At the end of this chapter, you should be able to:
Explain why health and well-being in early childhood is so important.
Describe qualities and benefits of high-quality early care and education programs.
Outline what the book will be addressing in regards to safety, health, and nutrition.
Discuss what licensing is and its role in keeping children safe and healthy.
Compare and contrast Title 22 and Title 5 licensing requirements.
A culture of wellness exists when staff and child health and safety are valued, supported, and promoted through health & wellness programs, policies, and environment.
1
Introduction
Evidence shows that experiences in childhood are extremely important for a child’s healthy development and lifelong learning. How a child develops during this time affects future cognitive, social, emotional, language, and physical development, which in turn influences school readiness and later success in life.
Research on a number of adult health and medical conditions points to pre-disease pathways that have their beginnings in early and middle childhood.
During early childhood, the human brain grows to 90 percent of its adult size by age 3. Early childhood represents the period when young children reach developmental milestones that include:
Emotional regulation and attachment
Language development
Cognitive development
Physical development (motor skills)
All of these milestones can be significantly delayed when young children experience inadequate caregiving, environmental stressors, and other negative risk factors. These stressors and factors can affect the brain and may seriously compromise a child’s physical, social-emotional, and cognitive growth and development.
More than any other developmental periods, childhood sets the stage for:
School success
Health literacy
Self-discipline
The ability to make good decisions about risky situations
Eating habits
Conflict negotiation and healthy relationships with family and friends
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Understanding Childhood Health Concerns
Although young children are typically healthy, it is during this time that they are at risk for conditions such as:
Developmental and behavioral disorders
Child maltreatment
Asthma and other chronic conditions
Obesity
Dental caries (cavities)
Unintentional injuries
While typically nonfatal, these conditions affect children, their education, their relationships with others, and the health and well-being of the adolescents and adults they will become.
5
Emerging Issues in Childhood Health
The keys to understanding childhood health are recognizing the important roles these periods play in adult health and well-being and focusing on conditions and illnesses that can seriously limit children’s abilities to learn, grow, play, and become healthy adults.
Prevention efforts in early and middle childhood can have lasting benefits. Emerging issues in early and middle childhood include implementing and evaluating multidisciplinary public health interventions that address social determinants of health by:
Fostering knowledgeable and nurturing families, parents, and caregivers
Creating supportive and safe environments in home, schools, and communities
Increasing access to high-quality health care
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Early Childhood Development and Education
Early childhood, particularly the first 5 years of life, impacts long–term social, cognitive, emotional, and physical development.
Healthy development in early childhood helps prepare children for the educational experiences of kindergarten and beyond.
Early childhood development and education opportunities are affected by various environmental and social factors, including:
Early life stress
Socioeconomic status
Relationships with parents and caregivers
Access to early education programs
Early life stress and adverse events can have a lasting impact on the mental and physical health of children.
Specifically, early life stress can contribute to developmental delays and poor health outcomes in the future. Stressors such as physical abuse, family instability, unsafe neighborhoods, and poverty can cause children to have inadequate coping skills, difficulty regulating emotions, and reduced social functioning compared to other children their age.
Additionally, exposure to environmental hazards, such as lead in the home, can negatively affect a child's health and cause cognitive developmental delays. Research shows that lead exposure disproportionately affects children from minority and low–income households and can adversely affect their readiness for school.
The socioeconomic status of young children's families and communities also significantly affects their educational outcomes. Specifically, poverty has been shown to negatively influence the academic achievement of young children. Research shows that, in their later years, children from disadvantaged backgrounds are more likely to need special education, repeat grades, and drop out of high school. Children from communities with higher socioeconomic status and more resources experience safer and more supportive environments and better early education programs.
The Effects of Poverty on Education
“Despite being one of the most developed countries in the world, the United States has one of the highest rates of childhood poverty globally.”
7
“Poverty has a particularly adverse effect on the academic outcomes of children, especially during early childhood.”
8
Research has shown that children from families in poverty enter school with a readiness gap. Contributions to this gap include:
Poor physical development and health (due to poor nutrition and lack of access to medical care)
Challenges with concentration, memory, attentiveness, curiosity, and motivation
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due to the chronic stress of living in poverty
Greater risk for behavioral and emotional problems
Exposure to environmental hazards (such as lead paint) and violence in their communities.
Two additional things that are important to note:
This gap disproportionately affects Black and Latinx children.
Families experiencing poverty have challenges finding affordable, high-quality early care and education programs and are often in districts with under-resourced schools.
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Early childhood programs are a critical outlet for fostering the mental and physical development of young children. According to the Center on the Development Child at Harvard University’s
A Science-Based Framework for Early Childhood Policy,
“ The principal elements that have consistently produced positive impacts include:
highly skilled teachers;
small class sizes and high adult-to-child ratios;
age-appropriate curricula and stimulating materials in a safe physical setting;
a language-rich environment;
warm, responsive interactions between staff and children; and
high and consistent levels of child participation.”
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The National Association for the Education for Young Children says that high quality programs:
Create caring communities of learners in which children develop relationships with each and the teachers and each child and family are included.
Teach to support children’s development and learning by being intentional with the environmental design, materials, and activities and by providing positive guidance for children’s behavior.
Have developmentally appropriate curriculum that helps children learn and grow that sets challenging, yet achievable goals for children, balances adult instruction and group activities with play and child-chosen experiences, provides enough time for deep engagement, and is based on the children’s interests, abilities, and knowledge.
Regularly assesses children’s development and learning to inform their environmental design, curriculum, and interactions with children and their families.
Is founded on partnerships with families in which families are respected and valued, share their goals and concerns, are encouraged to participate, and with clear communication (in a family’s home language whenever possible).
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And you can check out the checklist
15 Must-Haves for All Child Care Programs
published by The Administration for Children and Families Office of Child Care in Appendix A.
Early childhood development and education programs can also help reduce educational gaps. For example, Head Start is a federally funded early childhood program that provides comprehensive services for children from low–income families. Head Start aims to improve health outcomes, increase learning and social skills, and close the gap in readiness to learn for children from low–income families and at-risk children. Enrolling children in full-day kindergarten after the completion of preschool has also been shown to improve academic achievement.
Furthermore, extended early childhood programs for children up to 3rd grade, also referred to as booster programs, can provide comprehensive educational, health, and social services to complement standard early childhood and kindergarten programs. These programs help sustain and bolster early developmental and academic gains. Characteristic of such programs include:
Low student-teacher ratio
Teacher training
Creation of school-family partnerships
School meals
Provision of transportation to and from school
Health care services and referrals
Home visitation
Supportive social services
Quality education in elementary school is necessary to reinforce early childhood interventions and prevent their positive effects from fading over time. Research also shows that school quality has an impact on both the short– and long–term educational attainment of children, as well as on their health. For example, children who enroll in low–quality schools with limited health resources, safety concerns, and low teacher support are more likely to have poorer physical and mental health.
The developmental and educational opportunities that children have access to in their early years have a lasting impact on their health as adults. The Carolina Abecedarian Project found that the children in the study who participated in a high–quality and comprehensive early childhood education program, including health care and nutritional components, were in better health than those who did not. The study found that, at age 21, the people who participated in the comprehensive early education program exhibited fewer risky health behaviors—for example, they were less likely to binge drink alcohol, smoke cigarettes, and use illegal drugs. This group also self–reported better health and had a lower number of deaths.
Furthermore, by their mid–30s the children who participated in the comprehensive early childhood development and education program had a lower risk for heart disease and associated risk factors, including obesity, high blood pressure, elevated blood sugar, and high cholesterol. These studies show that quality early childhood development and education programs can play a key role in reducing risky health behaviors and preventing or delaying the onset of chronic disease in adulthood. We will look at what high quality programming looks like at the end of the chapter.
Early childhood development and education are key determinants of future health and well–being. Addressing the disparities in access to early childhood development and education opportunities can greatly bolster young children’s future health outcomes.
Additional research is needed to increase the evidence base for what can successfully impact the effects of childhood development and education on health outcomes and disparities. This additional evidence will facilitate public health efforts to address early childhood development and education as social determinants of health.
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Importance of Considering Holistic Development
Early childhood education (ECE) is not a singular concept, but rather a holistic concept that focuses on several aspects of a child's development, including their cognitive, social, emotional, moral, spiritual, and physical well-being (American Academy of Pediatrics 2012; Chisholm 2004; Tinajero & Loizillon 2012). According to Shonkoff,
et al.
(2011), debates about early childhood education often focus on education and the enhancement of children's cognitive skills and later academic progress. However, these authors stress the importance of viewing children in a holistic manner as part of a bigger system. In this manner, early childhood education becomes a vehicle for enhancing the physical, cognitive, mental, social and economic well-being of individuals and the societies in which they live. Early care and education programs should enhance multiple interrelated dimensions of a child's life; including health and safety, nutrition, emotional well-being, and social competence.
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Focus on Wellness
Rather than waiting for health issues to arise, families and early childhood education programs should focus on supporting children’s wellness. “Wellness describes the entirety of one’s physical, emotional, and social health; this includes all aspects of functioning in the world (physiological, intellectual, social, and spiritual), as well as subjective feelings of well-being. A child who is doing well frequently experiences joy, delight, and wonder, is secure and safe in his/her family and community, and is continually expanding and deepening his/her engagement with the world around him/her.”
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Wellness is an active process. It requires awareness and directed, thoughtful attention to the choices we make. Early care and education programs can play a critical role in helping children, families and staff commit to and implement healthy lifestyle choices that promote both physical and mental well-being. The two, in fact, are closely linked. Our feelings, thoughts, and behaviors directly impact our physical health. Similarly, our physical health status has a direct impact on our feelings, thoughts, and behaviors.
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We must also support children’s mental well-being and help them navigate everyday stress and adversity as well as trauma and significant sources of stress. The American Psychological Association shares that “[b]uilding resilience — the ability to adapt well to adversity, trauma, tragedy, threats or even significant sources of stress — can help our children manage stress and feelings of anxiety and uncertainty.”
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It is important that children are in an environment that keeps them physically and emotionally safe and healthy and provides sound nutrition. As an early educator, providing these requires attention, planning, and intention.
Introduction to Safety, Health, and Nutrition
This book is divided into three sections. These include:
Safety
Health
Nutrition
Safety
Children are curious and eager to learn. They depend on their caregivers to keep them safe by making sure that nothing within a child’s reach can harm them. Injuries are a serious health risk to young children. But most injuries are predictable and preventable.
20
But it fails to protect children by being enclosed with a fence and gate.
21
ECE programs can prevent risks and unnecessary harm to children by committing to a culture of safety. A culture of safety prioritizes safety at all levels. It encourages programs to learn from past problems and prevent them in the future.
22
Programs should not assume that nothing will ever go wrong. In fact, they should plan that something is going to go wrong. And their goal is to make it as hard as possible for things to go wrong.
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Chapters 2.1 through 2.7 will focus on ways programs can protect children’s safety.
Chapter 2.1 discusses active supervision and creating a culture of safety
Chapter 2.5 is an example of an accident reporting form
Chapter 2.6 covers preparing for and managing emergencies
Chapter 2.7 discusses child maltreatment (abuse and neglect)
Health
“Health is more than merely the absence of disease—it is an evolving human resource that helps children and adults adapt to the challenges of everyday life, resist infections, cope with adversity, feel a sense of personal well-being, and interact with their surroundings in ways that promote successful development.”
24
As mentioned at the beginning of the chapter, research is showing that many adult health issues, such as high blood pressure, heart disease, and diabetes, are linked to what happens during early childhood (and even prenatally!). We also know that during early childhood there are biological systems that are more sensitive to environmental factors (such as child maltreatment, malnutrition, and recurring issues to infectious disease).
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It is vital for children and their families to have support for children’s physical, oral, and mental health. This happens through promoting health and protection from illness.
Chapters 3.1 through 3.10 focus on children’s health.
Chapter 3.1 examines promoting health
Chapter 3.2 talks about developmental and health screening
Chapter 3.3 is a list of developmental milestones
Chapter 3.4 looks at preventing illness
Chapter 3.5 addresses supportive health care
Chapter 3.6 is an example of a form used when children are excluded from care
Chapter 3.7 is an example of an exposure notice
Chapter 3.8 describes special health care needs during childhood
Chapter 3.9 addresses physical activity for young children
Chapter 3.10 discusses children’s mental health
Nutrition
Healthy eating and being active are essential to a child's well-being. Children who are under- or over-nourished are at risk for chronic health problems.
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Early childhood is an important time for developing healthy habits for life. Children’s bodies grow and develop in ways that affect the way they think, eat, and behave.
28
A healthy diet not only affects growth, but also immunity, intellectual capabilities, and emotional well-being. Families and educators must ensure that children receive an adequate amount of needed nutrients to provide a strong foundation for the rest of their lives.
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Chapters 4.1 through 4.7 focus on nutrition for children.
Chapter 4.1 delves into basic nutrition for children
Chapter 4.2 examines protecting nutrition and wellness
Chapter 4.3 discusses providing good nutrition
Chapter 4.4 addresses menu planning
Chapter 4.5 discusses food safety
Chapter 4.6 is an example of a food allergy management checklist
Chapter 4.7 is an example of a self-assessment of the food your center serves
Introduction to Licensing for Child Care Centers in California
Licensing for child care programs in the state of California is overseen by the Community Care Licensing Division of the California Department of Social Services, whose primary mission is to ensure the health and safety of all children enrolled in licensed child care facilities in California.
Licensing oversees the operation of licensed child care facilities in child care centers and family child care homes. By definition, both types of child care facilities provide nonmedical, age-appropriate care and supervision of infant to school-age children for less than 24 consecutive hours at a time.
Child care centers
provide care in a large-group setting, usually operate in an institutional or commercial building, and must meet a number of requirements regarding their physical facilities, and the services they provide. For the most part, when this book refers to licensing requirements, it will be referencing licensing for child care centers.
Family child care homes
provide care in small-group settings in the licensee’s private house or apartment. They include two types of facilities: small family child care homes that care for no more than 8 children at any one time, and large family child care homes that care for no more than 14 children at any one time.
The key to licensing’s effort to protect the health and safety of children in child care is a thorough and fair licensing and inspection program that ensures all facilities are in compliance. Community Care Licensing is mandated by law to ensure that licensed facilities meet established health and safety standards and that the licensee has access to all relevant information about the department.
Once a facility meets all the requirements to merit a license, licensing’s principal way of helping facilities maintain compliance is through periodic unannounced site visits by licensing program analysts (LPAs). In addition to conducting these inspections, our LPAs work with licensees to address any needed changes, and conduct follow-up visits to confirm that problems have been eliminated. It is also the role of the LPA to investigate any complaints about a facility and consult with licensees to ensure they are aware of their rights and responsibilities.
Licensing also provides ready access to the child care advocate program. The advocates serve as a link between licensing and the community of licensees, provide information about licensed child care to families and the public, act as a liaison with businesses, child care organizations, and resource and referral agencies, and coordinate complaints and concerns on behalf of children in care. As a result, licensing is both an enforcement agency and a resource on health and safety requirements.
31
The complete licensing regulations, often referred to as Title 22, can be found on the Community Care Licensing Division of the California Department of Social Services Child Care Regulations
Online California Code of Regulations, Title 22, Division 12 only
webpage (see Resources for Further Exploration). Highlights of the regulations can be found in Appendix B.
Licensing Requirements for Early Childhood Programs that are State-Subsidized
There are more stringent requirements for programs whose families get tuition assistance from the state of California, commonly referred to as Title 5. The most notable difference in Title 5 regulations is stricter adult-to-child ratios and staff qualifications. See Table 1.1 for a comparison of ratios.
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Table 1.1 – Title 22 and Title 5 Adult to Child Ratio Comparison
33
,
34
,
35
Age Group
Title 22
Title 5
Infants
1 adult to 4 children
1 adult to 3 children
Preschoolers
1 adult to 12 children
1 adult to 8 children
School-Aged
1 adult to 14 children
1 adult to 14 children
Accreditation from the National Association for the Education of Young Children
While not legal regulations, there are even further requirements in place for programs that choose to pursue voluntary accreditation by the National Association for the Education of Young Children. One of the differences you will notice between licensing and accreditation is some levels of staff qualifications. See Table 1.2 for a comparison of staff qualifications.
Must be at least 18 years old and be supervised at all times by a teacher
Title 5
Aide: same as Title 22
Assistant: Must have 6 ECE units
NAEYC Accreditation
Child Development Associate (CDA) or 12 units in early childhood education, child development, elementary education, and/or early childhood special education
Teacher
Title 22
Must have 12 ECE units and 6 months of experience
Title 5
Associate teacher: 12 ECE units
Teacher: 24 ECE units and 16 GE units
Master Teacher: Teacher requirements
and
6 units in specialization area
and
2 units in adult supervision
NAEYC Accreditation
A minimum of higher education degree in early childhood education, child development, elementary education, or early childhood special education or 60 units with 30 units in early childhood education, child development, elementary education, and/ or early childhood special education. (preferred accredited higher education institutions)
Supervisor/ Director/ Administrator
Title 22
Must have 12 core ECE units and 3 administration units
Title 5
Site Supervisor: AA or 60 units with 24 ECE units
and
5 administration units
and
2 adult supervision units
Director: BA
and
24 ECE units
and
6 administration units
and
2 adult supervision units
NAEYC Accreditation
A minimum of a baccalaureate-level higher education degree in early childhood education, child development, elementary education, or early childhood special education; or 120 college units with 36 units in early childhood education, child development, elementary education, and/or early childhood special education.
While licensing regulations ensure that children stay safe and healthy, high quality care goes even further to provide the best start for young children. One reason that programs choose to become NAEYC accredited is to document the quality of care and education they provide children and families they serve. There are other processes and assessments that programs may use to ensure high quality, as well.
Pause to Reflect
As you progress through this book and course, what connections can you make about how being knowledgeable about health, safety, and nutrition will support early childhood educators in both following licensing and other applicable regulations and ensuring they provide high quality care for young children and their families?
Summary
Early childhood is a critical time in development. Many outcomes, both positive and negative, have their beginnings in these years. It is vital that children’s health and safety be protected. High-quality early care and education programs can play a valuable role in improving outcomes for children.