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  • Introductory comments:
    Your background and interests
    Determine who is in the audience (show of hands)
    Ask a few folks what they want to learn or what they want you to know about their work
  • We will be reviewing common terms, all professional groups have their own “lingo”
    Some professional groups use different terms, we have common ground re quality care, health and safety, etc.
    Daycare is an outdated term – shift the focus towards children and quality and use “child care”
    “Early education and child care" is a preferred term: education occurs in all settings (home, child care, pre-school, etc)
    Some folks base their practices on “health beliefs” rather than evidence; this leads to errors that put children at risk
    We’ll talk about using available resources to address these issues
  • There are many types of child care arrangements
    Most families use a combination of types
    The best child care situation is whichever works best for the child and family
  • Because most young children are in child care, using child care programs as an access point:
    Maximizes health promotion early on
    Enables caregivers to support health education, be good role models
    Helps children to learn healthy behaviors they can use throughout their life
  • Here’s the distribution of where kids are
    Other licensed facilities may be linked to park districts, YMCAs, schools
    Hard to reach children in unlicensed/unregulated care, particular if there’s a state law that requires licensing
  • Child Care Resource and Referral Agencies help parents find quality child care
    Website has database to locate local CCR&R agencies by entering a zip code
    CCR&Rs have listings of community resources: professionals can partner to improve/distribute info
    Accredited Programs are typically of higher quality – There are national associations that help to educate child care professionals
    National Association for the Education of Young Children accredits centers and offers info for all child care professionals
    National Association of Family Child Care accredits family child care homes and offers info for family child care providers
    State Child Care Regulations are different in each state and can be found online
  • Licensed – States, counties, cities license child care programs like any other businesses
    Regulated – Child care regulations identify the minimum rules/laws that a program must follow (has the power of a “law”)
    Monitored – Someone is checking or visiting to ensure regulations are followed; State Dept that licenses child care programs will respond to a report from a parent or other public officials
    States may use Early Learning Guidelines and Quality Rating Systems, different state-guided systems to improve the quality of early education and child care
    QRS/QRIS – QRS are sometimes called “Quality Rating and Improvements Systems” and have “report card” or “star-rating” system w/incentives
  • Clearly supervision and safety come first – preventable deaths in child care are tragic, unnecessary
    High quality programs improve child health and promote development and learning
    When care is consistent, developmentally sound and emotionally supportive, the child, family, and society benefits
    Children who attend high quality child care do better in school, have less need for special education/related services, lower incidence of crime, lower adolescent pregnancy rates, and are more likely to graduate from high school
  • Children who participate in non-parental care have increased risks for:
    SIDS
    Infections, infectious diseases, and illness (earlier on)
    Children in certain situations/settings (depending on environment, practices, supervision, etc)
    May be at risk for injuries
    May be at risk for compromised social-emotional development
  • When children are cared for by someone other than their parents, their risk for SIDS is more than double the expected rate
    Babies who die from SIDS in child care
    60% are in family child care
    20% are in centers
    20% are in relative care
  • What is it about child care that puts babies at risk?
    Unaccustomed tummy sleeping, parents may not tell the caregiver that the baby sleeps on their back
    Caregiver may place baby to sleep on their tummy side when this is not a position in which the infant typically sleeps
    Caregivers are challenged if parents (their customers) require tummy or side sleeping, want to use “comfort items”: blankets/toys from home
    Best practice is a written policy shared with caregivers (before they start work) and parents (before their child starts)
    Caregivers need ongoing encouragement and support from their director, health consultant, regulators/licensing agencies, etc.
    Emphasize placing all babies up to 12 months to sleep on their back (physician waiver used rarely, only if medical reason is provided)
    If they role back-to-front and front-to-back, still place to sleep on back, use discretion about returning them to their back
  • Not all caregivers know about or use safe sleep practices (even after training)
    Child care providers find it hard to stand up to parents without a policy and back-up support
    Folks who use tummy sleeping with younger babies fear they won’t be comfortable, will choke etc.
    Think about creative strategies [if babies are always placed to sleep on their back, they don’t know other ways!]
    Ways to talk with parents/caregivers who raised children when tummy sleeping was recommended
    Make sure cribs are available in child care and suggest displaying blankets, comforters
    Encourage adults to give gifts of handmade “safe sleep sacks”
    Discuss ways for caregivers/parents to comfort babies when the are going to sleep
  • This is a picture from the Consumer Product Safety Commission that shows how a baby should be placed in a crib when placed to sleep
    If a blanket is used: THIN with “Feet to Foot” rule (blanket is tucked on 3 sides and does not reach over the baby’s chest)
    The infant is sleeping in a crib, not an adult bed, car seat, swing, etc.
    Bumpers are not used or needed
    There is no soft bedding or toys in the crib
    Only 1 baby per crib
    Infants should always sleep alone (not with parents, adults or other children)
  • There are issues to consider regarding infections/illness in child care
    Health professionals, child care professionals, and parents are not yet on the same page
    Health professionals tend to understand that excluding children from child care isn’t always effective
    Child care professionals “over-exclude” (to avoid parent complaints and staff and child illness)
    Parents may either want other children to be sent home (so their child doesn’t get sick) or may not be able to miss work (and want their child to stay in child care)
  • Many infections that occur in child care go away without any treatment
    Seeing a doctor or getting antibiotics is not as necessary as some people believe
    Children in child care may be more ill earlier on, but will generally have a better-developed immune system when they go to school
  • Best approach is to be clear up front regarding center policies and expectations
    Working with a child care health consultant can be very beneficial!
  • Be sure that your child receives the proper immunizations according to the AAP Recommended Childhood and Adolescent Immunization Schedule, which is published in Pediatrics and on the AAP Web site every January (www.aap.org/immunization)
    Children younger than 5 - even previously healthy children - are more likely than older children to end up in the hospital with serious complications if they get the flu. AAP recommends that all children 6 months to 59 months get a flu shot. (Flu shots are not approved for children younger than 6 months old.) Caregivers of children younger than 5 years old should also get vaccinated against the flu.
    If children or caregivers elect not to be immunized for a medical or religious reason, the reason should be documented and kept on file.
    Promote proper hand washing skills and model this.
    Bleach solutions are an effective and inexpensive sanitizer.
  • Children in different child care arrangements may have an increased risk of injuries
    Environment, safety practices, and supervision strategies play a part in this
  • The key to preventing injuries is to identify and eradicate safety risks and to directly supervise children by sight and sound at all times.
  • The components of quality child care have been studied, identified, and are available in many formats.
    The 13 indicators of Quality Child Care can be found online at http://aspe.hhs.gov/hsp/ccquality-ind02/
    NACCRRA 38-Indicators Checklist is online at http://www.naccrra.org/parent/quality_indicators.php
    HK/HC is based on 34 indicators http://www.healthykids.us/
  • This manual contains national health and safety recommendations and guidelines for children in family-and center-based child care programs. It is an essential resource for any child care provider or health professional!
    The entire text of the manual can be viewed, searched, or downloaded online at http://nrc.uchsc.edu/CFOC/index.html.
    Major policy changes since the publication of this manual can be found at http://nrc.uchsc.edu/CFOC/updates.htm
  • Incorporating content from Caring for Our Children, and the AAP Red Book®, this manual offers information and materials to help parents, caregivers/teachers, and health professionals “get on the same page” to prevent, identify, and respond to the most common childhood infectious diseases. Reference sheets for more than 50 infectious diseases and conditions, a symptoms chart, and information on when mildly ill children can remain in care or should be sent home.
  • This AAP website provides resources on child care health and safety with customized sections for health professionals, child care providers, and parents. On this website, you can find:
    AAP policy Quality Early Education and Child Care from Birth to Kindergarten
    Health and Safety E-News for Caregivers and Teachers
    A Child Care Provider's Guide to Safe Sleep
    A Parents' Guide to Safe Sleep
    Tummy Time.
  • Based on Caring for Our Children, reviewed by AAP members, and designed for parents, this new Web site and booklet provides key information on 34 health and safety practices to look for when evaluating child care programs.
  • At the end of the session, ask the audience if they have questions.
    Provide your contact information and pass out and relevant handouts.
  • Slide 1

    1. 1. INSERT CONFERENCEINSERT CONFERENCE INSERT PRESENTER’S NAMEINSERT PRESENTER’S NAME INSERT DATEINSERT DATE American Academy of Pediatrics 2007American Academy of Pediatrics 2007 Choosing Quality Child Care
    2. 2. OverviewOverview  TerminologyTerminology –Key words in the child care–Key words in the child care field and how to use these phrases to findfield and how to use these phrases to find quality child care.quality child care.  Benefits/RisksBenefits/Risks – What are they?– What are they?  Quality Child CareQuality Child Care – What is it?– What is it?  ResourcesResources – Access AAP resources.– Access AAP resources.  QuestionsQuestions – How to get your child care– How to get your child care questions answered.questions answered.
    3. 3. Types of Child CareTypes of Child Care  Parent only careParent only care  Relative careRelative care (kith/kin)(kith/kin)  Nannies/babysittersNannies/babysitters  Friend/neighbor careFriend/neighbor care  Family child careFamily child care homehome  Child care centerChild care center  Specialized careSpecialized care Most familiesMost families use a combinationuse a combination of care types.of care types. The “best” care is theThe “best” care is the arrangement thatarrangement that works for your familyworks for your family and meets yourand meets your child’s needs.child’s needs.
    4. 4. US Children in Child CareUS Children in Child Care  A majority of children are in child care in the USA majority of children are in child care in the US (60-70% of children less than 6 years old; by the(60-70% of children less than 6 years old; by the age of 6, 84% of all children have been enrolledage of 6, 84% of all children have been enrolled at some time).at some time).  Most health issues (caries [cavities], obesity,Most health issues (caries [cavities], obesity, mental health issues) have their basis in earlymental health issues) have their basis in early childhood, so focusing on this audiencechildhood, so focusing on this audience maximizes health promotion for many kids at amaximizes health promotion for many kids at a critical age!critical age!
    5. 5. US Children in Child CareUS Children in Child Care  12 million children: more than 9 million are in12 million children: more than 9 million are in licensed child care facilities.licensed child care facilities.  105,444 child care centers.105,444 child care centers.  213,966 family child care homes.213,966 family child care homes.  16,110 other licensed facilities.16,110 other licensed facilities.  About 3 million children are cared for inAbout 3 million children are cared for in unlicensed and unregulated care.unlicensed and unregulated care.
    6. 6. Helpful Terms and ToolsHelpful Terms and Tools  Child Care Resource & Referral Agencies OnlineChild Care Resource & Referral Agencies Online www.childcareaware.orgwww.childcareaware.org  Accredited/AccreditationAccredited/Accreditation  NAEYCNAEYC www.naeyc.orgwww.naeyc.org  NAFCC www.nafcc.orgNAFCC www.nafcc.org  Child Care Regulations by State OnlineChild Care Regulations by State Online http://nrckids.org/STATES/states.htmhttp://nrckids.org/STATES/states.htm
    7. 7. Helpful Terms and ToolsHelpful Terms and Tools  Day Care, Child Care, Early Care and Education,Day Care, Child Care, Early Care and Education, Early Education and Child CareEarly Education and Child Care  Licensed, Regulated, MonitoredLicensed, Regulated, Monitored  Early Learning Guidelines/Quality Rating andEarly Learning Guidelines/Quality Rating and Improvement SystemsImprovement Systems
    8. 8. Benefits ofBenefits of High Quality Child CareHigh Quality Child Care  Safety first.Safety first.  Health is the foundation of quality care.Health is the foundation of quality care.  First few years are key due to brain development.First few years are key due to brain development.  Promotes development (physical, cognitive,Promotes development (physical, cognitive, social-emotional).social-emotional).  Improves school performance (better math,Improves school performance (better math, language, cognition, social skills, relationships, andlanguage, cognition, social skills, relationships, and self-regulation).self-regulation).
    9. 9. Risks Related to Child Care:Risks Related to Child Care:  Children exposed to a poor quality environmentChildren exposed to a poor quality environment (whether at home or at school) are less likely to be(whether at home or at school) are less likely to be prepared for school demands and more likely toprepared for school demands and more likely to have their socio-emotional development derailed.have their socio-emotional development derailed.  Sudden Infant Death Syndrome (SIDS).Sudden Infant Death Syndrome (SIDS).  Infectious diseases and illness.Infectious diseases and illness.  Injuries.Injuries.
    10. 10. SIDS in Child CareSIDS in Child Care  SIDS is the unexplained death of seeminglySIDS is the unexplained death of seemingly healthy babies 12 months or younger.healthy babies 12 months or younger.  Experts don’t know what causes SIDS; cannotExperts don’t know what causes SIDS; cannot predict or prevent SIDS (only reduce the risk).predict or prevent SIDS (only reduce the risk).  About 20% of deaths attributed to SIDSAbout 20% of deaths attributed to SIDS occurred while the infant was in the care of aoccurred while the infant was in the care of a non-parental caregiver.non-parental caregiver.  60% in family child care.60% in family child care.  20% in child care centers.20% in child care centers.
    11. 11. SIDS in Child CareSIDS in Child Care  AboutAbout 11 //33 of SIDS deaths in child care occurof SIDS deaths in child care occur in the first week,in the first week, 11 //22 of these on the first day.of these on the first day.  Something intrinsic to child care? No.Something intrinsic to child care? No.  Unaccustomed tummy sleeping? Yes.Unaccustomed tummy sleeping? Yes.  Caregivers challenged by parents? Yes.Caregivers challenged by parents? Yes.  Best practices:Best practices:  Child care policies, training, and regulations.Child care policies, training, and regulations.  Back to sleep, tummy to play, no soft bedding.Back to sleep, tummy to play, no soft bedding.
    12. 12. State Child Care RegulationsState Child Care Regulations ShouldShould REQUIREREQUIRE::  Written “Safe Sleep” policy, shared with allWritten “Safe Sleep” policy, shared with all  Training for a child care professionals beforeTraining for a child care professionals before they start work and regularly thereafterthey start work and regularly thereafter  Caregivers should place all babies up to 12Caregivers should place all babies up to 12 months to sleep on their backs, in a safety-months to sleep on their backs, in a safety- approved crib, with no soft beddingapproved crib, with no soft bedding (bumpers, comforters, quilts, toys etc)(bumpers, comforters, quilts, toys etc)
    13. 13. Baby in a Safe CribBaby in a Safe Crib
    14. 14. Infectious Diseases and IllnessInfectious Diseases and Illness  Increased illness before age 1.Increased illness before age 1.  Increased illness first year of child care.Increased illness first year of child care.  Children in care with 6 or more have a higherChildren in care with 6 or more have a higher incidence of:incidence of:  Infections (ear and respiratory).Infections (ear and respiratory).  Antibiotic use.Antibiotic use.  Diarrhea (Salmonella, Shigella, Giardia, Hepatitis A).Diarrhea (Salmonella, Shigella, Giardia, Hepatitis A).
    15. 15. Infectious Diseases and IllnessInfectious Diseases and Illness  Good news:Good news:  Most infections are mild, are present in theMost infections are mild, are present in the general community, and resolve withoutgeneral community, and resolve without treatment.treatment.  More common colds in preschool years,More common colds in preschool years, but protected against colds (and asthma)but protected against colds (and asthma) between the ages of 6-11 (same number ofbetween the ages of 6-11 (same number of colds at age 13).colds at age 13).
    16. 16. Exclusion and PreventionExclusion and Prevention  State regulations not based on medicalState regulations not based on medical evidence.evidence.  Programs are allowed to adopt stricterPrograms are allowed to adopt stricter standards.standards.  Evidence shows:Evidence shows:  Children may be infectious before symptoms.Children may be infectious before symptoms.  Exclude if a) child too ill to participate, b) childExclude if a) child too ill to participate, b) child needs greater care than caregivers can offer, or c)needs greater care than caregivers can offer, or c) child has a harmful infectious disease.child has a harmful infectious disease.  Parents, caregivers, pediatricians equallyParents, caregivers, pediatricians equally misinformed about evidence, when to exclude.misinformed about evidence, when to exclude.
    17. 17. Exclusion and PreventionExclusion and Prevention  The Keys to PreventionThe Keys to Prevention  ImmunizationsImmunizations  Hand washingHand washing  Sanitation of toys and surfacesSanitation of toys and surfaces  ResourcesResources  Article:Article: Equipment in Child Care Centers Can Reduce IllnessEquipment in Child Care Centers Can Reduce Illness  Health and Safety E-News:Health and Safety E-News: Infectious DiseasesInfectious Diseases  Handout: Preventing the FluHandout: Preventing the Flu
    18. 18. InjuriesInjuries  Children in:Children in:  Child care centers fewer injuries than those only at home.Child care centers fewer injuries than those only at home.  Child care centers fewer injuries when they are at homeChild care centers fewer injuries when they are at home than those who receive care only at home.than those who receive care only at home.  Family child care programs have more injuries than eitherFamily child care programs have more injuries than either children in centers or those who only at home.children in centers or those who only at home.  May be due to increased supervision in childMay be due to increased supervision in child care or more risk-taking behaviors amongcare or more risk-taking behaviors among children transitioning from care to home.children transitioning from care to home.
    19. 19. InjuriesInjuries  Most common and severe injuries happenMost common and severe injuries happen when children fall from climbing equipmentwhen children fall from climbing equipment that don’t have appropriate cushioningthat don’t have appropriate cushioning materials under them.materials under them.
    20. 20. 13 Indicators of Quality Care13 Indicators of Quality Care  Appropriate supervision/discipline.Appropriate supervision/discipline.  Nurturing care.Nurturing care.  Staff to child ratio and group size.Staff to child ratio and group size.  Immunization requirements.Immunization requirements.  Hand washing and diapering sanitation.Hand washing and diapering sanitation.  Staff director qualifications.Staff director qualifications.  Staff teacher qualifications.Staff teacher qualifications.
    21. 21. 13 Indicators of Quality Care13 Indicators of Quality Care  Staff training.Staff training.  Medication administration.Medication administration.  Emergency plan/contact.Emergency plan/contact.  Fire drills.Fire drills.  Appropriate outdoor playground.Appropriate outdoor playground.  Safe storing of toxic substances.Safe storing of toxic substances.
    22. 22.  Developed by AAP.  Includes rationale for why standards are important; based on evidence where possible.  Available online at http://nrc.uchsc.edu Print copies from: AAP, APHA, NAEYC.
    23. 23. Managing Infectious DiseasesManaging Infectious Diseases  Written for parents, caregivers, teachers and health professionals.  Signs/Symptoms chart.  Quick Reference Sheets for more than 50 common infections.
    24. 24. Healthy Child Care Web siteHealthy Child Care Web site www.healthychildcare.orgwww.healthychildcare.org Existing Web site – originally designed toExisting Web site – originally designed to support the national Healthy Child Caresupport the national Healthy Child Care America CampaignAmerica Campaign
    25. 25. HEALTHY KIDS, HEALTHY CARE: Parents as Partners in Promoting Healthy and Safe Child Care www.healthykids.us Available in Spanish – www.healthykids.us/spanish
    26. 26. Questions?Questions?
    27. 27. Your name/contactYour name/contact information hereinformation here

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