Unit 7 video - click to launch

Unit 7 video - click to launch

Unit 7

healthy practices, part 1


Ask any parent and you'll know: the most important aspect of a child care center or family child care home is safety. Parents quite rightly expect that children will be safe in your care.

And many rules and guides are in place to help you ensure children's safety and well-being. In this unit, we'll talk about all that.

Remember that keeping children safe and healthy helps you stay healthy too!

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Regulations & You

The one thing parents expect of you is this: that when they come to pick up their child in the evening, he is there, safe and sound, with no physical or emotional scars. Nothing else you do matters as much as this. Keeping children safe is Job One.

To help you in doing this, the state of Washington has created two licensing guides, one for child care centers and one for family child care homes

Be sure to download a copy of one or the other of these and keep it nearby. It is your helper in maintaining the level of quality demanded by parents and licensing reps and in keeping children safe.

Keep in mind that regulations are minimum standards, not ideals. Every licensed center - even the very worst ones! - must meet the minimum standards, which are spelled out in state regulations. Your center can do better, by holding itself to even higher standards.

In these guides (pages 123-125 in the Child Care Licensing Guidebook, and Sections 5 and 6 in the Family Home Child Care Guide), you will find specific requirements for each of these areas:

  • How to clean classroom areas

  • How to clean and sanitize equipment

  • How to prevent, manage and report communicable diseases

  • How to handle minor injuries such as scrapes

  • How to provide first aid

  • How to screen children daily for illnesses

  • How and when to notify parents that children have been exposed to infectious diseases and parasites

  • How to handle minor illnesses, such as the flu

  • How to decide when children are ill, how to call for pick up and how to care for a child until family arrives.

  • How to handle major injuries and medical emergencies

  • How to manage medication

  • How to handle hand washing, diapering and toileting

  • How to handle food

  • How to provide nutritious meals and snacks

  • How to respond during a disaster

  • How to meet specific requirements for the care of children with special needs

  • How to meet the specific care needs of infants

This list is a reminder of the huge responsibility we undertake as child care professionals. Everyone in the center must know all of this because all of this may come up at some point in the daily care of children. How can you make certain everyone in the center knows what they need to know?

Your Policy Manual

All licensed child care programs must have written health policies and procedures that are written down. This written policy guide should be shared with staff and also available for parents. In addition, key points should be posted where they are most likely to be read at the time needed.

For example, handwashing policies should be posted near the toilets, in the diapering area, and in areas used for food preparation. Policies regarding illnesses could be posted outside classroom doors, where parents can see them. And so on. The important thing to remember is that policies work to keep children healthy and safe only if they are followed. Make it easy to be reminded to follow your policies.

A good policy manual has these elements:

  • It is written in a way that is clear and easy to understand, using plain words and simple sentences.

  • It is organized in a way that makes sense and is easy to follow. It uses headings to set things apart. There is a table of contents and an index.

  • It is dated so a reader can tell when the manual was last updated. A manual should be reviewed and updates made to it as needed but at least every year.

  • If changes are made to the manual, it is reviewed, signed and dated by a physician, physician's assistant or registered nurse. A signature page is included so this sign-off is made clear to a reader.

  • If the manual is changed, staff and families are notified of the changes.

Notice that this policy manual is different from a "parent handbook." A parent handbook - which is another good thing to have - includes some of this policy information but also includes information about fees, payment, pickup and drop-off times, behavior policies, vacation policies, and so on. A parent handbook is important but the information it contains is focused on the business and educational operation of the center, not so much on children's health and safety.

How do you share this information?

Putting Policies Into Play

A policy manual does no good if no one follows it. No one can follow it if she doesn't know the policies backwards and forwards. Here's the thing: if a staff member has to look up a policy in order to know where to find the first aid kit or how to clean up urine, then the policy is unlikely to be followed at all. In the heat of the moment, staff must know what to do without referring back to the manual.

So a key task of individual staff members is to read and understand the center's policies. To ensure that this happens, center directors or owners should take the following steps:

  • Make policies and the policy manual part of new staff orientation

  • Talk about individual policies in staff meetings, at annual retreats, and other training events.

  • Engage staff in the annual review of the policy manual and in making any changes.

In order for the policy manual to be useful, it has to be used as a daily guide to practices. In many centers, health and safety policies become "givens" and more time is spent on curriculum and fun things to do with children than on keeping them healthy and safe.

Remember that keeping children healthy and safe is essential. 

It's the one thing parents assume you do without being asked.

A Mandated Reporter

As an early childhood professional, you are, automatically, a "mandated reporter." The word "mandated" means "required." You are required by law to report any incidents or suspicions you have about possible abuse or neglect of children. 

This just makes sense. You are in a unique position to notice any maltreatment of the children you see every day. You are the eyes and ears of a concerned community, dedicated to the protection of children. If you don't step up and say what you see, who will? Who else will protect the children?

In the state of Washington, your status as a mandated reporter is contained in Chapter 26.44 RCW.  A video from the state is included in the Additional Resources above.

The law makes it very clear: “When any licensed or certified child care provider or their employee has reasonable cause to believe that a child… has suffered abuse or neglect, he or she shall report such incident, or cause a report to be made, to the proper law enforcement agency or to the department as provided in RCW 26.44.040.” 

This means that whenever you have reason to suspect that a child is suffering from physical, sexual or emotional abuse, neglect, or exploitation, you must immediately report it to your local office of Child Protective Services (CPS). 

If you believe the child is in immediate physical danger or has been harmed and needs immediate medical attention, you must also make a report to local law enforcement. If the suspected child abuse or neglect involves you or your staff, you must inform your licensor.

You must contact CPS if you 

  • Even suspect that certain injuries or bruises may not be accidental.

  • See signs of emotional or sexual abuse or physical neglect.

  • Even if you have made a report to CPS about a particular child earlier and nothing seemed to have happened.

You can be charged with a gross misdemeanor if you do NOT report a suspected case of child abuse, neglect, or exploitation. 

What Happens Next?

First of all, do not attempt to interview the child or to manage the situation yourself. Both interviewing and investigating are the responsibility of CPS. Care for the child normally.

Cooperate with CPS and law enforcement. When you report a case of suspected child abuse, CPS has the right to interview the child in your care without any other adults present. They can look at any of your files.

In most cases, do not inform parents that you are making a report (and do not threaten parents with making a report if you "see that again." If you see something, make a report, not a threat!). Your parent handbook and posted policies should make it clear that center staff are all mandated reporters. 

Do not be concerned if "nothing seems to happen." Child Protective Services may be monitoring the situation or working behind the scenes. It is not your job to do the job of CPS but to continue to be on alert for evidence of more trouble for this child. Report any new incidents.

Once you file a report with CPS you are immune from any civil or criminal liabilities. 

Key Points to Remember

You personally are a mandated reporter. You personally are responsible for making reports to CPS. Do not permit yourself to be bullied by a center administrator into covering up incidents or into thinking there is "no need" to make a formal report. Protect yourself and the children you serve: if you think a report should be made, make it.

Although it's possible to make an anonymous report to CPS, you should use your name and the name of your center. If you don't, you, as a mandated reporter, will still be liable for prosecution. If you stay anonymous, no one knows you fulfilled your mandate.

Effects of Abuse and Neglect

Of course, being abused or neglected as a child is traumatic. There can be little doubt that it's 

important to stop abuse and neglect immediately. But what you may not know is that early trauma has long-lasting effects.

The Adverse Childhood Experiences (ACE) study has demonstrated that early exposure to abuse, neglect, and violence leads to lifelong difficulty with social adjustment and also with chronic diseases, leading to early death. Early trauma is linked to development of heart disease, alcoholism, depression, obesity, and a host of other life-threatening conditions.

This study has also demonstrated that 63% of participants experienced at least one traumatic event before age 18 and 20% had experienced three or more.

Signs of Abuse and Neglect

Obviously, you cannot protect children from all the adverse experiences included in the ACE study. But you must be alert to signs of abuse and neglect that constitute criminal treatment. What should you look for?

Keep in mind that child abuse can come in several forms: physical abuse, sexual abuse, sexual exploitation, emotional maltreatment, neglect and abandonment. In addition, understand that physical and emotional abuse and neglect are part of a pattern of behavior, so that a single instance doesn't necessarily constitute a pattern. With that being said, here's a quick list of what to watch for.

Physical Abuse. This may be signaled by unexplained injuries, conflicting accounts about how injuries happened, fearful behavior when around parents, labeling of the child as "evil," engaging in a pattern of corporal punishment.

Emotional Maltreatment. This may be evidenced by lack of attachment to the parent, unusually passive or aggressive behavior, unusually babyish or sophisticated behavior, lack of concern by the parent for the child, or the parent expresses open rejection of the child.

Sexual Abuse. Suspect this if a child has difficulty walking or sitting, "knows too much" about sex, acts out sexual behavior, refuses to change clothes, or if the parent is overly controlling of the child or other family members, including limiting their contact with other people.

Neglect. This may be occurring if you notice that the child is frequently hungry, dirty, or smelly, if the child says no one takes care of him, if he lacks clothing for cold weather, if the parent seems indifferent to the child, shows signs of drug or alcohol abuse, or acts bizarrely.

In general, a child may be a victim of Abuse or Neglect if she seems always waiting for something bad to happen, comes to school early and never wants to go home, shows a sudden change in behavior, if the parent is inappropriately demanding of the child, seems to dislike the child, is indifferent the problems the child has at school, or blames the child unreasonably.

It is normal to feel self-doubt about making a report. You might wonder, how will you know if this is "real" or not? Remember that a child may be depending on you to speak up.

The phone number for Child Protective Services should be one of the emergency numbers posted by each telephone in your center. Don't be afraid to make a call.

Making Healthy Surroundings

Whether you're a parent or a caregiver, being around children greatly improves your imagination. You can easily imagine all sorts of terrible things happening to the children in your care, everything from choking on toys or snacks to running full tilt into a table edge or doorway. If you find keeping kids safe is keeping you up at night, you're not alone.

Make your imagination work for you. Use it as you look around your classroom and playground. Use it as you watch how individual children play. Where are the hazards and what could go wrong? Take the time to reduce the chances of injury right now.

Planning for Safety

You know, of course,that little children shouldn't have toys small enough to fit through a paper towel roll. If you have a mixed-age group of children, this means segregating the toys for bigger children from the play spaces of the younger children. What else can you do?

Since running and wrestling often cause children to be scraped and bruised, rearrange your classroom to eliminate long raceways and reconfigure large open spaces that invite over-active play. Outdoors, remove obstacles and tripping hazards and install resilient surfaces to cushion falls. Watch out for places children can climb into and get trapped, places that invite climbing (and falling), and places where children cannot be seen.

As we've said before, supervision is an important element in keeping children safe. Paying attention to how children use space and materials will help you to take action before a child gets hurt. Think ahead and use your imagination to head off trouble. Don't wait for approval if you see a dangerous situation. Take charge to keep kids safe.

Safety is Everyone's Job

Safety of children is everyone's responsibility, and not just in the role of mandated reporters, but as planners and supervisors of children's behavior and of the center itself.

Staffing. The people who work at the center are the most important element in protecting children from harm. They should be bound by a culture of care that puts physical and emotional health ahead of cost. This means that there must be adequate numbers of staff to monitor children at all times, staff must be provided with training in doing their jobs well, and staff must be selected on the basis of their ability to take responsibility and be alert to children's well-being. This culture of care starts at the very top, in the way management treats employees, and is supported in small ways that communicate every day the importance of loving attention.

Adequate staffing means that no one is all alone with children at any time during the day. There is always someone else to take over in an emergency situation and to validate the appropriateness of another adult's behavior.

Background checks of new employees and periodic rechecks of existing employees are essential in avoiding scandal and actual harm to children. It is a mistake to treat background checks casually or to think one knows a relative or old friend so well that a check of his or her background is unnecessary.

At every center, the people are more important than curriculum or facilities. It's the people who matter. 

Security In and Out. Children are most in danger from those they know best. Kidnapping and other violence are far less likely to be perpetrated by strangers than they are to be committed by people known to the children in your care or to their families.

So know who is permitted to pick up every child and have established procedures for delegating that responsibility to someone else. Do not release a child to anyone except authorized individuals. A sign-in system gives you proof of which children were in attendance on any given day (or were not) and a sign-out system gives you proof that a permitted person took the child from the center and at what time. You likely will never need this information but on the rare occasion that you do, having a secure system will give you the validation you require.

Many centers these days have limited access in from the outside, so that visitors must be "buzzed in" and cannot simply walk in through the door. If your center does not have such a system, you might consider adding this.

Child-proofing. The minute you see something potentially dangerous is the time to fix it. Be aware of your classroom layout, playground equipment, and toys and materials from a child's point of view. What will children run into, trip over, put in their mouths, poke their fingers into or be tempted to do? While it's true that children will think of things you never would have imagined, trying to stay one step ahead by using your imagination will help to keep kids safe. 

And safety is everyone's responsibility. Don't wait for someone else to fix something or put up a barrier. Be proactive. Remember that it's far easier to prevent injury than it is to administer first aid, write up an accident report, and call a child's parents to let them know.

Planning for Good Health

Naturally, you understand the value of keeping things clean. Every surface in a child care center - floors, tables, chairs, door knobs, faucets, and toys - should be capable of being cleaned to squeaky-clean perfection and must be cleaned daily. A bleach solution should be used to disinfect surfaces, and soft toys and dress-ups should be machine washed. Cleanliness is indeed next to godliness in the child care center, and it's the key to keeping the children - and you! - healthy.

Frequent and thorough hand-washing is essential for both staff and children. Soap and water are far better than hand-sanitizer, which is often used incorrectly. Control of coughs and sneezes and careful toileting practices are also essential.

Step-by-step directions for keeping things clean can be found in the licensing guides mentioned earlier in this unit. Pay attention to correct practices and even become obsessive about them!

Health screening of employees is another element in a plan to ensure children's well-being. In addition to routine mandatory screening for tuberculosis. staff should confirm their fitness to work with children without danger of spreading to them any communicable disease. The center's sickday policy should make it easy - not difficult - for ill staff to stay home. Staff should also consider their ability to keep up with active youngsters and to carry them, if necessary. Child care is physical work.

Taking Time for Health and Safety

The point at which all our good intentions to preserve health and safety fall flat lies in taking the time to do things right. We hurry. We get haphazard. We skip stuff.

The aspect we tend to skip over most often is teaching children what is expected of them. We forget that little kids don't know how to wash their hands. They don't even notice when they might run into someone or something. They understand so much less than we grown-ups do. So we have to take time to guide them, to be their conscience for them, to teach and reteach every day.

Many times, children at home live by different rules than we do at the center. This makes sense - even we adults tend to have "home rules" and "public rules" about dropped cookies, cleanliness, and keeping safe. But this means that children really have no idea about the level of care expected in the child care setting. We have an obligation to take the time to teach these skills and continue to teach over and over again.

In addition, children have no ability whatsoever to see the consequences of their actions. They race headlong into things, put things into their ears and nose, and poke their fingers into tight places without any realization that they might get hurt. All our words of caution float right past them. It's up to us to prepare a safe environment and then take the time to guide children in being as careful and controlled as they can be.

The answer, as we shall see in a later Unit, isn't being so directive and limiting that children can't have any fun. The answer is to let children know what they should do and then practice doing it. This takes time. But this sort of learning is more important than whatever other "real" learning you had in your lesson plan for the day.

When you see the need to guide children in staying safe and healthy, take the time to do that.

Accidents Will Happen

Despite your best efforts, accidents will happen. Make certain your center has established policies for dealing with injuries and that you're ready to implement those policies. Know where the first aid kit is, know first aid and be CPR certified, keep emergency numbers posted in plain sight, and have an emergency action plan.