Food Safety in Early Childhood

1. Food safety
issues

2. The safety of foods and meals prepared
for young children is of equal
importance to their nutritional value.
Food-borne illness is a major public
health concern that poses an especially
dangerous risk, including death, for
young children (Maki, 2009).
A food-borne illness outbreak occurs
when two or more people become ill
after ingesting the same food and a
laboratory analysis confirms that food
was the source of the illness.

3. Those groups at greatest risk are:
• infants and children, especially
under 4 years
• pregnant women
• individuals 50 years of age and
older
• persons with chronic diseases
and weakened immune systems

4. Our increased reliance on mass food
production and restaurant meals has
raised the risk of exposing large
numbers of people to food-borne
illnesses. However, while outbreaks of
food-borne illnesses associated with
fast-food chains and food processing
plants receive extensive media
coverage, many cases are caused by
home-cooked meals.

5. Causes of Food-Borne Illness
Food can become unsafe in several ways.
Hazards to food are present in the air, in
water, in other foods, on work surfaces,
and on a food preparer’s hands and body.
These hazards can be divided into three
categories:
• biological
• chemical
• physical

7. food-borne illness outbreak – two or more
persons become ill after ingesting the
same food. Laboratory analysis must
confirm that food is the source of the
illness.
Hazard Analysis Critical Control Point
(HACCP) – a food safety and self-
inspection system that highlights
potentially hazardous foods and how they
are handled in the food service
department.

8. Bacteria present in the environment pose the greatest threat to
food safety. Some bacteria can cause serious and dangerous
illnesses while others are beneficial (e.g., blue cheese, yogurt).
The risk of environmental contamination of foods can be
reduced through two basic approaches:
• following strict personal health and cleanliness habits
• maintaining a sanitary food service operation
Hazard Analysis and Critical Control Point (HACCP) HACCP,
Hazard Analysis and Critical Control Point, is a food safety and
self-inspection system that highlights potentially hazardous
foods and how they are handled in the food service
environment. The U.S. Food and Drug Administration (FDA)
recommends the implementation of HACCP because it is one of
the most effective and efficient ways to ensure that food
products are safe (Riggins & Barrett, 2008).

9. A sound HACCP plan is based on seven principles:
1. Conducting a hazard analysis. In this phase, an HACCP team is assembled.
The team should list all food items used in the establishment with the
product code, preparation techniques, and storage requirements for each
one. A flow chart should be developed that follows the food from
receiving to serving in order to identify potential hazards during each step
of this process (Figure 19–2).
2. Determining the critical control point (CCP). These are points during food
preparation where potential and preventable hazards are identified (i.e.,
cooking foods to appropriate temperatures; using proper thawing
techniques; maintaining proper refrigerator/ freezer temperatures).
3. Establishing critical limits. Procedures and operating guidelines are
developed to help prevent or reduce hazards in the food service area.
Requirements should be established and monitored to ensure that they are
being met.

10. 4. Establishing monitoring procedures. This principle needs to be
accomplished through consistent documentation in temperature
logs, observation and measurement of requirements, and
frequent feedback and monitoring by the food service manager.
5. Establishing corrective actions. Specific actions need to be
developed and implemented if a critical control point procedure
is not being met. These episodes should be accurately
documented so that future occurrences can be prevented.
6. Establishing recordkeeping and documentation procedures.
Records of importance include recipes, time/temperature logs,
employee training documentation, cleaning schedules, and job
descriptions.
7. Establish verification procedures. Management must be
diligent in observing staff members’ routine behaviors and
provide continued training to address any deficiencies.

11. Personal Health and Cleanliness
Persons who are involved in food preparation and
service must take great care to maintain a high level of
personal health. Food handlers must meet health
standards set by health department and child care
licensing agencies in each state. Personnel who work in
licensed early childhood or school-based programs are
generally required to provide written confirmation that
they are currently free of communicable diseases such
as tuberculosis and hepatitis. Food handlers should also
also undergo periodic physical examinations to
document their state of general health.

12. Everyone who is involved in food preparation
and service should also be free of all
communicable illnesses, such as colds,
respiratory or intestinal types of influenza,
gastrointestinal upsets, or acute throat
infections. People who are experiencing even
mild forms of these conditions often believe
they are well enough to work, but in doing so
they may transmit their illness to others. A
person who is ill should refrain from handling
food until he or she is symptom free for at least
24 hours

14. Programs should prepare for the
possibility of a cook’s absence by
maintaining an emergency menu with
easy-to-prepare foods, such as:
• canned soups
• peanut butter
• canned or frozen fruits and vegetables
• canned tuna or frozen, cooked chicken
• cheese (can be frozen)
• dried beans, rice, and pastas
• eggs

15. Meals that require a minimum of time and/or cooking
skill can easily be prepared when adequate food
supplies are kept on hand. Food handlers should wear
clean, washable clothing and change aprons frequently
if they become soiled. Hair should be covered by a net,
cap, or scarf while the worker is preparing food. Head
coverings should be put on and shoulders checked
carefully for loose hair prior to entering the kitchen.
Fingernails should be properly maintained and no
polish or artificial nails allowed. Jewelry should not be
worn with the exception of a plain wedding band to
prevent transfer of trapped food particles. Food
handlers should also refrain from chewing gum or
smoking around food to prevent contamination from
saliva.

16. The Importance of Hand Washing
Hand washing is of utmost importance
to personal cleanliness Hands should
be washed thoroughly:
• upon entering the food preparation
area
• before putting on gloves to work
with food
• before touching food
• after handling nonfood items such
as cleaning or laundry supplies

17. • between handling different food
items
• after using the bathroom
• after coughing, sneezing, or
blowing the nose
• after using tobacco, eating, or
drinking
• after touching hair or bare body
parts ( face, ears, nose)

20. Careful hand washing is also mandatory after
handling raw foods such as fish, shellfish, meat,
and poultry to prevent cross-contamination with
other foods. Latex gloves offer an additional
measure of protection but hands must still be
washed carefully following their removal.
Current recommendations suggest that soap
and water remains the accepted method of
cleaning hands in non-health care settings (Liu
et al., 2010). Although waterless, alcohol-based
gels are increasingly being used in health care
settings, they are never considered a substitute
for proper hand washing.

21. Disease prevention and control also
depend on teaching children proper hand-
washing technique. This can be
accomplished by having children count to
20 and state their full name, or by singing
the entire alphabet song while washing
their hands. Any cuts or abrasions on the
food handler’s forearms, arms, or hands
must be bandaged and covered with
gloves (hands only). Gloved hands should
be washed as often as bare hands because
they also pick up and transmit infectious

22. Safe and Sanitary Food Service
The way in which food is handled, stored,
transported, and prepared ultimately
affects the health of those who consume
it. Food preparers must understand how
each of these steps may become a
potential source of contamination and
develop and practice safety measures to
minimize the risk of causing food-borne
illness.

23. Food
All raw produce should be inspected for spoilage
upon delivery and should be thoroughly washed
before use. Fresh fruits and vegetables can carry
bacteria and numerous pesticide residues (Katz &
Winter, 2009). Produce that won’t be peeled, such as
strawberries, potatoes, and green onions, can be
washed under running water and a small brush used
to remove surface dirt. Lettuce leaves should be
washed individually. Even produce that will be peeled,
such as melons, bananas, oranges and carrots should
be rinsed well to prevent bacteria from being
introduced into the edible portions when cutting into
the food or touching it with hands that have handled
contaminated peel or rind.

24. All dairy products must be pasteurized. The
tops of canned foods should be washed before
they are opened; this prevents any
contaminants from being introduced into the
food or from contaminating other cans or work
surfaces via a dirty can opener. (Can openers
must be washed thoroughly between uses to
prevent cross-contamination). Food in cans that
“spew” when opened should be discarded
immediately. The integrity of all packaged food
wrappers should be intact (e.g., no broken film
on meat packages, no dented cans) to protect
the product from potential contamination.

25. The sink, faucet handles, and drain should
be cleaned with a disinfectant after any
contact with raw meat, fish, shellfish, eggs,
or poultry. Food particles trapped in the
drain and disposal along with moisture in
the drain provide an excellent
environment for bacterial growth. A
disinfecting solution
(1 tablespoon of chlorine bleach per one
quart of water) can be mixed and poured
down the drain.

26. Food Storage
Careful handling and storage of foods at
appropriate temperatures are important
safety measures that can be taken to
prevent illness. Thermometers should be
hung in the warmest area of the
refrigerator and in the freezer to
determine if appropriate temperatures are
being maintained. Refrigerators should be
kept at 38°F to 40°F and freezers at 0°F or
below.

27. Foods must remain frozen until they
are ready to be used, and then
thawed:
• in the refrigerator
• in cold water (place food in
watertight, plastic bag; change
water every 30 minutes)
• in a microwave oven
• while cooking
Caution: Frozen food should never be
thawed at room temperature! Once

28. Transport
Food should be covered or wrapped
during transport to help maintain
temperature control and avoid the
possibility of microbial contamination.
When serving foods, each serving bowl,
dish, or pan should have a spoon; spoons
should not be used to serve more than
one food. Caution should also be used not
to touch serving spoons to a person’s
plate to prevent contamination from saliva.

29. Food Service
Food that has been served should not be
saved. An exception to this rule are fresh fruits
and vegetables that can be washed after
removal from the table and served later or
incorporated into baked products such as
muffins. Foods are safe to serve if they have
been held in the kitchen at proper
temperatures (160°F for hot food or 40°F or
below for cold foods) for no longer than 2
hours. Foods that are to be saved should be
placed in shallow pans (three inches or less in
depth so they cool quickly) and immediately

30. Foods such as creamed dishes, meat,
poultry, or egg salads are especially
prone to spoilage and should be
prepared from ingredients that have
been cooked and chilled or
maintained at temperatures below
40°F until they are used. Protein-
based dishes such as these should
also be assembled quickly and served
or immediately refrigerated in shallow
containers.

31. Sanitation of Food Preparation Areas and Equipment
Cleanliness of the kitchen and kitchen equipment is essential
for ensuring food safety. Traffic through the kitchen should be
minimized to reduce the introduction of dirt and bacteria. A
schedule, such as that shown in Figure 19–5, is useful for
assuring that all areas of the kitchen, including floors, walls,
ranges, ovens, and refrigerators, are cleaned on a regular basis.
Equipment used in the direct handling of food must also
receive extra care and attention. Countertops and other
surfaces on which food is being prepared should be sanitized
or disinfected with a chlorine bleach solution (¼ cup bleach to
a gallon of water or 1 tablespoon per quart of water) between
every preparation of different food types (meat, salads, fruit). A
fresh bleach solution must be mixed daily to retain its
disinfecting strength.

32. Caution: Never mix bleach with anything other
than water—a poisonous gas can result!
Cutting boards should be nonporous and
always washed with hot, soapy water and
sanitized with a bleach solution after each use.
Separate cutting boards should be designated
for different food preparations (e.g., meat, raw
poultry, salad, fresh fruits) to reduce the risk of
cross contamination (Fravalo et al., 2009).
Cutting boards can be labeled or color coded
to indicate their specific purpose.

34. Dishwashing
Dishes may be washed by hand or with a mechanical
dishwasher. If washing by hand:
• Wash dishes with hot water and detergent.
• Rinse dishes in hot, clear water.
• Sanitize dishes with chlorine bleach solution or scald
with boiling water.
• Air dry (not dried with a towel) all dishes, utensils,
and surfaces.
If a mechanical dishwasher is used to wash dishes, the
machine must meet local health department
standards. Some state licensing regulations provide
guidelines as to which dishwashing method is perm

35. Sanitation of Food Service Areas
The eating area also requires special
attention. Tables used for classroom
activities must be washed and
sanitized with a disinfecting solution:
• before and after each meal
• before and after each snack
Children and adults must always
wash their hands carefully before
eating and especially before they
begin to set the table or to prepare

37. Children should also be taught that
serving spoons are used to serve food
and then replaced in the serving dishes.
They must never be allowed to eat food
directly from the serving dishes or
serving utensils. Continuous assessment
of sanitation and food service conditions
is essential for preventing food-related
illnesses. A functional tool for monitoring
the food environment and food handling
practices is illustrated in Figure 19–6.

50. Food poisoning
refers to a variety of food-borne
illnesses that may be caused by the
presence of bacteria, viruses,
parasites, or some forms of molds
growing on foods. Descriptions of
common food-borne illnesses,
including the source of
contamination, symptoms, and
prevention methods, are presented in
Table 19–1.

51. Foods that are visibly moldy, soured,
discolored, or beginning to liquefy should not
be used; nor should food from bulging cans or
cans in which the liquid is foamy or smells
strange. However, many foods infected with
disease-producing organisms provide the
consumer with few notable clues. These foods
may smell and appear safe, yet be capable of
causing severe illness. Adhering to proper
sanitation procedures, food preparation
guidelines, and food handling techniques
significantly decreases the risk of most food-
borne illnesses (Ewen et al., 2009; Luber, 2009).

52. The introduction of irradiation as a food
preservation technique has played an
important role in reducing the incidence
of some food-borne disease
(Arvanitoyannis, Stratakos, & Tsarouhas,
2009). The U.S. Food and Drug
Administration (FDA) has approved this
technology as a “processing aid” for
destroying illness-producing
microorganisms, such as salmonella and E.
coli in beef and poultry products, lunch
meats, fresh fruits and vegetables, and

53. It is also used to eliminate parasites and
insects in spices and teas, slow the
sprouting process (as in potatoes), delay
ripening, and decrease spoilage. This
procedure involves briefly exposing foods
to low levels of gamma radiation; the
amount of exposure and the types of
foods that can be irradiated are closely
regulated by the FDA (Trigo et al., 2009).
The U.S. Department of Agriculture has
approved the use of irradiated ground
beef for the School Lunch Program since

54. Irradiated foods must carry the
symbol and message shown in
Figure 19–7. Irradiation is
allowed in nearly 40 countries
and is endorsed by the World
Health Organization, the
American Medical Association,
and the CDC, among other
groups.

55. Although some consumer groups remain
skeptical about food irradiation, the
practice is considered to be a safe and
effective method for improving food
safety. Irradiated foods are not
radioactive, nor do they retain any
radioactivity. Nutrient loss during
irradiation, particularly of vitamins A, E,
and C, and thiamin is minimal and
significantly less than losses that occur
during most conventional food
preservation methods (Alothman, Bhat, &

56. Irradiation serves an important role in
improving food safety, but it is not the
solution to preventing all food-borne
illness. Concerns that irradiation will be
used to cover up unsanitary food
processing procedures or that consumers
will depend on this process to prevent
food-related illnesses have been raised by
various groups. However, no technology
will ever replace the need for consumers
to follow safe food handling practices.

58. bacteria – one-celled microorganisms;
some are beneficial for the body but
pathogenic bacteria cause diseases.
viruses – any of a group of
submicroscopic infective agents, many
of which cause a number of diseases in
animals and plants. parasites –
organisms that live on or within other
living organisms.
irradiation – food preservation by short-
term exposure of the food to gamma ray
radiation.

60. Conditions for Bacterial Growth
Because our environment contains
numerous bacteria, why do food-borne
illnesses not occur even more frequently
than they do? For illness to occur the
following conditions must be present:
• Potentially hazardous food—
generally prefer foods that are high in
protein, such as meat, poultry, eggs,
and dairy products.

61. • Oxygen—some bacteria require oxygen. Others
cannot tolerate oxygen. A few bacteria can
grow in environments with or without oxygen.
• Temperature—temperature is probably the
most critical factor in bacterial growth. The
hazard zone of 41°F–140°F is the ideal range in
which bacteria grow most rapidly.
• Time—a single bacterial cell can multiply into
one million cells in 5 hours under ideal
conditions.
• Water—bacteria grow in foods with a higher
moisture content.
• Acidity—bacteria prefer conditions that are

63. Food infections
result when food containing large
amounts of viable (live), disease-
producing bacteria is ingested.
Salmonella, E. coli, and campylobacter
are examples of bacteria that
commonly cause this type of food-
borne illness. Symptoms typically
develop within 12–24 hours after
contaminated food has been ingested
and bacteria have had sufficient time

65. Food intoxications
occur when food containing the
bacterial toxins is consumed.
Symptoms usually develop within
a shorter time period (1–6 hours),
with the exception of botulinum
toxins, which take longer to cause
illness (8–36 hours).

66. The incidence of food-borne illnesses remains
a significant health threat to populations,
especially young children, in the United States
and worldwide (CDC, 2009). Large-scale food
production and increased demands for exotic
and out-of-season produce have made food-
related diseases more difficult to control and
prevent. International food inspection and
production systems have also been slow to
improve. In the United States, new legislation
and resources have been added to increase
food inspections and recalls, but they are still
inadequate to address the complexity of the

67. For example, the USDA regulations allow
federal meat inspectors to conduct brief
(several second) visual examinations of animal
carcasses. Because bacteria are not visible to
the human eye, the results of any “inspection”
must be questioned. Thus, the consumer must
assume full responsibility for choosing, storing,
and preparing these products to minimize the
chances of becoming ill. Since protein-based
foods such as milk, eggs, meat, fish, and
poultry are the most common carriers of
infectious agents and/or toxins, extra care must
be taken whenever preparing these items.

68. Safe-handling instructions attached to
packaging should be followed carefully (Figure
19–8). Most bacteria and toxins are destroyed
when foods are cooked to the proper
temperatures (Figure 19–9). It is NEVER safe to
allow young children to eat raw or
undercooked eggs, meat products, fish, or
seafood because their immature immune
systems leave them more vulnerable to food-
borne illness (Pesavento et al., 2010).
Remember that cold temperatures STOP most
(not all) bacterial growth, while heat KILLS most
(not all) bacteria.