhs.gov/sites/default/files/pdf/emergency-preparedness-manual-early-childhood-programs.pdf. Accessed February 15, 2022.
Needle S, Wright J, Disaster Preparedness Advisory Council, Committee on Pediatric Emergency Medicine. Ensuring the health of children in disasters. Pediatrics. 2015;136(5). https://publications.aap.org/pediatrics/article/136/5/e1407/33847/Ensuring-the-Health-of-Children-in-Disasters

NOTES

Content in the STANDARD was modified on 03/22/2022.

9.2.4.6: Use of Daily Roster During Evacuation Drills

The center director or his/her designees should use the daily class roster(s) in checking the evacuation and return to a safe space for ongoing care of all children and staff members in attendance during an evacuation drill. In centers caring for more than thirty children enrolled, the center director should assign one caregiver per classroom, the responsibility of bringing the class roster on evacuation drills and accounting for every child and classroom staff at the onset of the evacuation, at the evacuation site and upon return to a safe place. The center director or designee should account for all non-classroom staff, volunteers, and visitors during the evacuation drill process using the program’s sign-in/sign-out system.

Small and large family home child caregivers/teachers should count or use a daily roster to be sure that all children and staff are safely evacuated and returned to a safe space for ongoing care during an evacuation drill.

RATIONALE

There must be a plan to account for all the children and adults in a facility at the time of an evacuation. Assigning responsibility to use a roster(s) in a center, or count the children and adults in a large or small family child care home, ensures that all children and adults are accounted for. Practice accounting for children and adults during evacuation drills makes it easier to do in an emergency situation.

TYPE OF FACILITY

Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home

RELATED STANDARDS

9.2.4.7 Sign-In/Sign-Out System

9.2.4.7: Sign-In/Sign-Out System

The facility should have a sign-in/sign-out system to track who enters and exits the facility. The system should include name, contact number, relationship to facility (e.g., parent/guardian, vendor, guest, etc.) and recorded time in and out.

RATIONALE

This system helps to maintain a secure environment for children and staff. It also provides a means to contact visitors if needed (such as a disease outbreak) or to ensure all individuals in the building are evacuated in case of an emergency.

TYPE OF FACILITY

Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home

RELATED STANDARDS

9.2.4.8 Authorized Persons to Pick Up Child
9.2.4.9 Policy on Actions to Be Followed When No Authorized Person Arrives to Pick Up a Child
9.2.4.10 Documentation of Drop-Off, Pick-Up, Daily Attendance of Child, and Parent/Provider Communication

9.2.4.8: Authorized Persons to Pick Up Child

Content in the STANDARD was modified on 08/27/2020.

During the enrollment process, the legal guardian(s) of the child should be established and documented along with clarification and documentation of any custody issues and court orders. A noncustodial parent should not be allowed to pick up a child without permission from the custodial parent.

Also, during enrollment, names, addresses, and telephone numbers of persons authorized to take a child out of the early care and education program should be documented.

Early care and education program staff should establish a written policy for identifying individuals for whom the parents/guardians have given prior written authorization to pick up their child, such as requiring photo ID or including a photo of each authorized person in the child’s file.

If there is a circumstance in which the parent/guardian or other authorized person is not able to pick up the child, another individual may pick up a child if they are authorized to do so by the parent/guardian in authenticated communication. This communication can be

A witnessed phone conversation in which the caller provides prespecified identifying information (ie, passwords). The telephone authorization should be confirmed by a return call to the parents/guardians.
Written permission (paper, email, or text message) that includes the name, address of the individual picking up the child, and current date.¹
The individual authorized to pick up the child must show valid identification (photo ID) during pickup.

Policies and procedures should address how the early care and education program will handle the situation if a parent/guardian arrives who is intoxicated or otherwise incapable of bringing the child home safely. Caregivers/teachers should not attempt to handle on their own an unstable (ie, intoxicated or aggressive) parent/guardian who wants to enter the facility but whose behavior poses a risk to the children. Early care and education programs have the right to deny access to anyone who poses a potential risk to children enrolled in the early care and education program.²

Should an unauthorized individual attempt to pick up a child without the early care and education program receiving prior communication with the parent/guardian, the parent/guardian should be contacted immediately. If the parent/guardian does not provide authenticated communication about the individual, the child will not be permitted to leave the early care and education program. The early care and education program should document information about the individual attempting to pick up the child. If the individual does not leave and their behavior is concerning to the early care and education staff, or if the child is abducted by force, the police should be contacted immediately with a detailed description of the individual and any other obtainable information, such as a license plate number.¹

Early care and education programs should consider having a child car seat policy stating all authorized persons who pick up a child must have an age-appropriate car seat to transport the child. This policy is discussed with parents/guardians during the enrollment process. Repeated failure to comply with the policy may be grounds for dismissal. Many early care and education programs have extra car seats on hand to lend in case a parent/guardian forgets one.

RATIONALE

Releasing a child into the care of an unauthorized person may put the child at risk. If the caregiver/teacher does not know the person, it is the caregiver’s/teacher’s responsibility to verify that the person picking up the child is authorized to do so. This requires checking the written authorization in the child’s file and verifying the identity of the person.

TYPE OF FACILITY

Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home

RELATED STANDARDS

9.2.4.9 Policy on Actions to Be Followed When No Authorized Person Arrives to Pick Up a Child

REFERENCES

Child Care Law Center. Know the law about who may pick up a child from child care. http://childcarelaw.org/wp-content/uploads/2014/06/Know-the-Law-About-Who-May-Pick-a-Child-Up-From-Child-Care-in-California.pdf. Published June 2014. Accessed May 18, 2020
Cal Health & Safety Code §1596.857(g)

NOTES

Content in the STANDARD was modified on 08/27/2020.

9.2.4.9: Policy on Actions to Be Followed When No Authorized Person Arrives to Pick Up a Child

Content in the STANDARD was modified on 08/27/2020.

Early care and education programs should have a written policy identifying actions to be taken when no authorized person arrives to pick up a child. The plan should be developed in consultation with the child care health consultant, local law enforcement, and child protective services. The plan should also be shared with each child’s parent or guardian during the enrollment process, so that these individuals understand what to expect in this type of situation.

In the event that no authorized person arrives to pick up a child, the early care and education program should attempt to reach each authorized contact listed in the child’s record. If these efforts fail, the program should immediately implement the written policy on actions to be followed when no authorized person arrives to pick up a child.

RATIONALE

Early care and education programs are responsible for all the children in their care. If an authorized person does not come to pick up a child, and one cannot be reached, caregivers/teachers must know what authority to call and to whom they can legally and safely release the child. This is to ensure the safety of the child and to protect the early care and education program from legal action.

COMMENTS

ADDITIONAL RESOURCES

Pennsylvania Chapter of the American Academy of Pediatrics. Model Child Care Health Polices. Aronson SS, ed. 5th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2014

TYPE OF FACILITY

Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home

RELATED STANDARDS

9.2.4.8 Authorized Persons to Pick Up Child

NOTES

Content in the STANDARD was modified on 08/27/2020.

9.2.4.10: Documentation of Drop-Off, Pick-Up, Daily Attendance of Child, and Parent/Provider Communication

Child care programs should have policies that include:

A daily attendance record should be maintained, listing the times of arrival and departure of the child, as well as the person dropping off and picking up;
Parents/guardians are expected to communicate (confirmation required) with the caregiver/teacher/program on a daily basis by a specified time if their child will not be in attendance;
The caregiver/teacher/program must communicate as early as possible (within one hour) with the parent/guardian if there is no communication from the parent/guardian about a child’s absence. If the caregiver/teacher/program is unable to reach the child’s parent/guardian, emergency contacts will be notified;
A timely method of communication (phone, email, text, etc.) between the parent/guardian and the caregiver/teacher/program should be agreed upon at the time of enrollment;
A printed roster should be available in the event of an evacuation drill or evacuation to account for the children in care.

RATIONALE

Operational control to accommodate the health and safety of individual children requires basic information regarding each child in care. This standard ensures that the facility knows which children are receiving care at any given time including evacuation. It aids in the surveillance of child:staff ratios, knowledge of potentially infectious diseases (i.e., influenza), planning for staffing, and provides data for program planning. Accurate record keeping also aids in tracking the amount (and date) of service for reimbursement and allows for documentation in the event of child abuse allegations or legal action involving the facility. Furthermore, each year, twenty to forty children die from hyperthermia after being left/locked in a car or van. Some of these unfortunate deaths include children whose parents/guardians meant to drop their child off at a child care program or preschool; thus, timely communication with these parents/guardians could prevent death from hyperthermia (1,2).

COMMENTS

Time clocks and cards can serve as verification, but they should be signed by the adult who drops off and picks up the child each day. Some notification system should be used to alert the caregiver/teacher whenever the responsibility for the care of the child is being transferred to or from the caregiver/teacher to another person.

TYPE OF FACILITY

Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home

RELATED STANDARDS

9.2.4.7 Sign-In/Sign-Out System
Appendix F: Enrollment/Attendance/Symptom Record

REFERENCES

Guard, A., S. S. Gallagher. 2005. Heat related deaths to young children in parked cars: An analysis of 171 fatalities in the United States, 1995-2002. Injury Prevention 11:33-37.
Null, J. 2010. Hyperthermia deaths of children in vehicles. San Francisco State University. http://ggweather.com/heat/.

9.2.5 Transportation Policies

9.2.5.1: Transportation Policy for Centers and Large Family Homes

Written policies should address the safe transport of children by vehicle to or from the facility, including field trips, home pick-ups and deliveries, and special outings. The transportation policy should include:

Licensing of vehicles and drivers;
Vehicle selection to safely transport children, based on vehicle design and condition;
Operation and maintenance of vehicles;
Driver selection, training, and supervision;
Child:staff ratio during transport;
Accessibility to first aid kit, emergency ID/contact and pertinent health information for passengers, cell phone, or two-way radio;
Permitted and prohibited activities during transport;
Backup arrangements for emergencies;
Use of seat belt and car safety seat, including booster seats;
Drop-off and pick-up plans;
Plan for communication between the driver and the child care facility staff;
Maximum travel time for children (no more than forty-five minutes in one trip);
Procedures to ensure that no child is left in the vehicle at the end of the trip or left unsupervised outside or inside the vehicle during loading and unloading the vehicle;
Use of passenger vans.

RATIONALE

Motor vehicle crashes are the leading cause of death in children two to fourteen years of age in the United States (1). It is necessary for the safety of children to require that the caregiver/teacher comply with requirements governing the transportation of children in care, in the absence of the parent/guardian. Not all vehicles are designed to safely transport children, especially young children. The National Highway Traffic Safety Administration (NHTSA) recommends that preschool and school aged children should not be transported in twelve- or fifteen-passenger vehicles due to safety concerns (2,3). Children have died because they have fallen asleep and been left in vehicles. Others have died or been injured when left outside the vehicle when thought to have been loaded into the vehicle. The process of loading and unloading children from a vehicle can distract caregivers/teachers from adequate supervision of children either inside or outside the vehicle. Policies and procedures must account for the management of these risks.

COMMENTS

Maintenance should include an inspection checklist for every trip. Vehicle maintenance service should be performed according to the manufacturer’s recommendations or at least every three months.

TYPE OF FACILITY

Center, Early Head Start, Head Start, Large Family Child Care Home

RELATED STANDARDS

1.1.1.4 Ratios and Supervision During Transportation
6.5.1.2 Qualifications for Drivers
6.5.2.1 Drop-Off and Pick-Up
6.5.2.2 Child Passenger Safety
6.5.3.1 Passenger Vans
9.2.5.2 Transportation Policy for Small Family Child Care Homes

REFERENCES

National Safety Council (NSC). 2009. Injury facts. 2009 ed. Chicago: NSC.
National Highway Traffic Safety Association. Safecar.gov. http://www.safercar.gov.
National Highway Traffic Safety Association. Passenger van safety. http://www.safercar.gov/Vehicle+Shoppers/Passenger+Van+Safety/.

9.2.5.2: Transportation Policy for Small Family Child Care Homes

Written policies should address the safe transport of children by vehicle to and from the small family child care home for any reason while the children are attending child care. Policies should include field trips or special outings. The following should be provided for:

Child:staff ratio during transport;
Backup arrangements for emergencies;
Use of seat belt and car safety seat, including booster seats;
Accessibility to first aid kit, emergency ID/contact and pertinent health information for passengers, and cell phone or two-way radio;
Licensing of vehicles and drivers;
Maintenance of the vehicles;
Safe use of air bags;
Maximum travel time for children (no more than forty-five minutes in one trip);
Procedures to ensure that no child is left in the vehicle at the end of the trip or left unsupervised outside or inside the vehicle during loading and unloading the vehicle;
Use of passenger vans.

RATIONALE

Motor vehicle crashes are the leading cause of death for children between one and fourteen years of age in the United States (1). It is necessary for the safety of children to require that the caregiver comply with minimum requirements governing the transportation of children in care, in the absence of the parent/guardian. Children have died because they have fallen asleep and left in vehicles. Others have died or been injured when left outside the vehicle when thought to have been loaded into the vehicle. The process of loading and unloading children from a vehicle can distract caregivers/teachers from adequate supervision of children either inside or outside the vehicle. Policies and procedures should account for the management of these risks.

TYPE OF FACILITY

Early Head Start, Head Start, Small Family Child Care Home

RELATED STANDARDS

1.1.1.4 Ratios and Supervision During Transportation
6.5.2.2 Child Passenger Safety
6.5.3.1 Passenger Vans
9.2.5.1 Transportation Policy for Centers and Large Family Homes

REFERENCES

Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. 2008. Web-based injury statistics query and reporting system. http://www.cdc.gov/ncipc/wisqars/.

9.2.6 Play Area Policies

9.2.6.1: Policy on Use and Maintenance of Play Areas

Child care facilities should have a policy on the use and maintenance of play areas that address the following:

Safety, purpose, and use of indoor and outdoor equipment for gross motor play;
Selection of age-appropriate equipment;
Supervision of indoor and outdoor play spaces;
Staff training (to be addressed as employees receive training for other safety measures);
Recommended inspections of the facility and equipment, as follows:
1. Inventory, once at the time of purchase, and updated when changes to equipment are made in the playground;
2. Audits of the active (gross motor) play areas (indoors and outdoors) by an individual with specialized training in playground inspection, once a year;
3. Monthly inspections to check for U.S. Consumer Product Safety Commission (CPSC) recalled or hazard warnings on equipment, broken equipment or equipment in poor repair that requires immediate attention;
4. Daily safety check of the grounds for safety hazards such as broken bottles and toys, discarded cigarettes, stinging insect nests, and packed surfacing under frequently used equipment like swings and slides;
5. Whenever injuries occur.

For centers, the policy should be written. Documentation of the recommended inspections should be maintained in a master file.

RATIONALE

Properly laid out outdoor play spaces, age-appropriate, properly designed and maintained equipment, installation of energy-absorbing surfaces, and adequate supervision of the play space by caregivers/teachers/parents/guardians help to reduce both the potential and the severity of injury (2). Indoor play spaces must also be properly laid out with care given to the location of equipment and the energy-absorbing surface under the equipment. A written policy with procedures is essential for education of staff and may be useful in situations where liability is an issue. The technical issues associated with the selection, maintenance, and use of playground equipment and surfacing are complex and specialized training is required to conduct annual inspections. Active play areas are associated with the most frequent and the most severe injuries in child care (1).

COMMENTS

Increasing awareness and understanding of issues in child safety highlight the importance of developing and maintaining safe play spaces for children in child care settings (3). Parents/guardians expect that their child will be adequately supervised and will not be exposed to hazardous play environments, yet will have the opportunity for free, creative play.

To obtain information on identifying a Certified Playground Safety Inspector (CPSI) to inspect a playground, contact the National Recreation and Park Association (NRPA) at http://www.nrpa.org/Content.aspx?id=3531.

The National Program for Playground Safety (NPPS) is another source of information on playground safety at http://www.uni.edu/playground/.

TYPE OF FACILITY

Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home

RELATED STANDARDS

9.2.6.2 Reports of Annual Audits/Monthly Maintenance Checks of Play Areas and Equipment
9.2.6.3 Records of Proper Installation and Maintenance of Facility Equipment

REFERENCES

Rivara, F. P., J. J. Sacks. 1994. Injuries in child day care: An overview. Pediatrics 94:1031-33.
U.S. Consumer Product Safety Commission. 2008. Public playground safety handbook. Washington, DC: CPSC. http://www.cpsc.gov/cpscpub/pubs/325.pdf.
Quality in Outdoor Environments for Child Care. POEMS Website. http://www.poemsnc.org.

9.2.6.2: Reports of Annual Audits/Monthly Maintenance Checks of Play Areas and Equipment

Report forms should be used to record the results of the annual audits of the indoor and outdoor play areas and monthly maintenance inspections of play equipment and surfaces. Corrective actions taken to eliminate hazards and reduce the risk of injury should be included in the reports. The forms should be filed in the facility’s master file. The forms should be reviewed by the facility annually and should be retained for the number of years required by the state’s statute of limitations.

RATIONALE

Written records of annual audits of the indoor and outdoor play areas, monthly maintenance inspections and appropriate corrective action are necessary to reduce the risk of potential injury. Annual review of such records provides a mechanism for periodic monitoring and improvement of equipment and surface type and quality (1).

COMMENTS

Individual jurisdictions may have specific regulations regarding information, records, equipment, policies, and procedures.

A sample site checklist is provided in Model Child Care Health Policies, available at http://www.ecels-healthychild
carepa.org/content/MHP4thEd Total.pdf.

For more information regarding facility equipment, contact ASTM International (ASTM) at http://www.astm.org, the U.S. Consumer Product Safety Commission (CPSC) at http://www.cpsc.gov, and the National Program for Playground Safety (NPPS) at http://www.uni.edu/playground/.

For information about playground safety see the Public Playground Safety Handbook, available at http://www.cpsc
.gov/cpscpub/pubs/325.pdf and Outdoor Home Playground Safety Handbook available at http://www.cpsc.gov/cpsc
pub/pubs/324.pdf.

TYPE OF FACILITY

Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home

RELATED STANDARDS

9.2.6.1 Policy on Use and Maintenance of Play Areas

REFERENCES

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

9.2.6.3: Records of Proper Installation and Maintenance of Facility Equipment

The facility should maintain all information and records pertaining to the manufacture, installation, and regular inspection of facility equipment. Recordkeeping on play area equipment is specified in Standard 9.2.6.2. No second-hand equipment should be used in areas occupied by children, unless all pertinent data, including checking for recalls and the manufacturer’s instructions, can be obtained from the previous owner or from the manufacturer. All equipment should meet ASTM International (ASTM) standards.

RATIONALE

Information regarding manufacture, installation, and maintenance of equipment is essential so that the staff can follow appropriate instructions regarding installation, repair, and maintenance procedures. Also, in the event of recalls, the information provided by the manufacturer allows the owner to identify the applicability of the recall to the equipment on hand. Products used in areas occupied by children must have these instructions for identification, maintenance, repair, and reference in case of recall.

COMMENTS

Individual jurisdictions may have specific regulations regarding information, records, equipment, policies, and procedures.

For more information regarding facility equipment requirements, contact the ASTM at http://www.astm.org and the U.S. Consumer Product Safety Commission (CPSC) at http://www.cpsc.gov.

TYPE OF FACILITY

Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home

RELATED STANDARDS

9.2.6.1 Policy on Use and Maintenance of Play Areas