Health and Safety System Strategies- Resources to Support the Needs of Infants and Toddlers (Strategies and Resources)

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Article – Systems Strategies and Resources

Child laughingThe following information reflects considerations for the health and safety of infants and toddlers as a unique audience. For a complete description of the specific health and safety requirements for CCDF-funded child care, refer to the following sections in the CCDF Final Rule: “Health and Safety Requirements,” “Enforcement of Licensing and Health and Safety Requirements,” and “Criminal Background Checks” (45 C.F.R. § 98.41; § 98.42; § 98.43, 2016).

CCDF Final Rule Health and Safety Training Requirements: Preservice and Ongoing Training Requirements for CCDF Child Care Providers

Preventing and Controlling Infectious Diseases

In addition to the standard practices that need to be addressed within the training, such as inclusion and exclusion policies, universal precautions, and recognizing and managing infectious disease, caregivers of infants and toddlers should be trained on the following: daily cleaning, sanitizing, and disinfecting practices (e.g., infant toys cleaned and sanitized as needed between each use); daily health checks; diapering procedures; feeding practices; and preparing a clean and healthy environment.

Resources

Conduct of Daily Health Check (CFOC 3)

Diapering Poster (Early Childhood Education Linkage System)

Handwashing Procedure (CFOC 3)

Handwashing Sinks (CFOC 3)

Handwashing Sinks for Diaper Changing Areas in Centers (CFOC 3)

Handwashing Sinks for Diaper Changing Areas in Homes (CFOC 3)

Routine Schedule for Cleaning, Sanitizing, and Disinfecting (CFOC 3)

Selecting an Appropriate Sanitizer or Disinfectant (CFOC 3)

Situations that Require Hand Hygiene (CFOC 3)

Safe Sleep Practices

Safe sleep practices help reduce the risk of sudden unexpected infant deaths (SUIDS), including sudden infant death syndrome (SIDS.) Trainings should include information regarding safe environments, suffocation and strangulation risks, potential hazards, as well as safe sleep practices.

Resources

Crib Safety Regulations (ECLKC)

CPSC, Federal Play Yard Regulations

National Institute of Health (NIH), Safe to Sleep

Special Collection, Safe Sleep Practices and SIDS/Suffocation Risk Reduction (CFOC 3)

Medication Administration

In addition to the standard practices that need to be addressed within the training, such as preparation, authorization, administration, documentation, storage and errors, caregivers of infants and toddlers should be trained to approach administration of medication in a developmentally appropriate manner. This includes creating a calm environment, giving medication at the appropriate time, and avoiding mixing medication into formula or breast milk.

Resources

Contents of Medication Record (CFOC 3)

Labeling, Storage, and Disposal of Medications (CFOC 3)

Medication Administration (CFOC 3)

Medication Administration Packet, Appendix AA (CFOC 3)

Training of Caregivers/Teachers to Administer Medication (CFOC 3)

Written Policy on Use of Medications (CFOC 3)

Preventing and Responding to Emergencies Related to Food and Allergic Reactions

In addition to providing training on policies, allergy plans, and procedures for caring for children with food and other allergies, caregivers of infants and toddlers should be trained on working with families to introduce solid foods and to establish feeding plans.

Resources

Care for Children with Food Allergies (CFOC 3)

Food Allergy Research and Education – Resources for Child Care Facilities

Ensuring the Safety of Building and Physical Premises

For children younger than 1 year, falls account for more than 50 percent of nonfatal injuries. In addition to providing training on safety practices, creating safe indoor and outdoor environments, and following licensing guidelines, caregivers of infants and toddlers should be trained to identify choking hazards, establish safe sleep environments, and ensure bottles are prepared properly and are not overheated. Training on active supervision will inform caregivers on the importance of keeping infants and toddlers within sight and sound at all times.

Resources

American Academy of Pediatrics, Baby Walkers

CPSC, Public Playground Safety Handbook

Keeping Children Safe Using Active Supervision (ECLKC)

News You Can Use: Environment as Curriculum for Infants and Toddlers (ECLKC)

Placement of Equipment and Furnishings (CFOC 3)

Safety of Equipment, Materials, and Furnishings(CFOC 3)

Preventing Shaken Baby Syndrome and Abusive Head Trauma

According to the National Center on Shaken Baby Syndrome, shaken baby syndrome is the leading cause of child abuse deaths in the United States. In addition to providing training on the definition and facts regarding abusive head trauma and shaken baby syndrome, preparing caregivers about the different types of temperaments and developmentally appropriate communication for infants (which is crying) reminds caregivers to understand crying within the context of reasonable expectations and helps increase their empathy and understanding of children.

Resources

American Academy of Pediatrics, Coping with Crying

National Center on Shaken Baby Syndrome

Preventing and Identifying Shaken Baby Syndrome/Abusive Head Trauma (CFOC 3)

The Period of Purple Crying

Handling and Storage of Hazardous Materials

In addition to providing training on pest management practices, use and storage of toxic substances, and the Poison Control Center, caregivers of infants and toddlers should receive training on increased susceptibility to poisoning of children this age because they learn through sensorimotor exploration, and that includes putting all kinds of objects and substances in their mouths.

Resources

Integrated Pest Management (CFOC 3)

Put Your Medicines Up and Away and Out of Sight Campaign

Use and Storage of Toxic Substances(CFOC 3)

Use of a Poison Center(CFOC 3)

Safely Transporting Children

In addition to providing training on driver qualifications, transportation procedures, and safety equipment, caregivers should receive training on the proper installation of car seats, choosing an appropriate car seat, and never leaving a child alone in a car.

Resources

Car Seats: Information for Families (Healthy Children, AAP)

Keeping Children Safe in and Around Cars - ECLKC

National Highway Traffic Safety Administration (NHSTA)

Safe Kids, Worldwide – In and Around Cars

Transportation (CFOC 3)

Transportation Policies (CFOC 3)

Emergency Preparedness

Caring for infants and toddlers, which may include children who are not yet mobile or with limited ability to communicate their needs, requires additional planning on the part of the care providers. Caregivers will need training on procedures for evacuation, relocation, shelter-in-place and lock down, staff and volunteer emergency preparedness training and practice drills, communication and reunification with families, as well as continuity of operations. In addition, accommodations of infants and toddlers will needs to be considered, such as assessing potential hazards on evacuation routes, infant feeding during a disaster, and appropriate means for evacuating nonmobile children (evacuation cribs and portable play yards with wheels or strollers.)

Resources

Child Care Resources for Disasters and Emergencies (Office of Child Care)

Early Childhood Disaster-Related Resources for Children and Families (Office of Human Services, Emergency Preparedness and Response)

Emergency Preparedness (Early Childhood Training and Technical Assistance System (ECTTAS))

Emergency Preparedness Tip Sheets (ECLKC)

Emergency Procedures (CFOC 3)

Federal Emergency Management Agency (FEMA) Emergency Management Offices

Pediatric First Aid and CPR

Caregivers need to be trained in a first aid and CPR certification program that includes content on caring for infants and toddlers.

Resource

First Aid and CPR Training for Staff (CFOC 3)

Recognition and Reporting Child Abuse and Neglect

In addition to receiving training on the different types of abuse, protective factors, and community resources, infant and toddler caregivers need to be trained on shaken baby syndrome and recognizing indicators of abuse in nonverbal children.

Resources

Child Abuse and Neglect Education (CFOC 3)

Identifying and Reporting Child Abuse and Neglect, Health Chat Webinar (ECLKC)

Recognizing and Reporting Suspected Child Abuse, Neglect, and Exploitation (CFOC 3)

Child Development, Including the Major Domains (Cognitive, Social, Emotional, Physical Development, and Approaches to Learning §98.44)

Child development is an interactive process that requires responsive relationships with caregivers to be optimal. Learning about children’s typical development helps caregivers know what to expect of infants and toddlers at different ages and stages. Training for caregivers of infants and toddlers needs to include information about all domains of development, information regarding brain development and the importance of the first 3 years, the impact of significant stressors on the child and family, and the importance of relationship-based care.

Resources

Healthy Children (AAP) - Infant

Healthy Children (AAP) - Toddler

Learn the Signs, Act Early (Centers for Disease Control and Prevention)

Resource Guide: Child Development Resources for Parents and Providers (ECCTAS)

  • Optional training listed in the Child Care and Development Fund Final Rule (45 C.F.R. § 98.41(a)(xii), 2016)
    • Nutrition for infants and toddlers;
    • Physical activity;
    • Providing care for infants and toddlers with special needs; and
    • Any other subject area determined by the Lead Agency to be necessary to promote child development or to protect children’s health and safety.

Immunizations

child care provider with childDoes your State or Territory meet the requirements for assuring that children receiving services under CCDF have age-appropriate immunizations? (45 C.F.R. §98.41, Health and safety requirements)

  • Children who may be exempted are as follows:
    • Children who are cared for by relatives (defined as grandparents, great grandparents, siblings [if living in a separate residence], aunts, and uncles), provided there are no other unrelated children who are cared for in the same setting.
    • Children who receive care in their own homes, provided there are no other unrelated children who are cared for in the home.
    • Children whose parents object to immunization based on religious grounds.
    • Children whose medical condition contraindicates immunization.
  • Lead Agencies shall establish grace periods that allow children experiencing homelessness and children in foster care to receive services under this part while providing their families (including foster families) a reasonable time to take any necessary action to comply with immunization and other health and safety requirements. For more information regarding grace periods, see §98.41(a)(1)(i)(C)(1) through (4).

Group Size and Ratios

child care provider and two childrenDoes your State or Territory address adult child ratios and group size as an important approach to protecting the health and safety of infants and toddlers?

  • Do your ratios and group size requirements align with recommendations for infants and for toddlers found in Caring for Our Children Basics: Health and Safety Foundations for Early Care and Education (ACF, 2011)?
  • Have you considered the benefits of aligning your ratios and group size requirements with the Program for Infant/Toddler Care’s (PITC) Six Essential Program Practices for Relationship-Based Infant and Toddler Care (Child Care State Capacity Building Center, 2016)?
    • Primary care
    • Small groups
    • Continuity of care
      • Do your ratio and group size requirements lay the groundwork for infants to remain with the same caregivers/peers for their first 3 years in care?
    • Individualized care
    • Inclusion of children with special needs
    • Culturally sensitive care

References

Administration for Children and Families, U.S. Department of Health and Human Services. (2015). Caring for our children basics: Health and safety foundations for early care and education. Retrieved from  https://childcareta.acf.hhs.gov/sites/default/files/public/cfocb_alignment_tool.pdf

American Academy of Pediatrics. (2015). Baby walkers: A dangerous choice [Web page]. Retrieved September 20, 2017, from https://www.healthychildren.org/English/safety-prevention/at-home/Pages/Baby-Walkers-A-Dangerous-Choice.aspx

American Academy of Pediatrics. (2017). Car seats: Information for families [Web page]. Retrieved September 20, 2017, from https://www.healthychildren.org/English/safety-prevention/on-the-go/Pages/Car-Safety-Seats-Information-for-Families.aspx

American Academy of Pediatrics. (n.d.). Baby [Web page]. Retrieved September 20, 2017, from https://www.healthychildren.org/english/ages-stages/baby/Pages/default.aspx

American Academy of Pediatrics. (n.d.). Practicing safety: Coping with crying [Web page]. Retrieved September 20, 2017, from https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/practicing-safety/Pages/Coping-with-Crying.aspx 

American Academy of Pediatrics. (n.d.). Toddler [Web page]. Retrieved September 20, 2017, from https://www.healthychildren.org/English/ages-stages/toddler/Pages/default.aspx

American Academy of Pediatrics, American Public Health Association, National Resource Center for Health and Safety in Child Care and Early Education. (2011). Caring for our children: National health and safety performance standards; Guidelines for early care and education programs. 3rd edition. Elk Grove Village, IL: American Academy of Pediatrics; Washington, DC: American Public Health Association. Retrieved from http://cfoc.nrckids.org/

American Academy of Pediatrics, American Public Health Association, National Resource Center for Health and Safety in Child Care and Early Education. (2014). Caring for infants and toddlers in child care and early education. Applicable standards from: Caring for our children: National health and safety performance standards; Guidelines for early care and education programs, 3rd Edition. Elk Grove Village, IL: American Academy of Pediatrics; Washington, DC: American Public Health Association. Retrieved from http://cfoc.nrckids.org/CFOC/Infant_Toddlers

American Academy of Pediatrics Task Force on Sudden Infant Death Syndrome. (2016). SIDS and other sleep-related infant deaths: Updated 2016 recommendations for a safe infant sleeping environment. Pediatrics, 138(5): e20162938.

CCA Global Partners, Inc. (2013). Diapering poster. Retrieved August 28, 2017, from http://www.ecels-healthychildcarepa.org/tools/posters/item/279-diapering-poster

Centers for Disease Control and Prevention. (n.d.). Learn the Signs. Act Early. [Web page]. Retrieved August 28, 2017, from https://www.cdc.gov/ncbddd/actearly/index.html

Centers for Disease Control and Prevention. (n.d.). Put your medicines up and away and out of sight campaign [Web page]. Retrieved August 28, 2017, from http://www.upandaway.org/

Child Care and Development Fund, 45 C.F.R. § 98 (2016). Retrieved from https://www.ecfr.gov/cgi-bin/text-idx?SID=380a33504989a8dd54896324ac7e677c&mc=true&node=pt45.1.98&rgn=div5

Child Care State Capacity Building Center, Office of Child Care, Administration for Children and Families, U.S. Department of Health and Human Services. (2016). Aligning the six essential policies for infant and toddler care with licensing and the quality rating and improvement system (QRIS) (Part 1: Primary care, small groups, and continuity of care). Retrieved from http://www.occ-cmc.org/Infant-Toddler/pdfs/B-4_Handout.pdf

Early Childhood Training and Technical Assistance System, Office of Child Care, Administration of Children and Families, U.S. Department of Health and Human Services. (n.d.). Emergency preparedness [Web page]. Retrieved September 20, 2017, from https://childcareta.acf.hhs.gov/emergency-preparedness-0

Early Childhood Training and Technical Assistance System, Office of Child Care, Administration of Children and Families, U.S. Department of Health and Human Services. (2017). Resource guide: Child development resources for parents and providers. Retrieved from https://childcareta.acf.hhs.gov/resource/resource-guide-child-development-resources-parents-and-providers

Federal Emergency Management Agency. (2017). Emergency management offices [Web page]. Retrieved September 20, 2017, from https://www.fema.gov/emergency-management-agencies

Food Allergy Research and Education. (n.d.). Babysitters and other caregivers [Web page]. Retrieved August 28, 2017, from https://www.foodallergy.org/resources/child-care-facilities

National Center on Early Childhood Health and Wellness, Office of Child Care and Office of Head Start, Administration for Children and Families, U.S. Department of Health and Human Services. (n.d.). Child care providers: Your guide to new crib standards. Retrieved August 28, 2017, from https://eclkc.ohs.acf.hhs.gov/safety-practices/article/child-care-providers-your-guide-new-crib-standards

National Center on Early Childhood Health and Wellness, Office of Child Care and Office of Head Start, Administration for Children and Families, U.S. Department of Health and Human Services. (n.d.). Emergency preparedness tip sheets. Retrieved August 28, 2017, from https://eclkc.ohs.acf.hhs.gov/safety-practices/article/child-care-providers-your-guide-new-crib-standards

National Center on Early Childhood Health and Wellness, Office of Child Care and Office of Head Start, Administration for Children and Families, U.S. Department of Health and Human Services. (n.d.). Keeping children safe in and around cars. Retrieved August 28, 2017, from https://eclkc.ohs.acf.hhs.gov/transportation/article/keeping-children-safe-around-cars 

National Center on Early Childhood Health and Wellness, Office of Child Care and Office of Head Start, Administration for Children and Families, U.S. Department of Health and Human Services. (n.d.). Keeping children safe using active supervision. Retrieved August 28, 2017, from https://eclkc.ohs.acf.hhs.gov/safety-practices/article/keep-children-safe-using-active-supervision

National Center on Early Childhood Health and Wellness, Office of Child Care and Office of Head Start, Administration for Children and Families, U.S. Department of Health and Human Services. (n.d.). News you can use: Environment as curriculum for infants and toddlers. Retrieved August 28, 2017, from https://eclkc.ohs.acf.hhs.gov/learning-environments/article/news-you-can-use-environment-curriculum-infants-toddlers

National Center on Early Childhood Quality Assurance, Office of Child Care, Administration for Children and Families, U.S. Department of Health and Human Services. (2016a). Caring for our children basics health and safety standards alignment tool for child care centers and family child care homes. Retrieved from https://childcareta.acf.hhs.gov/resource/caring-our-children-basics-health-and-safety-standards-alignment-tool-child-care-centers

National Center on Early Childhood Quality Assurance, Office of Child Care, Administration for Children and Families, U.S. Department of Health and Human Services. (2016b). CCDF health and safety requirements brief # 1: Prevention and control of infectious diseases. Retrieved from https://childcareta.acf.hhs.gov/resource/ccdf-health-and-safety-requirements-brief-1-prevention-and-control-infectious-diseases

National Center on Early Childhood Quality Assurance, Office of Child Care, Administration for Children and Families, U.S. Department of Health and Human Services. (2016c). CCDF health and safety requirements brief # 2: Administering medications. Retrieved from https://childcareta.acf.hhs.gov/resource/ccdf-health-and-safety-requirements-brief-2-administering-medications

National Center on Early Childhood Quality Assurance, Office of Child Care, Administration for Children and Families, U.S. Department of Health and Human Services. (2016d). CCDF health and safety requirements brief # 3: Prevention of and response to emergencies due to food and allergic reactions. Retrieved from https://childcareta.acf.hhs.gov/resource/ccdf-health-and-safety-requirements-brief-3-prevention-and-response-emergencies-due-food

National Center on Early Childhood Quality Assurance, Office of Child Care, Administration for Children and Families, U.S. Department of Health and Human Services. (2016e). CCDF health and safety requirements brief # 4: Reducing the risk of sudden infant death syndrome and using safe sleeping practices. Retrieved from https://childcareta.acf.hhs.gov/resource/ccdf-health-and-safety-requirements-brief-4-reducing-risk-sudden-infant-death-syndrome-and

National Center on Early Childhood Quality Assurance, Office of Child Care, Administration for Children and Families, U.S. Department of Health and Human Services. (2016f). CCDF health and safety requirements. brief # 5: Building and physical premises safety. Retrieved from https://childcareta.acf.hhs.gov/resource/ccdf-health-and-safety-requirements-brief-5-building-and-physical-premises-safety

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