By the end of this chapter, you should be able to:
Summarize what goes into child and staff health records.
Describe the process of daily health checks.
Explain good dental hygiene practices in the classroom.
Discuss the importance of sleep.
Licensing Regulations
Title 22 Regulations that relate to this chapter include:
101220
CHILD’S MEDICAL ASSESSMENTS
Prior to, or within 30 calendar days following enrollment, the licensee will obtain a licensed physician’s written medical assessment of the child. The assessment must be less than one year old.
101220.1
IMMUNIZATIONS
Prior to admission to a Child Care Center, children shall be immunized against diseases as required by the California Code of Regulations, Title 17.
A child who does not meet any of these requirements shall not be admitted to a Child Care Center.
The licensee must document and maintain each child’s immunizations records for as long as the child is enrolled.
101221
CHILD’S RECORDS
A separate, complete and current record for each child must be maintained.
101226.1
DAILY INSPECTION FOR ILLNESS
The licensee shall be responsible for ensuring the children with obvious symptoms of illness are not accepted.
No child shall be accepted without contact between center staff and the person bringing the child to the center.
Introduction
Healthy development continues to support learning throughout childhood and later life. “Health in the earliest years…lays the groundwork for a lifetime of well-being…”
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To promote the health of children in early care and education programs, it’s important to keep records of both children's and staff’s health. Programs can support children’s oral health and healthy sleep habits. And they can help identify developmental and health concerns with screening.
Children’s Health Records
“The health and safety of individual children requires that information regarding each child in care be kept and available when needed. Children’s records consist of various documentation such as a child’s medical and immunization history, emergency medical care information, and parental permission to participate in specific activities…Each child care facility must keep accurate records on each child receiving care in child care.”
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Health records can help early care and education programs identify preventative health measures, develop care plans for children with special needs, and determine whether or not a child should be excluded from care due to illness.
California Title 22 Child Care licensing requirements list the following health-related items to include in the child’s records:
Medical assessment and the following health information:
Dietary restrictions and allergies.
Instructions for action to be taken in case the child's authorized representative, or the physician designated by the authorized representative, cannot be reached in an emergency.
A signed consent form for emergency medical treatment
Record of any illness or injury requiring treatment by a physician or dentist and for which the center provided assistance to the child in meeting his/her necessary medical or dental needs.
Record of current medications, including the name of the prescribing physician, and instructions, if any, regarding control and custody of medications.
Current and updated immunization records
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The National Health and Safety Standards recommends that the following also be included in the child’s records:
A health history completed by the family at admission
The child’s health insurance information
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Staff Health Records
It is also important for records to be kept to document the health of all staff in an early care and education program. Licensing requires the following health-related items to be in staff records:
Health Screening Report
TB Clearance
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In September of 2016, Senate Bill 792 was passed that requires staff or volunteers in an early care and education program to provide records of immunizations (or immunity) for
Pertussis
Measles
Influenza (annually between August 1 and December 1 of each year; can decline in writing)
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The Importance of Keeping Staff Healthy
A culture of wellness is a working environment where an employee's health and safety is valued, supported, and promoted through worksite, health and wellness programs, policies, benefits, and environmental supports. A culture of wellness for staff is really going to be the foundation for creating a culture of health and safety for children.
Staff have health problems such as obesity and depression at rates above the national average. Early care and education salaries are often low, creating personal financial stress. Staff turnover rates are high. In general, early childhood educators are undervalued for the important and high-demand work they do.
Staff wellness and stability will affect the quality of services a program is able to deliver to families and children. Children need consistent, sensitive, caring, and stable relationships with adults. Adults who are well, physically and mentally, are more likely to engage in positive relationships. When we support staff well-being, we strengthen early care and education.
Programs can use the CDC’s Workplace Health Model to support the health of their staff.
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It is outlined in this image (and a link is provided in the Further Resources to Explore feature at the end of the chapter).
planning and management, implementation, and evaluation.
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Pause to Reflect
What does staying healthy mean to you? What do you do (or could you do) to manage your stress, reinforce your resilience, and keep yourself physically healthy (nutrition, activity, etc.)? How could your employer help you stay healthy?
Daily Health Checks
Every day an informal, observation-based quick health check should be performed on every child (before the parent/caregiver leaves). Early childhood educators should use their knowledge about what is normal for a child to identify any concerns about the child’s well-being (but not as an attempt to formally diagnose illness). It is not a process that formally excludes children from illness, but following up concerns noticed at a health check may find reasons to exclude children.
“In a child care setting where lots of people are coming at the same time, it is hard to take a moment with each child. However, this welcoming routine can establish many things and is a good child development policy. This contact will help [teachers] better understand each child, help the children feel comfortable and good about themselves, reduce the spread of illness by excluding children with obvious signs of illness, and foster better communications with [families].”
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Conducting the Daily Health Check
Teachers should use all of their senses to check for signs of illness. This includes:
Listening to what families tell you about how their child is feeling and what the child sounds like (hoarse voice, coughing, wheezing, etc.)
Looking at the child from head to toe (with a quick scan) to see if the child looks flushed, pale, has a rash, has a runny nose or mucus in the eyes
Feeling the child’s cheek or neck (as part of a greeting) for warmth or clamminess
Smelling the child for unusual smelling breath or a bowel movement.
Here are the signs to observe for:
General mood and atypical behavior
Fever (elevated temperature)
Rashes or unusual spots, itching, swelling, and bruising
Complaints of not feeling well
Symptoms of illness (coughing, sneezing, runny nose, eye or ear discharge, diarrhea, vomiting, etc.)
Reported illness in child or family members
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Dental Hygiene
Dental hygiene is important to prevent Early Childhood Caries (ECC), which is a term used to describe tooth decay, including filled or extracted teeth due to decay, in the primary teeth (baby teeth). It is important to rethink the way we “treat” dental caries. Traditionally, we would wait until a child had a cavity and “treat” the cavity with a filling. In order to prevent ECC, we must intervene before the first cavity develops.
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Early care and education programs can teach children and families about dental hygiene and oral care as well as implement good dental hygiene practices. Here are some ideas:
Use teaching practices that engage children and promoting thinking critically. Consider asking questions such as:
How do you brush your teeth?
Why do you brush your teeth?
What else can you do to keep your mouth and teeth healthy?
What happens if you don’t brush your teeth?
Tell me about your last visit to the dentist.
Integrate oral health into activities (in addition to tooth brushing). Some possibilities include:
Having children separate pictures of foods that are good for oral health from pictures of foods that are high in sugar.
Reading books with positive oral health messages to children.
Having children pretend they are visiting a dental office.
Singing songs about oral health
Engage families in promoting oral health at home. Some ways to do this include:
Working with families to find the best ways to position their child for tooth brushing. Remind families that young children cannot brush their teeth well until age 7 to 8. It is also important for a parent to brush their child’s teeth or help them with brushing.
Asking families to take photographs of their child brushing his teeth and helping the child write stories about his experience.
Helping families choose and prepare foods that promote good oral health.
Encouraging families to ask their child what she learned about oral health in school that day.
Offering families suggestions for at-home activities that support what children are learning about oral health at school.
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Classroom Tooth Brushing Steps
Sitting at a table in a circle, children brush teeth as a group activity every day.
Give each child a small paper cup, a paper towel, and a soft-bristled, child-sized toothbrush.
Put a small (pea-sized) dab of fluoride toothpaste on the inside rim of each cup, and have children use their toothbrushes to pick up the dabs of toothpaste.
Brush together for two minutes, using an egg timer or a song that lasts for about two minutes.
Brush your teeth with the children to set an example, and remind them to brush all of their teeth, on all sides.
When the two minutes are up, have the children spit any extra toothpaste into their cups, wipe their mouths and throw the cups and paper towels away.
Children can go to the sink in groups to rinse their toothbrushes and put the toothbrushes in holders to dry.
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Sleep Hygiene
It's important to get enough sleep. Sleep supports mind and body health. Getting enough sleep isn’t only about total hours of sleep. It’s also important to get good quality sleep on a regular schedule to feel rested upon waking.
Sleep is an important part of life! Young children spend around half of their time asleep.
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Babies need to sleep between 12 and 16 hours a day (including naps).
Toddlers need to sleep between 11 and 14 hours a day (including naps).
Preschoolers need to sleep between 10 and 13 hours a day (including naps).
School-aged children need 9 to 12 hours of sleep each night.
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We know how busy they are when they are awake, but what are they doing during all of those restful hours? Actually, sleep has many purposes.
Growth: Growth hormone is released when children sleep (Berk 2002, 302). Young children are growing in their sleep, and since they have a lot of growing to do, they need all the sleep they can get.
Restoration: Some sleep researchers have found that sleep is important for letting the brain relax and restore some of the hormones and nutrients it needs (Jenni & O’Conner 1995, 205).
Memory: Sleep is also a time when the brain is figuring out what experiences from the day are important to remember (Jenni & O’Conner 1995, 205).
Health: One study found that infants and toddlers need at least 12 hours of sleep in a 24 hour day. When infants and toddlers had less than 12 hours they were more likely to be obese by the age of 3 (Taveras et. al. 2008, 305).
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The Culture of Sleep and Child Care
Across the world people sleep in different ways. Some people sleep inside, some sleep outside. Some people sleep in beds, others in hammocks or on mats on the floor. Some people sleep alone, some sleep with a spouse or children or both. Some people sleep only at night, while others value a nap during the day. How, when, and where people choose to sleep has a lot to do with their culture, traditions, and customs. This can include where they live, how their family sleeps, even how many bedrooms are in their home. Teachers have a role in providing a sleep environment that is comfortable and safe for the children in their care, while honoring families’ cultural beliefs.
What can teachers do to help young children feel more “at home” when it is time for them to rest?
Think of sleep and sleep routines as part of the child’s individualized curriculum.
Classroom teachers should meet with a family before a child enters your care. This is an opportunity to find out about a child’s sleep habits before they join the classroom. When you know how a baby sleeps at home, you can use that information to plan for how they might sleep best in your care.
Brainstorm ways to adapt your classroom to help a child feel “at home” during rest times. For example, a baby who is used to sleeping in a busy environment might nap better if you roll a crib into the classroom. Some mobile infants and toddlers might have a hard time sleeping in child care because they think they will miss something fun! These children benefit from having a very quiet place to fall asleep. When you have a positive relationship with a baby it will be easier to know what will help them relax into sleep.
Encourage families to bring in “a little bit of home” to the program – like a stuffed animal or special blanket. A comfort item from home can help children feel connected to their families. They might want that comfort all day. The comfort item from home can also help children make the transition to sleep while in your care. Make sure that infants under one year of age do not have any extra toys or blankets in the crib with them.
Share with families what you learn about their child. Use pick up and drop off times to ask questions about sleep at home. Families can share information that could make their child more comfortable in your care. You can be a resource for families about sleep and their child. Remember that families are the experts about their child.
Napping and Individual Differences
Have you noticed that some children will fall asleep every day at the same time no matter what else is going on? These kids could fall asleep into their lunch if it is served too late! Have you known children who seem to fall asleep easily some days and other times just can’t settle into sleep? These children might need a very stable routine. Some toddlers nap less and sleep more at night while others need to have a long sleep during the day.
Temperament and Sleep
Some of the different patterns in children’s sleep has to do with their temperament (Jenni & O’Connor 2005, 204). Temperament is like the personality we are born with. Some children are naturally easy-going and adapt to new situations while others really need a routine that is the same every day. One child might fall asleep easily just by putting her in her crib or cot when she is drifting off to sleep. Another child might fall asleep in your arms but startle awake the moment he realizes he has been laid down alone.
Circadian Rhythms and Sleep
Something else that can make nap time easy or difficult for young children has to do with their natural sleep cycles. Everyone has a kind of “clock” inside of their bodies that tells them when they are hungry or sleepy. The cycle of this clock is called circadian rhythms. Circadian rhythms are the patterns of sleeping, waking, eating, body temperature and even hormone releases in your body over a twenty-four hour period. How much children need to sleep, when they feel tired, and how easily they can fall asleep are all related to their circadian rhythms (Ferber 2006, 31).
Meeting Each Individual Child’s Sleep Needs
Thinking about the circadian rhythms and temperament reminds us how each child is different. That is why it is important to have nap times that meet the needs of all children in your care. Helping young children to learn to recognize their bodies’ needs and find ways to meet those needs is the very important skill of self-regulation.
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Individualizing Nap Schedules
Creating a space for sleepy children can allow them to relax or nap when their body tells them they are tired. It can take some creativity to figure out how to let a young child nap or rest when they are tired.
What do you do if a child won’t nap when others are? How does one child rest quietly in a busy classroom?
Two-and-a-half-year-old Henry is new to your classroom. His mother has shared with you that he does not nap during the day with her. When nap time comes around you can tell that Henry does not seem very tired.
What can you do for Henry, or other children like him, while the rest of the class sleeps?
Do you have a “cozy corner” that could also be a one child nap area?
Are there soft places to sit and relax with a book or stuffed animal?
Are books or other quiet activities provided if a child isn’t able to rest or settle when other children are?
Are children provided techniques and strategies for calming their bodies e.g. deep breathing, tensing and relaxing their bodies, feeling their heartbeat, etc?
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Summary
By keeping accurate records, conducting daily health checks, supporting children’s development of good dental hygiene, and by providing for individual children’s sleep needs early care and education programs can help promote good health on a daily basis. When programs monitor and screen children, they can ensure that conditions or situations that might interfere with a child’s health or well-being can be identified and supports put in place to mitigate potential negative effects.