Transcript Health and Safety of Staff and Children

Health and Safety of Staff and
Children
2011
Margaret Poppe RN, MSN
Child Care Worker’s Health
Working in Child Care settings can be associated
with:
• Increased exposure to infectious Diseases
• Muscle and Skeletal Injuries
• Falls
• Environmental Hazard Exposure
• Stress
Developmental Injury Risks for
Children
Preventing Injuries in Child Care
Settings
What types of injuries:
• Minor (cuts, scrapes, bruises)
• Severe( head injuries and broken bones, internal injuries,
dental injuries)
How:
– Falls
– Collisions
– Drowning
Why:
• Physical ability
• Hazards
• Lack of supervision
Site Specific
Safety Assessment Checklist
• Every child care facility should have daily
and monthly safety checklists in place that
are specific to their own facilities and
environments.
• Create injury prevention and response
policies and assure that all staff are aware.
Adapted from :
7/17/2015
The National Training Institute for Child
Care Health Consultants
5
Supervision
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Be alert and attentive
Be aware of age-appropriate equipment
Evaluate and inspect hazards
Know and apply safe playground rules
Teach children correct use of equipment
Be consistent with adult-child ratio
Intervene for inappropriate behavior
Ensure safe clothing for children
Assign staff to a “zone” and rotate
Adapted from :
7/17/2015
The National Training Institute for Child
Care Health Consultants
6
What is Sudden Infant Death Syndrome
(SIDS)?
• SIDS is the unexpected death of seemingly
healthy babies 12 months or younger.
• No cause of death is determined by
– Death scene investigation and autopsy.
– Review of baby’s medical history.
• Experts cannot predict which babies will die from
SIDS.
Reducing the Risk of SIDS in Child Care Speaker's Kit http://www.healthychildcare.org/sids.html
Willinger M, James LS, Catz C. Defining the sudden infant death syndrome (SIDS): deliberations
of an expert panel convened by the National Institute of Child Health and Human
Development. Pediatr Pathol. 1991;11:677–684
Revised – 12/08
Triple Risk Model
Critical development
period
SIDS
Vulnerable
infant
Reducing the Risk of SIDS in Child Care Speaker's Kit
http://www.healthychildcare.org/sids.html
Revised – 12/08
External stressors
Rebreathing Theory
• Infants in certain sleep environments are
more likely to trap exhaled CO2 around the
face
– Lie prone and near-face-down/face-down
– Soft bedding
– Tobacco smoke exposure
• Infants rebreathe exhaled CO2 : CO2 ↑ & O2 ↓
• Infants die if they cannot arouse/ respond
appropriately
SIDS and Sleep-related Deaths: Current Statistics, Accomplishments & Challenges
Reasons that people place babies on their
tummies
• They think that babies are more likely to
choke or aspirate if they vomit or spit up
• They are worried that babies won’t sleep as
well
• Parental requests
Reducing the Risk of SIDS in Child Care Speaker's Kit
http://www.healthychildcare.org/sids.html
Revised – 12/08
Anatomy when sleeping on stomach
Reducing the Risk of SIDS in Child Care Speaker's Kit
http://www.healthychildcare.org/sids.html
Revised - 0408
Anatomy when supine
Reducing the Risk of SIDS in Child Care Speaker's Kit
http://www.healthychildcare.org/sids.html
Revised – 12/08
Tummy to Play and
Back to Sleep
• Supervised tummy time when babies
are awake
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Promotes healthy physical and brain development
Strengthens neck, arm, and shoulder muscles
Decreases risk of head flattening and balding
Encourages bonding and play between the supervising
adult and the baby
• Back to sleep
– Reduces the risk of SIDS
– Comfortable and safe
Revised – 12/08
Tummy Time
• Tummy time is for babies who are awake
and being observed.
• It is needed to develop strong muscles.
• Have tummy time 2 to 3 times a day and
increase the amount of tummy time per
day as the baby gets stronger.
• There are lots of ways for babies
to enjoy tummy time!
Reducing the Risk of SIDS in Child Care
Speaker's Kit
http://www.healthychildcare.org/sids.html
Revised – 12/08
Safe Sleep Practices
• Always put healthy babies to sleep on their
backs for naps and at bedtime.
Reducing the Risk of SIDS in Child Care
Speaker's Kit
http://www.healthychildcare.org/sids.html
Revised – 12/08
Safe Sleep Practices
• Avoid overheating.
– Do not overdress baby.
– Never cover baby’s head with a blanket.
– Room temperature should be comfortable for a
lightly clothed adult.
Reducing the Risk of SIDS in Child Care Speaker's Kit
http://www.healthychildcare.org/sids.html
Revised – 12/08
Safe Sleep Practices
• Pacifiers may be offered to babies to reduce
the risk of SIDS
– If breastfed, wait until breastfeeding is well
established (approximately 3 - 4 weeks of age),
before offering a pacifier.
– If the baby refuses the pacifier, don’t force it.
– If the pacifier falls out while the baby is asleep,
you do not have to re-insert it.
Reducing the Risk of SIDS in Child Care
Speaker's Kit
http://www.healthychildcare.org/sids.html
Revised – 12/08
Safe Sleep Environment
• Safe crib, firm mattress.
• Avoid chairs, sofas, air mattresses, water
beds, and adult beds.
Reducing the Risk of SIDS in Child Care
Speaker's Kit
http://www.healthychildcare.org/sids.html
Revised – 12/08
Emergencies in
Child Care Facilities
• General emergencies
• Missing children
• Disgruntled or impaired parents/guardians or their authorized
representatives
• Medical emergencies
• Natural disasters, including hurricanes, tornados, and severe
storms
• Fire/smoke emergencies
• Bioterrorism/war emergencies (such as bomb threats)
• Nuclear or radiation emergencies
• Utility disruption
• Hazardous materials
• Chemical leaks
The National Training Institute for Child
Care Health Consultants, 2009
19
Grab and Go Kit
• List of emergency phone numbers, including parent contact
information
• A charged cell phone or calling card or “walkie talkies”
• Water
• Non-perishable food, manual can opener
• First aid kit
• Blankets
• Radio, flashlights, extra batteries
• Handwashing solution that does not require running water
• Extra clothing/shoes
• Diapers, baby food and formula
• Prescription medicines for children and staff
• Other items as needed for safety and comfort
• Child records and attendance sheets
The National Training Institute for Child
Care Health Consultants, 2009
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Musculoskeletal Injuries and Falls
Risk Factors
• Heavy lifting and
carrying
• Sitting on the floor or in
child sized chairs with
little back support
• Kneeling and squatting
• Reaching
Use “Good Body Mechanics”
to Prevent Injury
• Use adult size furniture
• When rising from child size furniture ( use squat
position, back straight, pelvis level, thighs tight
• Set up storage so you can reach from normal
standing
• To get to child level squat or kneel keep spine
straight
Lifting Children
• Feet apart , one foot along side of child one
slightly back.
• Squat, bend at knees . Tighten stomach keep
back straight
• Use leg strength
• Avoid twisting
• Putting child down same process, back
straight
Other Ways to Prevent Injury
• Wear supportive non skid
footwear
• Regular exercise &
stretching
• Maintain proper body
weight
• Floor sitting use the wall for
support
• Use or request carts for
moving heavy objects
OSHA Hazard Communication
Standard 1910.1200
Requires that all employees be informed of the identities and
hazards of the chemicals they are exposed to when working
• Warning labels should be visible on containers
• Products including sanitizing agents should have an
MSDS (Material Safety Data Sheets)
• Training on proper handling, storage, usage should be
provided for staff
Environmental Safety for Staff and
Children
• Avoid use of high solvent cleaners especially carpets
• Store cleaning products in their original containers
• Pest management should choose the lowest number
Health Hazard Rating
(0-4)
• Only certified professionals should be employed for
pest management or mold or mildew treatment
Environmental Safety
• Art Materials : ASTM-D-4236 or ACMI
• Staff should avoid personal use of adult art
supplies such as rubber cement and aerosols
or turpentine based materials
Infectious Disease Concerns ?
Why do Young Children Spread Illnesses
so Easily ?
• Immature immune system &
frequent illness
• Children need a lot of intimate
hands on care
• Hand to mouth activity
• Children are in close contact
• Great number of unrelated
children
• Age group mixing
• Children and staff bring mild
illness to school
Chain of Infection
Source of Germs
Route of
Transmission
Host
Attack the source of infection or the “first link” by identification,
treatment and, if necessary, isolation of the sick person
Attack the route of transmission or the “second link” by
personal and general hygiene: Handwashing
Protect the vulnerable person or the “third link” through
immunization, balanced nutrition, and healthy practices.
California Child Care Health Project
Modes of Transmission
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Droplets
Fecal Oral Route
Skin
Blood or Body Fluids
Droplets
Stool or Fecal/Oral transmission
Skin Contact
Blood or Other Body Fluids
Group Activity
Break the Chain by Enforcing
Exclusion Guidelines
• http://www.healthychildcare.org/PDF/InfDise
ases/Videos/Module3Video2.wmv
Break the Chain by Enforcing Exclusion
Guidelines Key Points
• The ill child is unable to take part comfortably in
regular activities
• The ill child needs care that significantly interferes
with provider’s ability to provide appropriate care for
other children
• The child has signs or symptoms of a possible serious
condition
• Signs or symptoms that indicate a contagious illness
or condition or has a diagnosed contagious illness
Caring for Our Children http://nrckids.org/SPINOFF/IE/IncExc.pdf
Exclusion Cont.
• Diarrhea that can’t be explained by diet
change, is watery , and can’t be contained in
the diaper or managed by regular toileting
• 2 or more episodes of vomiting in 24 hours
• Others
See VT licensing regulations
VT Exclusion Guidelines
• Axillary (armpit) temperature of 100°F or
greater and behavior change
• Rectal (anus) temperature of 102°F or
greater and behavior change
• Under 2 months old with temperature
100.4°F or higher rectal contact parent or
EMS if not reachable
http://dcf.vermont.gov/sites/dcf/files/pdf/cdd/care/EC
P_Appendix_B.pdf
Break the Chain : Morning Health Check
and Exclusion
Break the Chain : Immunizations
Concept of Herd Immunity
If enough of the
“herd “ is immunized
the whole “herd” is
protected . ( 95%)
Goal : Aim to get as
many children and
staff immunized as
possible to protect
the whole group.
Break the Chain :Hand Washing and
Sanitizing
Handwashing Activity
Policy Considerations
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What should be Done
Why
Who is responsible
When will it be done
How will it be done
How will it be communicated and enforced
What Should a Policy Include?
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Title
Belief Statement
Intent Statement
Background
Procedure/Practice
Application
© The National Training Institute for Child Care Health Consultants, UNC-CH, 2007
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What Should a Policy Include?
Communication
8. References
9. Review
10. Effective Date
11. Review Date
7.
© The National Training
Institute for Child Care Health
Consultants, UNC-CH, 2007
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Policy Activity
Sanitizing Surfaces Breaks the
Chain
• 1/4 cup household bleach to
one gallon of cool water
• One tablespoon household
bleach to one quart cool
water
• Spray don’t dip
• Contact time 2 minutes
• Mix ever day
• Safety issues
Safe Diapering Breaks the Chain
Evaluate This Diapering Set-up
Courtesy of Cheryl Frank and Andrea Miller
OSHA Blood borne Pathogen Standard
1910.1030
• Requires that any workplace that exposes
employees to blood borne pathogens
should have a written exposure plan. Staff
should be oriented to the plan.
– All body fluids should be considered potential
sources of infection and precautions should
be taken including
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Gloves and protective equipment as appropriate
Hand washing
Sanitizing
Reporting exposure and following the exposure
plan is program specific
Infectious Disease Policy & Procedures
• Checking children’s immunization status and informing
parents of gaps
• Universal precautions
• Hand washing
• Diapering
• Cleaning & disinfecting
• Identifying an ill child or child care provider
• Informing parents that their child is ill
• Routinely informing all families about highly infectious
condition or disease
Pregnant Employees
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Contact your physician for advice
Risk for CMV
Get tested for CMV antibody
Work with 2 year olds and older during
pregnancy
• Good hand washing
• Avoid saliva, toys, and utensils contaminated
with saliva
OBESITY RISK : Organizational &
Institutional: Childcare
• Attending childcare associated with obesity
• Need to Address Healthy Eating Standards
Regulations, Quality Stars, NAPSACC
– Meal pattern
– Limit Juice, ban SSB’s
– Reduce energy density
– Portion size
Gubbels, et al: Int J Obesity 2010 May; Khan, et al; MMWR 2009;58:1-26; Rolls: Poc
Nutr Soci, December 2009; Lehahy, et al: JADA 2008;108:41-48.
Barbara A. Dennison, MD, Early Childhood Obesity Role of nutrition Factors
Powerpoint presentation, 2010.New York State Department of Health School of
Public Health, SUNY Albany
Why are young children getting fatter?
They are eating too many calories.
FITS, JADA, 2004;
IOM, 2002; USDA,
ERS, 2004
Barbara A. Dennison, MD, Early Childhood Obesity Role of nutrition
Factors PowerPoint presentation, 2010.New York State Department of
Health School of Public Health, SUNY Albany
Socio-ecologic Model: A Framework to
Identify Levels of Influence
Barbara A. Dennison, MD, Early Childhood Obesity Role of nutrition
Factors PowerPoint presentation, 2010.New York State Department of
Health School of Public Health, SUNY Albany
High Resource
Low Resource
Frieden TR: Am J Public Health 2010;100:590-595
Barbara A. Dennison, MD, Early Childhood Obesity Role of nutrition Factors
PowerPoint presentation, 2010.New York State Department of Health School
of Public Health, SUNY Albany
Licensing Regulations, Standards, Stars
• What is the minimum required?
• Is it enough?
• What is the role of child care in promoting
healthy eating and physical activity?
• What are the challenges?
New Standards on Nutrition,
Physical Activity, and Screen Time
Recently released 2010 standards provide
guidance beyond what we currently have in
our licensing regulations.
• Preventing Childhood Obesity in Early Care
and Education Programs
http://nrckids.org/CFOC3/PDFVersion/prevent
ing_obesity.pdf
Highlights of New Guidelines
• General: Use USDA CACFP guidelines , meal pattern, menu, water,
100%juice
• Infants: Encourage breastfeeding, Consistent caregiver feeding, cue based,
storage of human milk, bottle feeding techniques, introduction of age
appropriate foods, soy based products
• Toddlers: Meal and snack pattern, serving size, self feeding
• Food brought from home: Quality and selection and preparation
• Nutrition education: Provide nutrition learning experiences for children,
parents/guardians, including health, nutrition , and physical activity
• Policies: Infant feeding, food and nutrition,
• Physical activity : Active indoor and outdoor play, policies and practices ,
role modeling
• Limit screen time
http://nrckids.org/CFOC3/PDFVersion/preventing_obesity.pdf
Preventing Childhood Obesity in Early Care and Education Programs :
http://nrckids.org/CFOC3/PDFVersion/preventing_obesity.pdf
Nutrition Key Points
• The Child Care program must promote a
Healthy Eating Environment
• Food Must Meet the Children’s Nutritional
Needs ( USDA Child and Adult Care Food
Program )
• Meal or snack provided every 3 hours
• Fruit juice recommendation
• Food Served Must Be Safe
Eating Environment Recommendation
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Family style
Separate serving utensil
Encourage but do not force eating ( ideas?)
Adults role model food choices that meet nutritional
standards
Socialize, talk about food, days events, color etc.
Don’t rush slow eaters
Accommodate special diets
Hold Infants for Bottle feeding
Harms, Clifford and Cryer
Environment Rating Scales
© The National Training
Institute for Child Care Health
Consultants, UNC-CH, 2007
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Scale Characteristics: Items
Each scale has items to evaluate:
• Physical environment
• Basic care
• Curriculum
• Caregiver/child interaction
• Schedule/program structure
• Provisions for parent/staff
ECKERS Video Clip meals and snacks
© The National Training
Institute for Child Care Health
Consultants, UNC-CH, 2007
66
USDA Child and Adult Program
Recommendations
Meal Pattern Recommendations :
http://www.fns.usda.gov/cnd/care/ProgramBasi
cs/Meals/Meal_Patterns.htm
Activity
Food Policy
Requirements
for Food Safety
• All children must be served food that is
stored, prepared, and presented in a
safe and sanitary environment.
• All child care facilities must follow the
steps for safe food handling.
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Storage Containers and Heating
Bottles made of plastics containing BPA or
phthalates should be avoided (labeled with
#3, #6, or #7). Glass bottles or plastic bottles
labeled BPA Free or with a #1, #2, #4, or #5
are acceptable.
Food Safety
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Hand washing before food preparation
Formula storage and labeling ( prepared for 24 hours )
Warming Bottles
Choking prevention Cut foods into pieces no larger than ½
inch. Teach children how to chew their food well.
• Food storage and labeling ( clearly labeled and dated )
• Food Allergies posted
• Cleaning surfaces
• Refrigerator temperatures ( <40 degrees)
• Washing fresh fruits and vegetables
VT Early Childhood Program Licensing Regulations:
http://dcf.vermont.gov/cdd/child_care_licensing ( Early Childhood Programs
pg. 30-33 and Regulations for Family Day Care Homes pg. 13 )
Nutritional Needs - Infants
• Exclusive breastfeeding is
recommended for the first six months
of life.
• Research shows breastfeeding has
strong benefits for both mother and
baby
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Support for Breast Feeding
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Establish a supportive breastfeeding policy
Train Staff In proper handling/storage of human milk.
Provide positive breastfeeding promotion messages
Provide a place to breastfeed or pump in privacy
Assure all know that mothers may breastfeed
her child wherever she and her child have a legal
right to be (Vermont Act 117)
• Encourage expectant mothers to breastfeed
• Connect new mothers with others who have
successfully combined breastfeeding and working.
http://healthvermont.gov/wic/foodfeeding/breastfeeding/childcare.aspx
Storing Breast Milk
• Store in firm plastic containers, either poly propylene
(cloudy and a little flexible) or polycarbonate (clear
and rigid), or glass.
• Store in the refrigerator no longer than 48 hours, and
in the freezer for no longer than two weeks.
• All containers must be labeled with the child’s name
and serving date.
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Serving Breast Milk
• Bottles of breast milk should be warmed by placing
them in a pan of hot (not boiling) water for 5
minutes or until it reaches the desired temperature.
• Milk should never be heated in a microwave.
• The temperature of the milk should always be tested
to reduce the risk of burns upon feeding.
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Nutritional Needs - Infants
• Feed infants whenever they are hungry.
• Juice is not necessary for infants and may be
detrimental.
• Hold infants when feeding.
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Nutritional Needs - Infants
• Solid Foods
May be introduced at 6 months of age,
depending on the individual child’s
development.
Finger feeding may be introduced
at
8-10 months of age.
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Nutritional Needs – Toddlers
and Preschoolers
• Eating Characteristics
Small frequent meals.
Child chooses how much food they eat
• Portion Sizes
Refer to CACFP and the Food Guide Pyramid
for age appropriate portion
sizes.
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Nutritional Needs – Toddlers
and Preschoolers
• Nutritional Requirements
Variety needed for growth and health
– CACFP and the Food Guide Pyramid
Use as a guide for meals and snacks.
Check for updates.
Limit sweets, fat, and juice.
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Special Needs and Allergies
• Special requirements obtained in
writing
• Individualized adaptations
• Monitoring and rapid response plan
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Menu Planning
• Plan menus in advance and work with a
nutrition specialist.
• Snacks make up 20% of children’s daily
energy and nutrient needs, so all foods
need to be nutritious.
• Avoid high sugar, high fat or sticky
foods.
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Juice Recommendation 2010
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Only 100% Juice or diluted full strength
No more than 4-6 oz. per day from age 1-3
Infants to 12 months : No fruit juice
No sweeteners
At meal and snack time
Conversations with Parents
Why : teeth and obesity research
Menu Planning Checklist
Meets the CACFP requirements
Includes a good source of vitamin C
Includes a good source of iron
Includes a good source of vitamin A
Includes foods with different textures
Includes foods with different colors
Includes new foods and favorite foods
Represents cultural foods of the children
Food safety standards are followed
Includes a variety of fruits and vegetables?
Food Allergies
• All children with food allergies should have a plan
which includes which foods need to be
eliminated and actions to take in an emergency
• Allergies should be prominently posted
• Staff should receive training
http://nrckids.org/CFOC3/PDFVersion/preventing_o
besity.pdf
Nutrition Scenarios
Communicating with Parents
Physical Activity
Physical Activity Guidelines
• Promote active play everyday
– 2-3 time outdoors weather permitting(
toddlers 60-90 minutes, preschoolers 90-120
minutes)
– 2+ structured adult led activities or games
that promote movement
– Opportunities to practice age appropriate
gross motor and movement
Activity
Creative Opportunities for Active Play
Examples/Resources
http://www.aahperd.org/headstartbodystart/ne
ws/takeItOutsideWeek/upload/movingwithbe
ac-ball.pdf
http://www.aahperd.org/headstartbodystart/
• Motion Moments videos
http://nrckids.org/Motion_Moments/index.ht
m
Too Much TV
The American Academy of Pediatrics (AAP)
recommends that children two years old and
under should
• not be exposed to television
• children over age two should limit daily media
exposure to only 1-2 hours of quality
programming
Resources
• Head Start Body Start Lead Structured
Activities
http://www.aahperd.org/headstartbodystart/news/t
akeItOutsideWeek/structuredactivities.cfm
• Eat Well Play Hard in Child Care Settings Curriculum
http://www.health.state.ny.us/prevention/nutrition/
cacfp/ewphccs_curriculum/
• Color me Healthy Preschoolers Eating and Moving
http://www.colormehealthy.com
Curriculum and Other Ideas?
Eat Well Play Hard : Choose Your Fun:
http://www.health.state.ny.us/prevention/nutrition/cacfp/ewphccs_curriculum/do
cs/choose_your_fun.pdf
Licensing Regulations , Standards,
Stars
• What is the minimum required?
• Is it enough?
• What is the role of child care in promoting
healthy eating and physical activity?
• What are the challenges?
What causes you to feel stress at work
?
What is Work Related Stress ?
• The harmful physical and emotional responses
that occur when the requirements of the job
do not match capabilities, resources and
needs of the worker “ ( NIOSH, 2002)
• “Job challenge is a positive experience that
energizes us psychologically and motivates us
to learn new skills and master our jobs “ (
NIOSH 2002)
Program Strategies that Help
Decrease Stressors
• Staff are responsible for one group of
children in one room
• Written job descriptions and
personnel policies ( family friendly)
• Regular staff meetings
• Staff involved in decision making
• Trained volunteers or parents for
breaks
• Emergency relief
How Do You Manage Stress ?