FAQ

This document includes answers to consumers' common inquiries regarding:

clarification of CFOC standards
implementation of CFOC standards, and
research that informed CFOC standard development.

DATE	TOPIC & LOCATION	QUESTION	ANSWER
Chapter 1: Staffing
10/13/2011	*Chapter 1* Staffing 1.4.3 First Aid and CPR Training	If a staff member is certified in pediatric first aid and pediatric cardiopulmonary resuscitation (CPR) from the American Heart Association (AHA) or Red Cross (which follows the AHA guidelines), is it reasonable to assume that rescue breathing skills were included in the CPR course? If not, it sounds like teaching staff would need to take healthcare provider level training in order to receive training in rescue breathing.	Yes. The key is that providers be required to take pediatric first aid and CPR.
10/13/2011	*Chapter 1* Staffing 1.6 Consultants	The National Association for the Education of Young Children (NAEYC) criterion 5.A.02 and its “guidance” state that the health consultant is “either a licensed pediatric health professional or a health professional with specific training in health consultation for early childhood programs.” “Licensed pediatric health professionals include (but are not limited to) pediatricians, family practice physicians, pediatric nurses, or pediatric nurse practitioners. Child care health consultation is a growing specialty for which training is available.” Do the individuals described in the NAEYC criteria meet the CFOC standard regarding the qualifications for a health consultant?	Yes.
10/13/2011	Chapter 1 Staffing 1.6 Consultants	There seems to be a stronger focus in the CFOC standards on mental health consultants. Could a general health consultant fulfill this role or would the individual need specific training in mental health issues?	The philosophy behind the three standards (general health, early childhood mental health, and early childhood education consultants) is that there is a continuum of care. The CCHC would often be first to determine that a mental health consultant should be involved for more intense consultation; likewise a mental health consultant may refer general issues back to the CCHC.
02/17/2012	*Chapter 1* Staffing 1.7.0.1: Pre-Employment and Ongoing Adult Health Appraisals, Including Immunization	This standard title suggests that something will be said about ongoing adult health appraisals and immunization, but the standard only addresses prechild contact requirements. Further, isn’t a “pre-employment” health appraisal not permitted before a job offer is made per the Equal Employment Opportunity Commission regulations? Shouldn’t there be a requirement for a health appraisal whenever someone has a change in position or role that has physical requirements and at least at the intervals recommended by whoever makes credentialed recommendations for such services for adults?	The intention of this standard is that a pre-employment health appraisal of all paid and volunteer staff should be conducted and that ongoing health appraisals should be required based on the employee’s primary health care provider’s recommendation and/or if there is a change in the physical requirements of the position or role. "Pre-employment" does not mean pre-hire. Often a job offer is issued and a pre-employment screening is then required prior to the assigned employment date.
10/13/2011	*Chapter 1* Staffing 1.1.1 Child:Staff Ratio and Group Size	Is CFOC recommending that programs do not need to meet staffing ratios during nap time for children older than 31 months?	Yes, for large family child care homes and centers. However, maximum group size must be maintained.
Chapter 2: Program Activities for Healthy Development
10/13/2011	Chapter 2 Program Activities Standard 2.2.0.2: Limiting In-fant/Toddler Time in Crib, High Chair, Care Seat, Etc.	Please provide more contexts surrounding the research that informed the recommendation that “children should not be left to sleep in equipment, such as car seats, swings, or infants seats that do not meet the ASTM International (ASTM) product safety standards for sleep equipment.” Is part of the intent regarding this standard to educate parents about safe infant sleep practices or is it actually dangerous for infants to sleep sitting up, or both?	Both. Extended periods of time in the crib, high chair, car seat, or other confined space limits infants’ physical growth (gross motor development) and also affects their social interactions. Injuries and Sudden Infant Death Syndrome (SIDS) have occurred when children have been left to sleep in car seats or infants seats. Please see the Standard’s rationale and references for information on related injuries and SIDS.
03/08/2012	*Chapter 2* Program Activities Standard 2.2.0.3: Limiting Screen Time - Media, Computer Time	This standard states that children two years and older in early care and education settings should not be exposed to more than thirty minutes per week of screen time and that computer use should be limited to no more than fifteen minute increments. Is the fifteen minute increment for computer use included in the total screen time of thirty minutes per week?	Yes.
Chapter 3: Health Promotion and Protection
10/13/2011	*Chapter 3* Health Promotion 3.1.4 Safe Sleep	Does the American Academy of Pediatrics (AAP) recommend pacifier use for infants who have already established breastfeeding as a means to help prevent Sudden Infant Death Syndrome (SIDS) or is the research on this topic still emerging?	Both.
10/13/2011	*Chapter 3* Health Promotion 3.1.4 Safe Sleep	CFOC states that no monitors should be used. Does this mean no heart/breathing monitors should be used or no mirrors/videos/sound monitors?	CFOC states that no “heart/breathing” monitors should be used unless ordered by the child’s primary care provider.
10/13/2011	*Chapter 3* Health Promotion 3.1.4 Safe Sleep	What research supports the recommendation that infants sleep in the same room as the caregiver and how does this relate to best practice issues regarding the “separation” of infant active play areas from infant sleep areas? There seems to be considerable research in the home environment in regards to infants sleeping in the same room as the parent(s)/guardian(s) at home to decrease the incidence of SIDS. However, there doesn’t seem to be research regarding the use of separate infant nap rooms in child care environments. What other research studies support this practice or is the recommendation erring on the side of caution due to potential program liability issues?	This practice, as discussed in Standard 3.1.4.1: Safe Sleep Practices and SIDS/Suffocation Risk Reduction, is a best practice to ensure that there is appropriate supervision of sleeping infants.
02/17/2012	*Chapter 3* Health Promotion 3.1.4 Safe Sleep	Because SIDS has no outward signs of distress by the infant, what should teachers be looking for when supervising sleeping infants other than over-heating?	Caregivers/teachers should check to ensure that the temperature in the room is comfortable for a lightly clothed adult, check the infants to ensure that they are comfortably clothed (not overheated or sweaty), and that bibs, necklaces, and garments with ties or hoods are re-moved (clothing sacks or other clothing designed for sleep can be used in lieu of blankets). Also, caregivers/teachers should ensure that the infant’s head remains uncovered and readjust clothing as needed. Please note that direct supervision will never interrupt SIDS, but can help in preventing other injury deaths.
02/17/2012	*Chapter 3* Health Promotion 3.1.4 Safe Sleep	Are play pens and play yards a safe sleep environment for infants?	Playpens and play yards, bassinets, etc. are acceptable sleep areas for infants as long as the furniture/equipment meets the ASTM F406-11b Standard Con-sumer Safety Specification for Non-Full-Size Baby Cribs/Play Yards and that they meet all of the criteria that would be expected for a crib: • a firm mattress that fits tightly without gaps, • a fitted sheet (that appropriately fits the mattress), • no bedding or blankets, and • the baby is put to sleep supine (on the back). As noted in Standard 5.4.5.2: Cribs, there are Consumer Safety Specifications for Non-Full-Size Baby Cribs/Play Yards. In this same standard the COMMENTS section states: “If portable cribs and those that are not full-size are substituted for regular full-sized cribs, they must be maintained in the condition that meets the ASTM F406-11b Standard Consumer Safety Specification for Non-Full-Size Baby Cribs/Play Yards. Portable cribs are designed so they may be folded or collapsed, with or without disassembly. Although portable cribs are not designed to withstand the wear and tear of normal full-sized cribs, they may provide more flexibility for programs that vary the number of infants in care from time to time.”
02/17/2012	*Chapter 3* Health Promotion 3.1.4 Safe Sleep	I am confused about the recent change in recommendations regarding the use of blankets during sleep. The AAP’s recent POLICY STATEMENT: SIDS and Other Sleep-Related Infant Deaths: Expansion of Recommendations for a Safe Infant Sleeping Environment states that blankets should not be used at all, but their TECHNICAL REPORT: SIDS and Other Sleep-Related Infant Deaths: Expansion of Recommendations for a Safe Infant Sleeping Environment says that “If a blanket is used, it should be thin and tucked under the mattress so as to avoid head or face covering.” Which is correct?	The focus of the AAP’s Policy Statement is group care settings (i.e., child care and early education settings), whereas the focus of the AAP’s Technical Report is hospital settings. The Technical Report also provides information that pediatricians can share with parents. As a result of the new AAP Policy Statement, the language under “Use of Blankets” in CFOC, 3^rd Edition Standard 3.1.4.1: Safe Sleep Practices and SIDS/Suffocation Risk Reduction was changed to say: “AAP recommendations state that blankets may be hazardous, and use of the blankets is not advisable.
04/05/2013	*Chapter 3* Health Promotion 3.1.4.2: Swaddling	Does CFOC ban swaddling?	CFOC Standard 3.1.4.2: Swaddling states: “In child care settings, swaddling is not recommended or necessary.” This specific language was carefully chosen and reviewed by national contributors and stakeholders, and then approved by the CFOC Steering Committee and each author organization (AAP, APHA, NRC). A child care setting is a group care setting, and therefore presents different health and safety concerns when compared to a private home. One of these concerns is inconsistency with caregivers/teachers. As noted in CFOC Standard 3.1.4.1: Safe Sleep Practices and SIDS/Suffocation Risk Reduction, “Infants who are cared for by adults other than their parent/guardian or primary caregiver/teacher are at increased risk for dying from SIDS” (Moon, 2005). To that end, implementing swaddling guidelines, training, and compliance across child care programs would be a significant challenge. We recognize the many benefits of swaddling (when done correctly) by parents/guardians for newborns and young infants in hospital nurseries and in private homes. However, the primary target audience for the CFOC standardsis caregivers/teachers in early education and child care settings. The majority of standards in CFOC use the phrase “should” or “should not.” The national contributors that developed Standard 3.1.4.2 made the conscious decision not to use this terminology in the standard language.Thus, CFOC does not ban or prohibit swaddling. Instead, it states that swaddling is not recommended or necessary. CFOC does, however, account for programs that may choose to swaddle in this same standard (Standard 3.1.4.2). The last sentence of the Comments section states: “If swaddling is used, it should be used less and less over the course of the first few weeks and months of an infant’s life.” Moreover, it is important to note that CFOC also includes Standard 1.1.2.1: Minimum Age to Enter Child Care, which states that “Healthy full-term infants can be enrolled in child care settings as early as three months of age.” The national contributors recognized that swaddling becomes less necessary for older infants, a time at which CFOC recommends entering a child care setting.
04/05/2013	*Chapter 3* Health Promotion 3.1.4.2: Swaddling	Does the AAP have a Policy Statement prohibiting Swaddling?	The American Academy of Pediatrics (AAP) does not have a Policy Statement prohibiting swaddling. The AAP does have a Policy Statement on the Safe Sleep Environment, which does recommend against loose blankets in a safe sleeping environment. “Loose bedding, such as blankets and sheets, might be hazardous and should not be used in the infant’s sleeping environment” (Task Force on Sudden Infant Death Syndrome, 2011). The AAP Technical Report specifically addresses swaddling (page e1356) in expanded recommendations for a safe infant sleep environment. The Technical Report states that “there is insufficient evidence to recommend routine swaddling as a strategy for reducing the incident of SIDS” (Task Force on Sudden Infant Death Syndrome, 2011). CFOC is co-authored by AAP, APHA, and NRC, and published by the AAP. It is consistent with AAP Policy, but is not “AAP Policy”, nor “APHA Policy”. Citations: Moon, R. e. (2005). Stable prevalence but changing risk factors for sudden infant death syndrome in child care settings in 2001. Pediatrics, 116(4):972-7. Task Force on Sudden Infant Death Syndrome. (2011). Policy Statement: SIDS and Other Sleep-Related Infant Deaths: Expansion of Recommendations for a Safe infant Sleeping Environment. Pediatrics, 128:5 1030-1039. Task Force on Sudden Infant Death Syndrome. (2011). Technical Report: SIDS and Other Sleep-Related Infant Deaths: Expansion of Recommendations for a Safe infant Sleeping Environment. Pediatrics, 128:5 e1341-e1367.
10/13/2011	*Chapter 3* Health Promotion 3.1.5 Oral Health	Is it correct that there is no research to support the practice of wiping an infant’s gums after feeding to pre-vent dental caries? Is this practice effective for infants who have teeth?	There is currently no strong research that shows any benefit to wiping the gums of a baby who has no teeth. Yes.
10/13/2011	*Chapter 3* Health Promotion Standard 3.2.1.1: Type of Diapers Worn	Does this standard allow for use of the newer cloth diapers (with either a removable or connected absorbent inner liner and waterproof Velcro closure cover)?	Yes, (for children who require cloth diapers for a medical reason), but only if the cloth diaper and cover are removed simultaneously as one unit and not removed as two separate pieces (see page 105). Please review the Comments section of this Standard for more information.
10/13/2011	*Chapter 3* Health Promotion 3.2.1 Diapering and Changing Soiled Clothing	Is it ok to allow older children to be changed standing on the floor (i.e. in the bathroom)?	Yes.
10/13/2011	*Chapter 3* Health Promotion 3.2.1 Diapering and Changing Soiled Clothing	Is there clear research that cloth diapers are not effective in preventing environmental contamination or is there just limited research on the topic?	There is limited research on this topic.
10/13/2011	*Chapter 3* Health Promotion Standard 3.2.1.4: Diaper Changing Procedure	Is the recommendation for an Environmental Protection Agency (EPA)-registered disinfectant different from the previous cleaning and sanitizing definitions? What’s the difference between a disinfectant and sanitizing agent?	For some surfaces it is important to disinfect to be healthy and safe (this is the deepest “clean”). For some surfaces sanitizing is enough to be healthy and safe, and for some surfaces cleaning is adequate. Remember that before some surfaces are disinfected or sanitized, the visible “dirt” must first be cleaned off. Please see Appendix J, Selecting an Appropriate Sanitizer or Disinfectant for more information.
11/22/2011	*Chapter 3* Health Promotion Standard 3.2.1.4: Diaper Changing Procedure	What is the rationale for requiring hand washing before diaper changing?	The diaper changing process may require many interactions with the child before the process, for example evaluating whether the diaper contains stool. Because of the potential for contamination of hands during this process, hand hygiene should be performed before collection of diaper supplies and further handling of the child to avoid contaminating the remaining diaper supplies. However, activities in child care do not occur in isolation. If hand hygiene has been done for another reason prior to a diaper changing event, the process does not have to be repeated if no contamination of hands has occurred.
10/13/2011	*Chapter 3* Health Promotion Standard 3.2.1.5: Procedure for Changing Children’s Soiled Underwear/Pull-Ups and Clothing	Should a distinction be made between “wet” and “soiled” pull-up, clothing, and underwear? Or are these terms interchangeable in the Standard and Rationale? More specifically, are the steps required for changing a pull-up with a bowel movement the same for changing a pull-up that is only wet?	The same changing procedure should be used regardless of the contents.
10/13/2011	*Chapter 3* Health Promotion 3.2.2 Hand Hygiene	Are alcohol-based hand sanitizing agents an effective alternative to soap and running water in situations other than field trips, such as in a classroom without a sink or on the playground?	The use of alcohol-based hand sanitizers is an alternative to traditional handwashing with soap and water by supervised children over 24 months of age and adults on hands that are not visibly soiled if all manufacturers’ instructions are followed. For visibly dirty hands, rinsing under running water or wiping with a water-saturated towel should be used to remove as much dirt as possible before using a hand sanitizer. But if running water is necessary before sanitizer, one may as well just clean hands using soap and water.
10/13/2011	*Chapter 3* Health Promotion 3.2.2 Hand Hygiene	This appears to be a significant change since the last CFOC edition. Can wet wipes be used to clean infant’s hands or is running water and soap recommended?	Pre-moistened cleansing towelettes do not effectively clean hands and should not be used as a substitute for washing hands with soap and running water.
10/13/2011	*Chapter 3* Health Promotion Standard 3.2.2.2: Handwashing Procedure	This standard recommends that children and staff members rub their hands with a soapy lather for at least 20 seconds. Why was this changed from 10 seconds?	This recommendation follows the recommendation of the Centers for Disease Control (CDC). This reference can be found at: http://www.cdc.gov/handwashing/.
10/13/2011	*Chapter 3* Standard 3.2.2.5: Hand Sanitizers	Is there evidence to address the flammability risk of hand sanitizers and the recommended countermeasures with this product?	Hand sanitizers are flammable as noted on product labels. Standard 5.5.0.5: Storage of Flammable Materials was updated in the CFOC Online Database to address that hand sanitizers in volume should be stored in a separate building, in a locked area, away from high temperatures and ignition sources, and inaccessible to children.
10/13/2011	*Chapter 3* Health Promotion 3.2.2 Hand Hygiene	Can single-use towels be used to dry hands if they are laundered with each use?	Yes, but they should not be made available to other children after use.
10/13/2011	*Chapter 3* Health Promotion 3.3 Cleaning, Sanitizing, and Disinfectant	Are disinfectant products “stronger” than sanitizing agents, i.e. do they kill more “germs?”	Yes and that is why there is a distinction. It is safer for some surfaces to be disinfected and not just sanitized. Please see Appendix J: Selecting an Appropriate Sanitizer or Disinfectant (p. 440) for specific definitions.
10/13/2011	*Chapter 3* Health Promotion 3.3 Cleaning, Sanitizing, and Disinfectant	Also, there seems to be a lot of interest in the use of “green” cleaning and sanitizing products. Many Early Childhood Education (ECE) programs have voiced a concern with the use of bleach solutions. Are properly diluted bleach solutions harmful to children’s health? Are there safer and more effective alternatives, such as hydrogen peroxide based sanitizing agents or other products?	Not only is proper dilution required, but also proper application and ventilation are required to reduce the risk of harm to children. Bleach used in this way is not harmful to children’s health. Please see Appendix J: Selecting an Appropriate Sanitizer or Disinfectant for specific information. If a product that is not chlorine bleach is registered with the EPA and described as a sanitizer or as a disinfectant and is used according to the manufacturers’ instructions (including proper application, drying time, ventilation, etc.), it can be used in child care settings, and can be as safe as bleach. Please see Appendix J: Selecting an Appropriate Sanitizer or Disinfectant for more specific information on this issue.
10/13/2011	*Chapter 3* Health Promotion 3.3 Cleaning, Sanitizing, and Disinfectant	What do I tell child care providers about bleach solutions? Should they be changing the strengths as mentioned in CFOC and do they need several strengths? Can providers prepare only one spray bottle? In the online version of CFOC, Appendix J no longer contains a recipe for bleach dilution. Why is there no longer a recipe?	Two different solutions (one for sanitizing and one for disinfecting) should be prepared. It was the consensus of the technical panel experts that CFOC differentiate between sanitizing and disinfecting to reduce the spread of infectious diseases in child care settings. Please see Appendix J: Selecting an Appropriate Sanitizer or Disinfectant (p. 440) for specific information. The concentration of bleach solutions sold in stores has changed in many areas of the country. The new bleach solution available in many stores is now 8.25% sodium hypochlorite solution (higher than the formerly available bleach solution of 5.25%-6% that the recipes were based on). Many of these products are now EPA-registered products as well. The NRC worked with national experts and determined that because of the variety of products available, it is no longer possible to provide a generic bleach recipe for sanitizing and disinfecting in early care and education programs. In addition, if you are using an EPA-registered product you should not be using a generic recipe, but should be following label instructions for use. The online Appendix J of Caring for Our Children has been revised to reflect these changes. The updated NRC recommendation is: Use EPA-registered products for sanitizing and disinfecting. Follow the manufacturer's instructions for diluting the EPA-registered product for sanitizing or disinfecting, as well as for the contact time. (Instructions on how to determine this for the EPA-registered product you are using can be found here) These instructions are also part of the revised Appendix J. If you are not using an EPA-registered bleach product at this time, we recommend you contact your state and/or local health department for assistance in creating the safe dilutions for the bleach products you are using to sanitize and/or disinfect surfaces in your early care and education environment.
11/07/2012	*Chapter 3* Health Promotion Standard 3.3.0.2: Cleaning and Sanitizing Toys	This standard states that plastic toys can be cleaned in a dishwasher but the Children's Environmental Health Network/Eco-Healthy Child Care generally discourages programs from exposing plastics to heat, including heated dishwashers, due to the potential risk of exposure to harmful chemicals in plastics, which could include toys that are frequently mouthed by children. What's your take on this issue considering that CFOC Standard 5.2.9.9: Plastic Containers and Toys also includes a standard on plastics, which states, “Do not place plastics in the dishwasher”?	BPA, phthalates, and other additives may leach from a plastic toy while being exposed to the heat of a mechanical dishwasher. Hence, the reason standard 5.2.9.9 states that following the guideline of not placing plastics in the dishwasher "may reduce exposure to phthalates and BPA." However, there is no evidence available to either support or refute the use of a mechanical dishwasher to clean, rinse, and sanitize toys. To best limit exposure to toxins, caregivers/teachers should follow the cleaning instructions provided by the toy's manufacturer, while also following their local regulations.
11/07/2012	*Chapter 3* Health Promotion Standard 3.4.1.1: Use of Tobacco, Alcohol, and Illegal Drugs	Should child care providers and other adults who have contact with children be allowed to smoke electronic cigarettes in the presence of children?	Electronic cigarettes, also known as e-cigarettes, are a fairly new alternative to traditional smoking cigarettes. E-cigarettes are battery-operated products designed to deliver nicotine, flavor and other chemicals. They turn nicotine, which is highly addictive, and other chemicals into a vapor that is inhaled by the user (U.S. FDA, 2012). Currently, the research on the safety of this product is limited. However, the use of e-cigarettes would fall into the same category tobacco, alcohol, and illegal drugs products that are prohibited from being used on the premises of the program (both indoor and outdoor environments) and in any vehicles used by the program at all times. Additionally, children model adult behavior. Cigarette smoking in any form is not a healthy behavior. U.S. FDA, 2013 article
10/13/2011	*Chapter 3* Health Promotion Standard 3.4.3.2: Use of Fire Extinguishers	Should all teaching staff be trained to use fire extinguishers or should the focus be on evacuating (maybe having facility staff training in use?)	Staff should be trained that the first priority is to remove the children from the facility safely and quickly. Putting out the fire is secondary to the safe exit of the children and staff. The staff should demonstrate the ability to locate and operate the fire extinguishers.
10/13/2011	*Chapter 3* Health Promotion 3.4.5 Sun Safety and Insect Repellant	Are Picaridin and IR3535 “safer” alternatives to N,N-Diethyl-meta-toluamide (DEET)?	CFOC does not provide a distinction.
02/17/2012	*Chapter 3* Health Promotion 3.4.5.1: Sun Safety Including Sunscreen	Why does this standard state that sunscreen should be applied thirty minutes before going outdoors, but the AAP reference listed on page 127 states that sunscreen should be applied 15-30 minutes before going outside?	The recommendation of how many minutes prior to going outside sunscreen should be applied was revised from 30 minutes to 15-30 minutes on January 30, 2012, which was after the publication of CFOC, 3rd Edition.
10/13/2011	*Chapter 3* Health Promotion 3.6.3 Medications	Are the 5 right practices of medication administration still current practices?	Yes, with added steps. These are the seven steps of medication administration (see page 143): Check that the name of the child on the medication and the child receiving the medication are the same; Check that the name of the medication is the same as the name of the medication on the instructions to give the medication if the instructions are not on the medication container that is labeled with the child’s name; Read and understand the label/prescription directions or the separate written instructions in relation to the measured does, frequency, route of administration (ex. by mouth, ear canal, eye, etc.) and the other special instructions relative to the medication; Observe and report any side effects from medications; Document the administration of each dose by the time and the amount given; Document the person giving the administration and any side effects noted; Handle and store all medications according to label instructions and regulations.
03/26/2015	*Chapter 3* Health Promotion 3.6.3 Medications	Is it necessary to have both a parent release and primary care provider’s written permission for the use of over-the-counter (OTC) medications?	Yes, with the exception of non-prescription sunscreen, insect repellant, and diaper cream. These require only parental consent.
03/26/2015	*Chapter 3* Health Promotion 3.6.3 Medications	Is it necessary for a staff member to receive medication administration training to apply sunscreen and/or insect repellent? What about non-prescription diaper cream, lotion or lip balm?	No. Non-prescription sunscreen, insect repellent, diaper cream, lotion or lip balm are preventive and therefore medication administration training is not required to apply these products.
10/13/2011	*Chapter 3* Health Promotion 3.6.3 Medications	Is a standing order written by a health care provider for program-wide use appropriate or is it best practice to require a written standing order for each individual child?	A written order for each individual child is best.
10/13/2011	*Chapter 3* Health Promotion 3.6.3 Medications	Should ECE programs prohibit the use of cough and cold medication for children under 6 years of age or are there some instances in which a primary care provider might recommend their use?	Cough and cold medication is not recommended for children under the age of six. An ECE program would need written orders from a health care provider and parent/guardian permission to administer.
07/21/2014	*Chapter 3* Health Promotion Standard 3.2.1.4: Diaper Changing Procedure	Step 6 of Standard 3.2.1.4: Diaper Changing Procedure states to "Use soap and warm water, between 60°F and 120°F, at a sink to wash the child’s hands, if you can." If the child is too heavy to hold at the sink, or has a special health care need that prevents him/her from standing at the sink, it is OK to use several wipes (one after the other) to clean the child's hands?	Wipes that have chemicals should not be used as a replacement for washing an infant's/toddler's hands. However, Managing Infectious Diseases in Child Care and Schools, 4th Edition and Model Child Care Health Policies, 5th Edition offers an alternative method to washing the hands of an infant/toddler at the sink if they are too heavy to hold or have a special need that prevents standing at the sink. This ”three paper towel” method is as follows: 1. Wipe the child’s hands with a damp paper towel moistened with a drop of liquid soap. 2. Wipe the child’s hands with a 2nd paper towel wet with clear water. 3. Dry the child’s hands with a 3^rd paper towel. Additionally, as stated in CFOC Standard 3.2.2.5: Hand Sanitizers, the use of hand sanitizers by children over twenty-four months of age and adults in child care programs is an appropriate alternative to the use of traditional handwashing with soap and water if the hands are not visibly soiled. Last, please remember to check your local and/or state regulations before implementing this strategy.
Chapter 4: Nutrition and Food Service
08/19/2012	*Chapter 4* Nutrition and Food Service Standard 4.9.0.13: Methods for Washing Dishes by Hand	I am hoping to get some clarification on the amount of bleach to use when washing dishes in a three compartment sink. I see in Appendix J the chart indicates 1 tablespoon of bleach + 1 gallon of cool water as a sanitizing solution. While the standard says: If the facility does not use a dishwasher, reusable food service equipment and eating utensils should be first scraped to remove any leftover food, washed thoroughly in hot water containing a detergent solution, rinsed, and then sanitized by one of the following methods: a. Immersion for at least two minutes in a lukewarm (not less than 75°F) chemical sanitizing solution (bleach solution of at least 100 parts per million by mixing 1 1/2 teaspoons of domestic bleach per gallon of water). The sanitized items should be air-dried; Can you clarify which measurement needs to be used in the three compartment sink method?	The sanitizing solution referenced in Standard 4.9.0.13 (1 ½ Teaspoons of bleach per gallon of water, ) is from the 2009 Food Code and this section has remained the same in the 2011 Food Code which came out after the publication of CFOC 3. The key words in the above Standard are “at least.” If you were to use the sanitizing solution referenced in Appendix J (1 Tablespoon of bleach per gallon of water) you would still be meeting this requirement since that solution is 200 parts per million. Using a higher concentration of bleach is not a problem as the 2011 Food Code requires “at least” 100 parts per million but does not provide an upper limit.
10/13/2011	*Chapter 4* Nutrition and Food Service 4.2 General Requirements	Should programs be encouraged to serve fresh fruit and vegetables and “whole” foods with minimal ingredients, versus canned, frozen or processed foods?	“Whole” fruit is more nutritious than canned, frozen or processed fruit, but these varieties are allowed.
10/13/2011	*Chapter 4* Nutrition and Food Service 4.2 General Requirements	Should canned fruits with sugar be restricted under the juice restrictions?	Foods with added sugar should be limited. Also, the juice that the fruit is packed in should be discarded and not served as juice.
10/17/2011	*Chapter 4* Nutrition and Food Service Standard 4.3.1.3: Preparing, Feed-ing, and Storing Human Milk	I cannot find any information in the new CFOC as to how long a bottle of breast milk can be kept after it is fed to an infant. It states that a bottle of formula should be discarded after one hour. I would think that it should be the same, since saliva is introduced into the bottle regardless of its contents, but I want to make sure. Can you offer some guidance?	This Standard provides two references at the end of the “Guide-lines for Storage of Human Milk” chart on page 166. Both re-sources state that breast milk should be discarded after it is fed to an infant. The Academy of Breastfeeding Medicine Protocol Committee states: “Milk left in the feeding container after a feeding should be discarded and not used again.” The Centers for Disease Control (CDC) states: “Do not save milk from a used bottle for use at another feeding.” A specific amount of time is not given (similar to the formula standard). The milk could be used again if it’s the same feeding (for example, if the infant takes a short break from eating), but if it is clearly a different feeding, it should be thrown away.
10/13/2011	*Chapter 4* Nutrition and Food Service Standard 4.3.1.8: Techniques for Bottle Feeding	Can infants who are able to sit and hold their own bottles feed themselves or should all infants through 12 months be held during feedings?	Infants should always be held for bottle feeding. Caregivers/teachers and parents/guardians need to understand the relationship between bottle feeding and emotional security.
10/13/2011	*Chapter 4* Nutrition and Food Service Standard 4.3.1.9: Warming Bottles and Infant Foods	I have concerns about the standards recommending glass and ceramic containers due to concerns about using plastic. Once again, it is good in theory, but I don’t feel it is safe. I had a center that had a glass bottle drop and shatter in their infant room.	BPA-free plastic bottles, those labeled #1, #2, #4, or #5, can be used to avoid the use of glass. For those child care and early education facilities that choose to use glass bottles, a relatively new option is to use a bottle sleeve with the glass bottle to reduce the risk of shattered glass. Efficacy on this product is still being proven. Overall, glass is safer than plastic with BPA.
10/13/2011	*Chapter 4* Nutrition 4.6 Food Brought From Home 4.8 Kitchen and Equipment	Can families bring solid food pre-pared at home for use by an individual infant or is it only acceptable for families to provide the program with infant food in factory-sealed container (i.e., baby food jars)?	Solid food prepared at home is acceptable. The food should have a clear label showing the child’s full name, the date, and the type of food.
Chapter 5: Facilities, Supplies, Equipment, and Environmental Health
10/13/2011	*Chapter 5* Facilities Standard 5.1.1.5: Environmental Audit of Site Location	Has the recommendation for minimum distance between a playground site and hazards, such as electrical transformers and high voltage power lines changed since the CFOC, 2^nd Ed., which stated 30 feet?	Yes, specific distances are no longer recommended as distances may differ according to local municipalities and states. Please consult your local ordinance for appropriate information.
10/13/2011	*Chapter 5* Facilities 5.1.2 Space Per Child	Generally, what is the rationale for the change in recommendation from 35 to 42 or 50 square feet of usable indoor space per child?	The standard of providing a minimum of 35 square foot of classroom space per child is not empirically supported. Research studies informed the change in standard to 42-50 square feet per child. Please see the references in Standard 5.1.2.1: Space Required Per Child to read more about this research.
10/13/2011	*Chapter 5* Facilities 5.2.1 Ventilation, Heating, Cooling, and Hot Water	If a Material Safety Data Sheet (MSDS) is prepared by the manufacturer of the chemical/product, are they reliable sources of information?	Yes.
12/14/2011	*Chapter 5* Facilities 5.2.4 Electrical Fixtures and Outlets	Should older outlets with plastic covers be replaced or phased out? Would there be any exemptions for programs with older facilities that have not recently completed facility renovations?	Older outlets with plastic covers should be replaced and updated. There are no exemptions to the standards. Although, local ordinances should be taken into consideration.
12/14/2011	*Chapter 5* Facilities 5.2.5 Fire Warning Systems	Is it reasonable to require fire extinguishers, fire alarms and smoke detectors in each classroom if children often sleep in the classroom?	Yes, depending on the type of facility. Smoke detectors/alarms should be placed in the following areas: each story in front of doors to the stairway; corridors of all floors; Lounges and recreation areas; Sleeping rooms. However, in large and small family child care homes, single-station smoke alarms are acceptable. Fire extinguishers should never be accessible to children. Local fire department codes should be followed as well.
12/14/2011	*Chapter 5* Facilities 5.2.7 Sewage and Garbage	Should garbage receptacle for used diapers be located in a room that is separate from the play area or in the closet?	The garbage receptacle should be kept in the diaper changing area so it is convenient and accessible for the caregiver/teacher during diaper changes. The outside of the garbage receptacle must be kept clean and the contents kept out of reach of children. Children must be closely supervised whenever in close proximity of the diaper changing area/receptacle.
12/14/2011	*Chapter 5* Facilities 5.2.9 Prevention and Management of Toxic Substances	What labels should programs look for to ensure that art materials are safe if labels that states “non-toxic” are not reliable? Is there a seal of approval or certification through the Art & Creative Materials Institute, Inc. (ACMI)?	The ACMI AP (Approved Product) Seal, with or without Performance Certification, identifies art materials that are safe and that are certified in a toxicological evaluation by a medical expert. The seal is currently replacing the previous non-toxic seals.
12/14/2011	*Chapter 5* Facilities 5.2.9 Prevention and Management of Toxic Substances	Would a certified playground safety inspector check for things like treatment of Chromated Copper Arsenate (CCA)-pressure treated wood when conducting an inspection?	Yes, a Certified Playground Inspector would look for CCA-pressure treated wood during their inspection. Both the ASTM International Playground Standards and Consumer Product Safety Council (CPSC) Guidelines recommend against the use of CCA-pressure treated wood on public playgrounds.
10/13/2011	*Chapter 5* Facilities Standard 5.3.1.4: Surfaces of Equipment, Furniture, Toys, and Play Materials	Do all pressed wood items contain formaldehyde?	All pressed wood items do not contain added formaldehyde; however, all wood naturally contains some formaldehyde. Pressed wood products that have the highest formaldehyde emissions are those that are made with urea-formaldehyde resins. Products designed for interior use, such as hardwood plywood, medium density fiberboard, and particleboard, are more likely to contain urea-formaldehyde than those designed for exterior use such as oriented strand board or structural plywood. However, hardwood plywood, medium density fiberboard, and particleboard don't necessarily contain added formaldehyde; they are sometimes made with no added formaldehyde based resins. Many companies are choosing to make products with no added formaldehyde (NAF) based resins as well as ultra low-emitting formaldehyde (ULEF) based resins both to market their products as green and to comply with California regulations on composite wood products. Some products are currently labeled as made with NAF or ULEF resins under the California regulations, and once EPA regulations are proposed and go into effect, more products will be labeled to inform consumers about formaldehyde content.