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Nutrition, Health, and Safety

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Pre-Test

1. Since administrators don’t work directly with children, they have little control over children’s health and safety. T/F

2. Early childhood programs can help reduce the prevalence of obesity among young children by demonstrating and promoting healthy habits. T/F

3. Each early childhood program has the autonomy to develop its own standards for food service and sanitation. T/F

4. All children who enroll in early childhood programs must be fully immunized. T/F

5. Early childhood administrators are responsible for ensuring that every risk to children’s safety has been eliminated. T/F

Answers can be found at the end of the chapter.

Learning Objectives

After reading this chapter, you should be able to:

1. Describe the role of an early childhood administrator in promoting good nutrition, supporting children’s health and well-being, and keeping children safe from harm or injury.

2. Discuss the state of childhood obesity in the United States today, and describe strategies that a day care or pre- school might take to help address the problem and promote good nutrition.

3. Summarize and explain the most recent government guidelines for food service in early childhood environments.

4. Summarize and explain the primary considerations and resources for menu planning.

5. Discuss the role that a day care or preschool might play in helping educate children and families about nutrition.

6. Describe the policies related to children’s health that must be implemented at the time of enrollment, at the time a child becomes ill, and on an ongoing basis.

7. Evaluate the safety risks when children are on a playground as compared to the safety risks when children are in a classroom. Explain how the strategies for keeping children safe outdoors may differ from indoors.

CHAPTER 6Section 6.1 Primary Roles of the Administrator in Nutrition, Health, and Safety

Lindsay has established a morning routine of stopping by each classroom for a few minutes to check in with each teaching team. On her visit to the Blue Room, a class of 4- and 5-year-olds, one of teach- ers, Jane, pulls Lindsay aside.

“Could you please take a look at Kelly?” asks Jane, gesturing toward a little girl sitting alone at the puzzle table. “She didn’t eat any of her snack this morning, which is very unusual for her. I felt her forehead and it seems a little warm.”

“It sounds like she may not feel well,” replies Lindsay.

Lindsay takes a seat at the puzzle table next to Kelly and says, “Hi, Kelly. How are you today?” but the little girl shrugs and looks away. Lindsay gently asks, “Are you feeling okay, sweetie?”

Kelly starts to cry. “I don’t feel good.”

Lindsay nods and moves a little closer. “I’m sorry you’re not feeling well. Let’s go to my office and we’ll take your temperature. Then we can call your mommy or daddy and tell them how you’re feeling.”

Lindsay walks Kelly to the office and takes her temperature with a digital ear thermometer. Kelly has a temperature of 101 degrees. Lindsay will now call Kelly’s parents and let them know that Kelly has a fever and needs to go home.

This scenario demonstrates several important practices, including the identification and exclusion of children who might carry a contagious illness.

Introduction

This chapter will describe the role of administrators in leading and overseeing the program in the area of health as well as nutrition and safety. We will look closely at the role of early childhood administrators in helping to prevent childhood obesity and develop healthy eat- ing habits. The chapter will describe the considerations that influence menu planning and meal service in an early childhood setting, such as meeting the guidelines and requirements of the Fed- eral Food Program. Finally, we will also cover the policies and practices that administrators must develop and implement to protect children’s health and safety.

6.1 Primary Roles of the Administrator in Nutrition, Health, and Safety

In the key areas of nutrition, health, and safety, the primary role of an administrator is to develop systems, policies, and procedures to help ensure that the children enrolled in the program are healthy and safe. The administrator can’t be in every classroom at every moment to directly monitor the health and safety of every child; but she can make certain that teachers, caregivers, and other staff members are thoroughly trained and supervised so that everyone is consistently and confidently implementing the systems, policies, and procedures that have been developed. Regardless of the setting—be it a preschool, a child care center, or a family child care home—the administrator’s work creating and implementing systems, training and supervising staff, and main- taining documentation will have a significant impact on children’s health, well-being, and safety.

CHAPTER 6Section 6.1 Primary Roles of the Administrator in Nutrition, Health, and Safety

Meal Planning, Meal Service, and Nutrition Education In the area of nutrition, administrators create and implement systems for planning and serving meals such as snacks and lunches. The administrator is responsible for knowing and following the regulations and requirements relevant for both meal planning and meal service. The administra- tor also takes the lead in developing nutrition education plans for both the children and the fami- lies. In short, these systems will determine when the children will eat and drink, what they will eat and drink, and how the meals will be prepared, served, and cleaned up.

Administrators are responsible for training and supervising staff to ensure that the systems are implemented efficiently and accurately. Some staff members in an early childhood program may be hired especially for a food service role, such as a cook or a nutrition aide. Others, such as teach- ers, will conduct specific tasks related to food, such as making sure children wash their hands before they sit down to eat. The administrator must make sure that each staff member under- stands the expectations for their roles and follows all the regulations and procedures.

Children’s Health, Immunization, and Illness Policies The administrator’s role in safeguarding children’s health is primarily related to documentation and communication. Administrators must make sure that each child’s health records, such as an immunization history, are complete at the time of enrollment, in accordance with any state or local regulations. Once children are enrolled, the administrator is also responsible for creating and implementing policies that exclude children from attending the early childhood program if they are ill.

The administrator communicates these policies to families in advance. Administrators also com- municate policies to staff members and train them to follow the policies and to recognize symp- toms of illness in the children in their care. Finally, administrators must continually monitor and document the program’s compliance with these procedures and regulations and stay current in any new developments or changes in the field.

Supervision and Assessment of Potential Safety Hazards In the area of safety, administrators create and implement systems that help protect children from injury or harm. These systems may include, for example, the procedures and plans for supervising children during playground play.

Administrators are responsible for training and supervising staff to ensure that safety procedures are followed at all times. Administrators also continually assess of the condition of the facility and environment for possible safety hazards. The administrator maintains program documentation, such as weekly safety checklists, and serves as a leader and role model for the rest of the staff, setting a high standard for others to follow by making children’s safety a top priority.

Questions to Think About 1. Of the three categories—nutrition, health, and safety—which do you think requires the

most time and attention from an early childhood administrator and why? 2. Imagine you are a new teacher in an early childhood program. What could the director

do or say that would let you know that safety is a top priority in this program?

CHAPTER 6Section 6.2 Nutrition

6.2 Nutrition

We all know what it’s like to get hungry, have something to eat, and then feel satisfied and ready to go on with our day. When we don’t get enough to eat, or if we eat some-thing that wasn’t what we really needed, feelings of hunger or fatigue can prevent us from accomplishing even the simplest tasks.

For infants and young children whose bodies are growing and developing at such a rapid pace, the consequences of not eating enough or not getting the right nutrition can be almost immediate and can have lasting effects. Adequate nutrition is essential for children’s physical and cognitive development.

The nutritional needs of young children, from infants and toddlers through preschoolers and kin- dergarteners, require that they eat meals and snacks often. Young children’s stomachs are small, and they are not able to eat enough in just three meals a day to meet all their nutritional needs. Most early childhood programs serve some kind of meal or snack every two to three hours

(National Food Service Manage- ment Institute, 2010). Children in full-day child care may eat more than four or five meals and snacks in their early childhood programs each day. Even chil- dren in a two-and-a-half-hour preschool play session will likely eat a small snack at school.

For many children, meals and snacks are their favorite time of day, especially if they like the taste of the foods that are served. This is often a social time, when interesting and entertaining con- versations occur and friendships are made or deepened.

Relationship Between Nutrition and School Success Common sense tells us that it is harder to concentrate when we’re hungry. Most of us have also had the experience of eating sweets, like candy, and then feeling either jittery or sluggish afterward. What we eat does affect our behavior and our emotions, as well as our ability to focus, remember, and solve problems. For young children, this is even more the case. Research shows that poor nutri- tion in early childhood may have an impact on children’s learning, both in the short term and in the long term (Sorhaindo & Feinstein, 2006). Multiple studies have shown that nutrition has an immedi- ate impact on levels of concentration and activity. Chronically malnourished children are especially vulnerable to these short-term effects (Bellisle, 2004; Benton & Parker, 1998; Benton, 2001).

The consequences of poor nutrition can also have a long-term impact on development. For exam- ple, one study found that deficiencies in vitamin B12 in early childhood reduced scores on cognitive tests in adolescence (Sorhaindo & Feinstein, 2006). Infants and toddlers are especially vulnerable to inadequate nutrition because their brains are growing and developing at a rapid pace (Berk, 2008). The earlier in life a nutritional deficit occurs, the more severe the damage on cognitive develop- ment (Morgan & Gibson, 1991). Malnutrition in the early years can also have a long-term negative effect on children’s physical development, resulting in slower rates of growth (Richard et al., 2012).

iStockphoto/Thinkstock

Many children consume the majority of their daily calories while in child care or preschool classrooms.

CHAPTER 6Section 6.2 Nutrition

Children at Risk Children in low-income families are especially at risk. More than 16 million American children live in homes with limited access to a sufficient food supply (United States Department of Agriculture [USDA], 2011). Administrators of early childhood programs that serve low-income families should be aware that the challenge of providing good nutrition for children living in poverty could be complex. Often the issue is not as simple as getting enough to eat; the issue is about having access to and consuming the right kinds of foods.

Malnutrition, which means essentially not consuming enough nutrients to meet the body’s needs, can result from eating poor-quality foods. Any child, in families from any income level, can be at risk of malnutrition, because even affluent families can have poor diets. But children from low- income families are at greater risk because they have limited access to healthy food. A child from a family that regularly consumes fast food and highly processed foods—which are typically high in salt, sugar, fat, and often, calories, but low in vitamins, minerals, and fiber—is more likely to expe- rience negative health effects. When children eat too much processed foods, which significantly increases the amounts of empty calories in their diets, instead of fresh foods, they may also be at risk for childhood obesity (Figure 6.1).

Figure 6.1: Nutrition Labels

Ingredients: Whole grain oats, (includes the oat bran), Modified Corn Starch, Sugar, Salt, Tripotassium Phosphate, Wheat Starch, Vitamin E (mixed tocopherols) added to preserve freshness.

Total Fat 2 g 3%

*Percent Daily Values are based on a 2.000 calorie diet. Your daily values may be higher or lower depending on your calorie needs:

Serving size 1 CUP Servings per container 14

Calories 100

Amount per serving

Calories from Fat 15 % Daily Value

Saturated Fat 0 g Trans Fat 0 g

Cholesterol 0 mg 0% Sodium 155 mg 7%

5% 7%

Protein 3 g

Vitamin A 10%

2,000 2,500

Total fat Sat fat Cholesterol Sodium Total Carbohydrate Dietary Fiber

65 g 20 g 300 mg 2400 mg

300 g 25 g

80 g 25 g 300 mg 2400 mg

375 g 30 g

Less than Less than Less than Less than

Calories:

Calories per gram

11% Sugars 1 g Other Carbohydrate 17 g

Dietary fiber 3 g Total Carbohydrate 20 g

Oatie–Oh’s

Iron 45% Vitamin C 10%

Calcium 10%

Potassium 165 mg

CONTAINS WHEAT INGREDIENTS

Ingredients: Sugar, Corn Flour, Wheat Flour, Malt Flavoring, High Fructose Corn Syrup, Salt, Sodium Ascorbate and Ascorbic acid, (Vitamin C), Niacinamide, Iron, Pyridoxine Hydrochloride (Vitamin B6), Riboflavin (Vitamin B2), Thiamine Hydrochloride (Vitamin B1), Vitamin A Palmitate, Folic Acid, BHT (Preservative), Vitamin B12 and Vitamin D.

Total Fat 0 g 0%

*Percent Daily Values are based on a 2.000 calorie diet. Your daily values may be higher or lower depending on your calorie needs:

Percent daily value reflects “as packaged” food. Product is marked with a Kosher symbol.

Serving size 0.75 CUP Servings per container 19

Calories 110

Amount per serving

Nutrition Facts Nutrition Facts

Calories from Fat % Daily Value

Saturated Fat 0 g Trans Fat 0 g

Cholesterol 0 mg 0% Sodium 135 mg 0%

6% 1%

Protein 1 g

Vitamin A 10%

2,000 2,500

Total fat Sat fat Cholesterol Sodium Total Carbohydrate Dietary Fiber

65 g 20 g 300 mg 2400 mg

300 g 25 g

80 g 25 g 300 mg 2400 mg

375 g 30 g

Less than Less than Less than Less than

Calories:

9% 3%Sugars 11 g

Other Carbohydrate 15 g

Dietary fiber 1 g Total Carbohydrate 27 g

Frostie–Frootie–Flakes

Iron 25% Vitamin C 10%

Calcium 0%

Potassium 15 mg

CONTAINS WHEAT INGREDIENTS, CORN USED IN THIS PRODUCT CONTAINS TRACES OF SOYBEANS

Fat 9 Carbohydrate 4 Protein 4 Calories per gram Fat 9 Carbohydrate 4 Protein 4

The nutrition label on the heavily sweetened breakfast cereal shows that it has 11 times as much sugar as the plain oat cereal.

The term obesity refers to carrying excess body fat to the point that it has a negative effect on health, with heart disease, type 2 diabetes, asthma, and sleep apnea being among the greatest

CHAPTER 6Section 6.2 Nutrition

risks. According to Centers for Disease Control, 17% of U.S. children are obese, and one in every three children from low-income families is obese (Centers for Disease Control and Prevention [CDC], 2011). The numbers are higher in low-income communities because these children often have less access to both healthy food choices and opportunities for physical exercise.

Obesity Prevention Early childhood programs can support families in their efforts to prevent the risk of obesity by helping children develop healthy eating habits. Children should be encouraged to eat a variety of whole (not processed) foods, they should be allowed to stop eating when they are full, and they should engage in adequate amounts of physical activity to help ensure they are burning through, rather than storing, the energy they consume (Let’s Move!, 2012).

The federal Centers for Disease Control and Prevention (CDC) recommend the following strategies to parents and caregivers to help prevent childhood obesity:

• Serve meals and snacks that include plenty of vegetables, fruits, and whole-grain products. • Choose milk and dairy products that are low-fat or nonfat. • For protein, choose lean meats, poultry, fish, lentils, and beans. • Serve reasonably-sized portions. • Drink lots of water throughout the day. • Avoid or limit sugar-sweetened beverages. • Limit consumption of sugar and saturated fat. • Help kids stay active and reduce sedentary time. (CDC, 2011)

Early childhood administrators can use these recommendations to model healthy habits at school and educate parents and families about how to make healthy choices for their children. For exam- ple, administrators can make sure that program staff are purchasing and preparing meals and snacks that include fresh fruits and vegetables every day. Administrators can also offer parent events that are focused on good nutrition, such as cooking classes that demonstrate how to pre- pare quick and easy recipes from inexpensive, healthy ingredients.

Focus On: The Question of Organic Foods In recent years, many families are increasingly choosing organic foods, which are grown in ways that eliminate synthetic pesticides or chemicals and encourage soil and water conservation. To receive the label “organic,” the food must be certified by the U.S. Depart- ment of Agriculture (USDA) as meeting specific standards that regu- late how the food is grown, handled, and processed. The market for organic foods has significantly expanded from $3.7 billion in 1997 to $26.7 billion in 2010 (Bottemiller, 2012).

In response to this growing interest, some early childhood programs serve all or some organic foods for their meals and snacks. Organic milk, fruits, and vegetables as well as products made from organic foods, such as bread or juice, are often more expensive than nonor- ganic foods (Mayo Clinic, 2012). Decisions about whether or not to include organic foods in an early childhood meal and snack plan are based on various factors, such as the program’s philosophy and vision, marketing plans, and budget.

United States Department of Agriculture Food products that contain more than one ingredient must be at least 95% organic to carry a USDA seal.

CHAPTER 6Section 6.3 Guidelines and Regulations for Food Service

Questions to Think About 1. How might the role of director of a program serving low-income families differ from

the role of the director of a program serving middle- or upper-income families when it comes to planning meals and snacks?

2. What can early childhood administrators do to help reduce the prevalence of obesity in young children?

6.3 Guidelines and Regulations for Food Service

In order to create and implement effective policies and procedures related to nutrition, early child-hood administrators need a trusted source for accurate and current nutrition information. One of the most respected sources for research-based nutrition recommendations is the United States Department of Agriculture (USDA). The mission of the USDA is very broad and includes providing consumer and industry information on the topic of food as well agriculture and natural resources.

The branch of the USDA that relates to nutrition is the Center for Nutrition Policy and Promotion (CNPP), which focuses on improving the nutrition and well-being of Americans. The center’s core projects include developing dietary guidelines and the USDA Food Guidance System (USDA & USD- HHS, 2010). Early childhood administrators can use these resources to inform the development of program policies and practices, to create nutrition-related curriculum for children, and to develop parent education activities and materials.

USDA Guidelines The USDA guidelines describe strategies for healthy eating that involve consuming fewer calories, making informed food choices, and being physically active. In general, the guidelines focus on two overarching concepts:

• Maintain caloric balance over time to achieve and sustain a healthy weight.

• Focus on consuming nutrient-dense foods and beverages. (USDA, 2010)

The information in the guide- lines that is especially relevant to administrators of programs serving young children are the food safety principles and the nutritional goals for specific age groups, such as children age 1–3 or 4–8 in the categories of calo- ries, protein, fat, and minerals, such as calcium and iron.

In 2011 the USDA created the MyPlate campaign to help edu- cate consumers about good

United States Department of Agriculture

The Choose My Plate graphic can be used to teach both children and families the basic foundations of a healthy diet.

http://www.cnpp.usda.gov/DGAs2010-PolicyDocument.htm

CHAPTER 6Section 6.3 Guidelines and Regulations for Food Service

nutrition. The MyPlate icon serves as a guide for healthy eating and is used on USDA materials and documents that describe current dietary guidelines. Half of the plate on the MyPlate graphic is filled with sections representing fruits and vegetables, demonstrating that half of the foods we eat should be fruits and vegetables. The other sections of the plate are labeled “grains” and “proteins,” demonstrating that we should also be eating whole grains and a variety of proteins. The graphic also includes a smaller circle labeled “dairy,” which represents the goal of drinking skim or 1% milk.

The USDA publishes free MyPlate materials and resources for both consumers and professionals. Teachers can use MyPlate posters and coloring pages in the classroom as part of their nutrition curriculum activities. Nutrition brochures and tip sheets can be distributed to families in program newsletters or at parent meetings. Many of the MyPlate resources are also available in Spanish, French, and Chinese.

Federal, State, and Local Guidelines Food plans in an early childhood program must meet federal, state, and local regulations and laws that are created to ensure that children receive enough food and the right kinds of food to meet all their nutritional needs. At the federal level, programs may receive funding from the Child and Adult Care Food Program (CACFP). At the state level, child care licensing requirements will likely include mandates for the frequency of meals, the variety of foods served, and the sanitation requirements for food service. Local health codes at the city or county level may also apply.

For early childhood programs in most locations, specific guidelines will require that meal and snack menus are posted for families in advance, that staff who handle and prepare food are trained in safe and sanitary food service practices, and that the facilities where food is prepared and served is properly cleaned and maintained.

NAEYC Accreditation Standard Requirements National Association for the Education of Young Children (NAEYC) accreditation criteria include standards related to nutrition and meal service. Early childhood administrators can use these stan- dards to inform and guide their work when their programs are seeking to achieve or maintain accreditation or simply as a guide for best practice. Some of the NAEYC guidelines mirror those of federal regulations, such as this criterion related to food safety:

5.B.—Ensuring Children’s Nutritional Well-Being

5.B.03 The program takes steps to ensure food safety in its provision of meals and snacks.

a. Staff discard foods with expired dates. b. The program documents compliance and any corrections that it has made according to

the recommendations of the program’s health consultant, nutrition consultant, or a san- itarian that reflect consideration of federal and other applicable food safety standards.

Definition: A sanitarian is a specialist in public sanitation and health.

An individual with a degree in nutrition could also meet this indicator. The health consul- tant, nutrition consultant, or sanitarian should be should be incorporating federal (U.S. Food and Drug Administration) and all applicable state and local food safety standards. (NAEYC, 2017)

http://www.choosemyplate.gov/

CHAPTER 6Section 6.3 Guidelines and Regulations for Food Service

Where the NAEYC accreditation criteria differ somewhat from federal and local requirements is in the attention to the nurturing relationships between staff and children and the role that feed- ing and meals can play in building those relationships. For example, NAEYC accreditation criterion 5.B.12 addresses the issue of consistency of care, stating that babies should be fed by someone the babies know and trust.

5.B.12 Teaching staff who are familiar with the infant feed him or her whenever the infant seems hungry.

b. Feeding is not used in lieu of other forms of comfort.

The intent of the criterion is to ensure that infants are fed by regular caregivers that children are fed when hungry, and they are not over- or underfed. (NAEYC, 2012a)

Child and Adult Care Food Program The Child and Adult Care Food Program (CACFP) is a federal entitlement program that sub- sidizes the cost of food for children in early childhood programs. Eligibility for the subsidies

is based on the number of low-income families served in the program. Throughout the United States CACFP provides funding for more than 3.2 mil- lion children to receive nutri- tious meals and snacks each day (USDA, 2010). Early child- hood programs that participate in CACFP include Head Start and both private and public child care centers.

Both nonprofit and for-profit programs are eligible for CACFP as long as they are licensed and serve children in low-income families. Family child care pro- viders may also participate if they sign an agreement with a

sponsoring organization that will provide training, monitoring, and assistance in planning menus and filling out reimbursement forms. Once eligible, participating programs must continue to meet all CACFP requirements regarding staffing, record keeping, equipment, and facilities.

The funding early childhood programs receive from CACFP comes in the form of reimbursements for some or all of the expense of serving meals and snacks. CACFP reimburses programs at free, reduced-price, or paid rates for food served to enrolled children, targeting benefits to those chil- dren most in need. The federal law governing CACFP reimbursement includes very specific guide- lines such as the following:

• Reimbursement must not be claimed for more than two meals and one snack or one meal and two snacks provided daily to each child.

Hemera/Thinkstock

Even programs not funded by the Child and Adult Food Program can use CACFP resources to inform their menu planning and food service practices.

CHAPTER 6Section 6.4 Considerations in Menu Planning

• A child care center may use existing school food service facilities or obtain meals from a school food service facility.

• Each child care center must maintain daily records of time of service meal counts by type (breakfast, lunch, supper, and snacks) served to enrolled children, and to adults perform- ing labor necessary to the food service. (USDA CACFP, 2010)

Questions to Think About 1. How might an early childhood administrator use USDA nutrition publications and online

resources? 2. How are NAEYC accreditation criteria similar to federal guidelines for food service? In

what ways are they different?

6.4 Considerations in Menu Planning

Early childhood administrators are responsible for ensuring that the menus planned for meals and snacks meet all applicable regulations, include foods that children enjoy eat-ing, and can be purchased within the guidelines established by the program budget. Some administrators plan the menus themselves while others delegate the tasks to other staff members or to contracted food service personnel.

Decisions about menu planning should be based on various factors. The basic considerations include the age and development of the children and the time of day the meal or snack will be served. A menu for infants, for example, would include breast milk or formula throughout the day, while a menu for preschoolers would include milk or juice served with meals and snacks. A menu for breakfast would likely include items that are traditionally served in the morning, such as cereal, while a menu for lunch might include traditional lunch fare such as sandwiches (see Figure 6.2). Other considerations include the variety of foods, the cultural backgrounds and preferences of the children, and whether any of the children or staff members who eat with the children have food allergies or dietary restrictions (USDA, n.d.).

Figure 6.2: Sample Menu for 4-Year-Olds in a Child Care Center

This sample menu for a day in child care demonstrates some of the compromises made to balance good nutrition and cost. It includes both canned and fresh fruit, both milk and water, and a simple yet healthy main dish at lunch.

Breakfast/Morning Snack

whole grain cereal

strawberries

1% milk

Lunch

parmesan-crusted fish

brown rice

green beans

apple slices

1% milk

Afternoon Snack

applesauce

wheat crackers

water

CHAPTER 6Section 6.4 Considerations in Menu Planning

Programs that participate in the Child and Adult Care Food Program must follow very specific guide- lines for the categories and quantities of food provided in each snack and meal menu. For example, Tables 6.1 and 6.2 show the CACFP requirements for an infant breakfast and a preschool lunch.

Table 6.1: Infant Meal Pattern: Breakfast

Infant Meal Pattern: Breakfast

Birth through 3 months 4 through 7 months 8 through 11 months

4–6 fluid ounces of formula1 or breast milk2, 3

4–8 fluid ounces of formula1 or breast milk2, 3 0–3 tablespoons of infant cereal1, 4

6–8 fluid ounces of formula1 or breast milk2, 3 and 2–4 tablespoons of infant cereal1 and 1–4 tablespoons of fruit or vegetable or both

1. Infant formula and dry infant cereal must be iron-fortified. 2. Breast milk or formula, or portions of both, may be served; however, it is recommended that breast milk be

served in place of formula for birth through 11 months. 3. For some breastfed infants who regularly consume less than the minimum amount of breast milk per feeding, a

serving of less than the minimum amount of breast milk may be offered, with additional breast milk offered if the infant is still hungry.

4. A serving of this component is required when the infant is developmentally ready to accept it.

Source: USDA Child & Adult Care Food Program, http://www.fns.usda.gov/cnd/care/ProgramBasics/Meals/Meal_Patterns.htm

Table 6.2: Child Meal Pattern: Lunch or Supper

Child Meal Pattern: Lunch or Supper

Food components Ages 1–2 Ages 3–5 Ages 6–121

1 milk2 fluid milk

1/2 cup 3/4 cup 1 cup

2 fruits/vegetables Juice3,fruit or vegetable

1/4 cup 1/2 cup 3/4 cup

1 grain/bread4 Bread or cornbread or biscuit or roll or muffin or cold dry cereal or hot cooked cereal or pasta or noodles or grains

1/2 slice 1/2 serving 1/4 cup 1/4 cup 1/4 cup

1/2 slice 1/2 serving 1/3 cup 1/4 cup 1/4 cup

1 slice 1 serving 3/4 cup 1/2 cup 1/2 cup

(continued)

CHAPTER 6Section 6.4 Considerations in Menu Planning

Child Meal Pattern: Lunch or Supper

Food components Ages 1–2 Ages 3–5 Ages 6–121

1 meat/meat alternate Meat or poultry or fish5 or alternate protein product or cheese or egg or cooked dry beans or peas or peanut or other nut or seed butters or nuts or seeds6 or yogurt7

1 ounce 1 ounce 1 ounce 1/2 egg 1/4 cup

1 1/2 ounces 1 1/2 ounces 1 1/2 ounces 3/4 egg 3/8 cup

2 ounces 2 ounces 2 ounces 1 egg 1/2 cup

1. Children age 12 and older may be served larger portions based on their greater food needs. They may not be served less than the minimum quantities listed in this column.

2. Milk served must be low fat (1%) or non-fat (skim). 3. Fruit or vegetable juice must be full-strength. 4. Breads and grains must be made from whole-grain or enriched meal or flour. Cereal must be whole-grain or

enriched or fortified. 5. A serving consists of the edible portion of cooked lean meat or poultry or fish. 6. Nuts and seeds may meet only one-half of the total meat/meat alternate serving and must be combined with

another meat/meat alternate to fulfill the lunch or supper requirement. 7. Yogurt may be plain or flavored, unsweetened or sweetened.

Source: USDA Child & Adult Care Food Program. http://www.fns.usda.gov/cnd/care/ProgramBasics/Meals/Meal_Patterns.htm

Variety Children are more likely to eat when they are served a variety of foods over the course of a week, rather than the same or similar items each day. For example, serving cold dry cereal and milk

as a morning snack may meet all the regulations for providing fiber, carbohydrates, and pro- tein at that meal; but after a few days, many children will become tired of eating cereal and might not find the meal appealing. As a result, children may begin to eat less and not take in enough nutrients and calories.

Serving a variety of foods over the course of a day or a week is also healthier, as different foods offer different nutrients. For example, an apple and orange are both fruit, and either would make a fine addition to a healthy lunch, but if children are only

Table 6.2: Child Meal Pattern: Lunch or Supper (continued)

iStockphoto/Thinkstock

One popular approach to teaching children to try new foods is asking them to “eat a rainbow,” which means trying a variety of foods, usually fruits and vegetables, that match the colors of the rainbow.

CHAPTER 6Section 6.4 Considerations in Menu Planning

served apples and never or rarely served oranges, they may miss out on a significant source of vitamin C in their diet.

Cultural Backgrounds and Preferences Children are more likely to eat well at each meal when the presentation, seasoning, and cooking practices are consistent with what they experience at home. For example, a child who is part of a Vietnamese-American family may be more likely to eat noodles than bread and may be accus- tomed to eating most meals from a bowl.

As mentioned in Chapter 4, one of the goals of an antibias curric- ulum is to encourage children to learn about how they are differ- ent from other children and how they are similar. Meals are one opportunity to do this. Admin- istrators of programs that serve a culturally diverse population can gather information from par- ents about their traditions and preferences through conversa- tions, surveys, parent meetings, or family potluck events. Teach- ers can introduce preschool-age children to foods from unfamiliar cultures through cooking proj- ects, and administrators can col- laborate with teachers to try to include some of these foods in the regular menu plans.

Some children may be from families in which the culture or religion restricts certain foods or cer- tain combinations of foods. For example, orthodox Jewish families who follow the rules of kashrut do not eat pork. They may eat certain other kinds of meat but not in combination with dairy prod- ucts. Early childhood administrators should strive to plan meals that are as culturally consistent as possible, working with each individual family to create appropriate plans.

Administrators can create procedures for gathering information about food preferences and food restrictions at the time of enrollment. In some cases, programs may not be able to accommodate a family’s needs. For example, if only a few families in the program follow the rules of kashrut, it might be impractical to renovate the food preparation area in order to keep meat and dairy prod- ucts separate. However, the administrator can work closely with the families to make a plan for them to bring meals from home and store them separately from the food for the other children. An early childhood program located in a Jewish synagogue with a mission and vision to teach children about the Jewish faith, however, would likely make culturally consistent food service a priority.

MIXA/Thinkstock

Children are more likely to eat well when they are served in a manner consistent with their family’s culture.

CHAPTER 6Section 6.4 Considerations in Menu Planning

Sometimes families will request that certain items are excluded from their children’s diets based on personal preference rather than religious (or medical) reasons. For example, some families maintain varying levels of vegetarian diets, in which they avoid either all or certain animal food products. Some vegetarians abstain from eating meat but make an exception for fish, others may abstain from all meat but eat daily products such as milk and eggs, and some vegetarians, usu- ally categorized as “vegan,” do not eat any kind of meat, eggs, dairy products, or processed foods containing any kind of animal-derived ingredients, including gelatin.

Early childhood administrators are responsible for balancing the needs of the family with the prac- tical and financial considerations involved with accommodating a family’s request to have their child eat a meal that is different from the other children. An administrator may decide, for exam- ple, to accommodate the requests of the family by having them bring a meal from home, rather than changing the menu for the whole class or whole program. The administrator is responsible for ensuring that any special accommodations are in compliance with local, state, and federal food service guidelines.

Food Allergies and Dietary Restrictions Food allergies are increasingly common in young children, with more than 6 million children in the United States having an identified food allergy (Food Allergy and Anaphylaxis Network, 2012). In any early childhood program it is likely that at least one child is severely allergic to at least one food. Among the most common allergens are peanuts, milk, eggs, and shellfish. For children with food allergies, an allergic reaction may occur not only when the food is ingested but even if the food is touched or inhaled in trace amounts.

Symptoms of an allergic reaction vary but may include a skin rash, watery eyes, or sneezing. In a very severe allergic reaction, anaphylaxis may occur, a full body response that may include cramps, wheezing, and difficulty breathing.

Children and adults with severe allergies often carry an epinephrine injector, often known as an “epi pen,” which can be used to administer a dose of medication that will help delay the severity of an allergic reaction so that emergency personnel can be called and provide medical care. Early childhood administrators are responsible for making sure a child’s need for an emergency epi pen is fully documented in compliance with all state and local health codes, usually requiring a permis- sion form signed by the parents and a physician. The administrator must also make sure that all staff members who work with the child are trained to recognize the signs of an allergic reaction and to know how to administer the epi pen.

Early childhood programs that serve children with food allergies must develop and implement policies and practices that will reduce the risk that children will be exposed to an allergen. Because peanut and tree nut allergies are so common among young children, many early childhood pro- grams develop “peanut/tree nut free” zones in classrooms or cafeterias. Some facilities are entirely peanut/tree nut free. Often it is the responsibility of the early childhood administrator to define exactly how a “peanut/tree nut free” policy will be implemented. Resources for school adminis- trators on this topic are available through organizations such as the Food Allergy and Anaphylaxis Network.

http://www.foodallergy.org/home

CHAPTER 6Section 6.4 Considerations in Menu Planning

In addition to allergies, some medical conditions, such as celiac disease, require that certain foods are eliminated from a child’s diet. In the example of celiac disease, the child could not eat anything containing gluten, which includes any food made with wheat, barley, or rye, such as most breads, crackers, and pastas. The early childhood administrator would work with these families at the time of enrollment to learn about and document the child’s needs, determine how the program might accommodate the child’s dietary restrictions, and then inform and train the staff in whatever plan is developed.

As is the case with religious or cultural practices or food allergies, there may be situations when the program is not able to provide special food items or prepare the food in ways that meet the child’s needs. In these cases, families may be invited to bring food from home, in compliance with local, state, and federal food service guidelines.

Contracting With a Service Many early childhood programs choose to contract food preparation to catering services. The advantages of hiring a contractor may include savings in the costs of both the food preparation and in the purchasing of food. Contracted food service may be a necessity in programs with lim- ited food preparation space in their facilities.

Some catering companies specialize in services for child care centers and offer meals that are aligned with the specifications of the federal Child and Adult Care Food Program. The adminis- trator often negotiates the contract and monitors the quality of services the catering company provides.

Cost Next to personnel costs, food is one of the biggest expenses in the budget of an early childhood program. Good quality, fresh food can be expensive. Fresh produce, for example, is typically more costly that frozen or canned fruits and vegetables, which contain fewer nutrients due to process- ing. Whole grain breads and crackers usually cost more than breads and crackers made with pro- cessed flour. Administrators are responsible for balancing the constraints of the program budget with the necessity of providing appealing, healthy meals for children.

To do this, administrators can collect information about the costs of food items available from vari- ous vendors in order to find the best prices for the items the program must purchase. Administra- tors can also seek input from parents and staff regarding their preferences and priorities. If, for example, feedback from parents and staff indicate that serving fresh fruit at snacks is a top priority but serving fresh vegetables at lunch is not as important, the administrator may decide that they can spend a bit more for fresh fruit if they begin spending a bit less at lunch by switching from fresh to frozen vegetables several days a week.

CHAPTER 6Section 6.4 Considerations in Menu Planning

Serving the Food Menus describe what food will be provided, but food service procedures describe how the food will be served. Procedures will vary widely depending on the age and development of the child. Very young infants, for example, may be fed “on demand,” rather than on a defined schedule, in order to accommodate for individual differences and needs. Toddlers and older children will likely have a set schedule for exactly when meals will be served each day.

What Would You Do? Betty is the director of a small child care center serving children age two through five. Currently they contract with a catering company called Happy Lunch, which delivers hot meals to the center each day. Betty has researched the other catering companies in town and knows that Happy Lunch offers the best deal to child care centers.

The meals from Happy Lunch, though inexpensive, are also not always very appealing to the children. For example, they use canned fruit, such as pears or peaches, rather than fresh fruit, and Betty has heard the children complain that the fruit is “too slippery.” Recently, several parents have come to Betty to complain about the quality of the lunches. One even brought a brochure from another cater- ing company, Fresh Finds, that includes fresh and organic ingredients in every meal. Betty would like to switch from Happy Lunch to Fresh Finds, but the cost of lunches is well beyond what her budget will allow. If you were in Betty’s position, what would you do?

a. Stay with Happy Lunch. Send families a copy of the budget with a special newsletter explaining to them why the program can’t afford to make any changes right now.

b. Switch to Fresh Finds and raise tuition rates to cover the increase in costs. c. Hold a parent meeting and explain the two options. Have parents take a vote to choose between

staying with Happy Lunch and keeping tuition rates the same, or switching to Fresh Finds and raising tuition.

d. Stay with Happy Lunch, but ask families to take turns volunteering to bring in fresh items to con- tribute to the meals.

Explanation: Betty is dealing with an issue familiar to many early childhood administrators: How do we provide the very best possible quality services to families within a limited budget? In this situation it seems clear that children would benefit from better quality meals because they would find the food more appealing and would likely eat more and eat a wider variety of foods. But raising tuition costs to cover the higher cost of meals could mean that some families might not be able to afford to stay in the program. How Betty handles this issue depends upon some specific information related to the economic situation of the families served in this program and the other budget considerations of this program. However Betty chooses to proceed, she will benefit from a careful analysis of the program’s budget, the needs and interests of the families, and input from other stakeholders, such as board members or local government and community leaders.

CHAPTER 6Section 6.4 Considerations in Menu Planning

Procedures for feeding infants and young toddlers will also require that the caregivers take a very active role in the feeding process, as babies and very young children have not yet developed the ability to feed themselves. All infants should be held when they are being fed from a bottle. Older infants may begin to learn to feed themselves small pieces of food that they can pinch with their fingers, but may not yet be able to use a spoon. Toddlers and some preschoolers may also need assistance feeding themselves with utensils. The administrator must ensure that all utensils and items used to feed children are appropriate for the age of the child.

The Benefits of Family Style Meals For children old enough to feed themselves, it’s generally true that the more active role the chil- dren can take in the meal, the more opportunities they will have to learn and develop. When preschool meals are served family style, where each type of food is served in a large bowl or con- tainer that is passed around the table, children tend to eat a wider variety of foods because they are making active choices about what to eat and how much to take. Certainly there are rules and guidelines the children might follow, such as “Everyone must try one bite of each dish,” to ensure that the children are still receiving a variety of healthy foods and proper nutrition.

Family style meals provide teachers and caregivers the opportunity to serve as role models for the children, eating the food and demonstrating polite table manners. Another benefit of family style meals is that there is less food waste than when children are presented with pre-served plates.

Food Safety and Sanitation Whether a program’s meals and snacks are prepared on site or whether the meals are delivered by a food or catering service, the most essential element in the process of preparing and stor- ing meals is food safety and sanitation. The health and safety of the children depends on careful attention to every detail in the process. The early childhood administrator is responsible for mak- ing sure food safety and sanitation policies and procedures are carefully followed every day. These responsibilities include developing and documenting the policies and procedures as well as train- ing and supervising staff to follow them.

The environment where food is prepared—including stoves and ovens, refrigerators, dishwashers, cutting boards, utensils, and serving dishes—must be clean and free of germs (pathogens) and materials that could contaminate food. Surfaces can be disinfected by spraying with a bleach and water solution or a disinfecting product. Utensils and serving dishes must be washed in machines with a disinfecting cycle or hand washed with a disinfecting rinse. Specific guidelines for disinfect- ing surfaces and other items are specified in local and state health regulations.

The workers who prepare the food and the teachers or caregivers who serve the food must be well trained in all aspects of food safety and sanitation. In many states the child care licensing require- ments demand that for any early childhood program that serves food to children, at least one staff

CHAPTER 6Section 6.4 Considerations in Menu Planning

member must be certified in food service and sanitation practices. Children and adults must wash their hands before every meal, and all food should be cut into pieces that will help prevent chil- dren from choking.

When food is prepared off site, the early childhood administra- tor is still responsible for the safety of the food. For example, a child care program that orders lunch through a catering service must keep hot foods hot and cold foods cold during the time between the delivery of the food and when it is served to the chil- dren. Food must be kept at the

proper temperature to avoid the growth of pathogens that might cause food-borne illness.

The temperature of the food must be carefully monitored, and any food found to be in the tem- perature danger zone—that is, above 40 degrees Fahrenheit for foods that must be kept cold, such as milk, and above 140 degrees Fahrenheit for foods that must be kept hot, such as chicken soup—must not be served to the children. If these practices are not followed, there is the risk that a food-borne illness will be spread to the children.

Ongoing staff training and monitoring of food service systems is an essential administrative responsibility in any early childhood program. Monitoring these systems usually involves practices such as designating a staff member to keep a temperature log, and checking and noting the tem- perature of catered meals at the time they are delivered and again at the time just before they are served to children.

Food Storage Early childhood administrators oversee the storage of food on site to ensure all health and safety regulations are followed. Even if food is not prepared on site, there must still be space to store it, such as refrigerators and ovens or warmers, between the time the food is delivered and the time it is served. Leftover food that has been served to children may not be saved and stored. Garbage from meals must be removed from the building as quickly as possible to avoid creating unpleasant smells and to help keep pests and rodents away.

San Diego County Office of Education

Food safety and sanitation for infants and toddlers includes keeping breast milk and formula at the appropriate temperature and sanitizing the surfaces where formula is stored and prepared.

CHAPTER 6Section 6.5 Nutrition Education for Children and Families

Food items purchased or delivered in bulk and stored at room temperature must be stored safely in sealed packages or airtight containers in cupboards or closets designated for food storage. As with the food preparation areas, food storage areas must meet all local, state, and federal codes for safety and sanitation. For example, most states require that food may not be stored in the same area where diapers are changed.

Questions to Think About 1. Suppose one of the preschool children in a child care center will eat only cold cereal

every morning. Should the administrator adjust the menu plan to allow this child to do this? Why or why not?

2. What steps could an early childhood administrator take to make sure that a child with an allergy to eggs is not served any food containing eggs?

6.5 Nutrition Education for Children and Families

Early childhood programs also play a role in educating children and families about the benefits of good nutrition. Nutrition education helps children and families develop healthy habits, a strategy for reducing the likelihood of obesity and other health problems. Early childhood programs educate parents by providing nutrition information, resources, or work- shops; and they educate children by integrating nutrition topics into the curriculum. Nutrition education is an important part of both Head Start curriculum and services for parents.

Early learning standards in many states include nutrition content. For example, North Dakota Early Learning Guidelines for children ages three through five include the following learning objective: “Children will exhibit knowledge about foods and nutrition (e.g., good food, junk food)” (North Dakota Department of Human Services, 2010).

For young children, a developmentally appropriate nutrition curriculum would include learning about where fresh produce comes from (perhaps by planting a garden or visiting a farm) and learning how healthy meals and snacks are prepared (for example, by participating in simple cooking projects).

Early childhood programs can also play a role in educating parents and family members about good nutrition. The care taken to plan and prepare meals and snacks for children in the program can serve as a model for parents regarding making healthy choices. Program menus and nutrition information can be shared through brochures and newsletters sent home as well as through post- ers on parent bulletin boards. Dieticians and nutrition experts could be invited to speak at parent meetings or workshops. Fun family activities such as potluck dinners, cooking nights, and recipe exchanges can be used as opportunities to share information about good nutrition and healthy eating habits.

Sometimes the best way to teach families to make good choices about what their children eat is by serving as positive role models. Policies and practices, such as celebrating children’s birthdays and accomplishments with fun activities instead of sweet treats, can demonstrate healthy habits for parents.

CHAPTER 6Section 6.6 Health

Questions to Think About 1. What are some examples of actions an administrator can take to help educate parents

and family members about good nutrition? 2. Imagine you are a parent of a child enrolled in an early childhood program. What kinds

of nutrition information would you be interested in receiving and in what format?

6.6 Health

Safeguarding children’s health means not just the prevention of disease but also supporting the overall well-being of children’s physical and mental health. The responsibility of the early childhood administrator is to develop and implement policies and practices that help keep the children, as well as the staff, as healthy as possible.

The early childhood administrator is responsible for maintaining chil- dren’s health and immunization records and for developing and implementing a policy for making sure children with a contagious ill- ness do not attend the school or center. The administrator is also responsible for making sure that all the health policies and prac- tices are in compliance with local, state, and federal health codes.

Enrollment Procedures Health policies and procedures often come into play even before the child’s first day in the school or day care, as families usually complete a health assessment as part of the initial enrollment process. The child must be seen by a health care provider who will evaluate the child’s overall health, check for signs of contagious illness, and, when appropriate, administer any required immunizations. The child’s health status must be documented and signed by the health care provider. These procedures are usually required as part of the state licensing code or the local health department (Figure 6.3).

iStockphoto/Thinkstock

Germs can spread quickly in an early childhood classroom where children have not yet learned good hygiene practices.

CHAPTER 6Section 6.6 Health

Figure 6.3: Health Assessment Form

General Health Appraisal Form

Parent:

Health Care Provider:

Please complete

Child’s Name: ______________________________________________ Birthdate: _________________

I, ________________________ give consent for my child’s health provider, school or camp personnel to discuss my child’s health concerns. My child’s health provider may fax this form (and applicable attachments) to my child’s childcare provider, school, or camp. FAX Number:_________________________

_______________________________________________________________ Date: _________________

Allergies:

Sleep: Your health care provider recommends all infants less than 1 year of age be placed on their back for sleep.

None Describe: ________________________________________________________

Diet: Breast Fed Formula: _____________________________ Age Appropriate

Type of Reaction: _______________________________________________________________________

Special Diet: ________________________________________________________________________

Preventative creams/ointments/sunscreen may be as requested in writing by parent, unless skin is broken or bleeding.

Parent or Legal Guardian Signature Authorization expires 365 days after this date

Please complete after parent section has been completed

Date of Last Exam: _______Recent Weight:_______ **HCT: ______ **B/P ______ **Lead Level:______ Physical Exam:

Significant Health Concerns:

Normal Abnormal (see explanation of significant health concerns:)

None Reactive Airways Disease Seizures

Immunizations:

Up-to-date See attached immunization record Administered today:__________

Diabetes

Developmental Delays

Acetaminophen (Tylenol®) may be given for pain or fever over 102° every 4 hours as needed: Dose_________________

Vision Hearing Hospitalizations Severe Allergies

Other (dental, nutrition, behavior, etc.)____________________________________________________________

Explain above concerns (if necessary, include instructions to childcare providers): ________________________ ________________________________________________________________________________________________

________________________________________________________________________________________________

Describe: ______________________________________Current Medications/Special Diet:

Fever reducer or pain reliever (mark only one product: max 3 consecutive days without additional medical authorization)

None

(Separate medication authorization form required for medications given in Child Care)

See attached Dosage Schedule from our office

Ibuprofen (Motrin®,Advil®) may be given for pain or fever over 102° every 6 hours as needed: Dose_________________ See attached Dosage Schedule from our office

Signature:

Next Well Visit:

This child is healthy and may participate in all routine activities, sport, camps, and child care. Any concerns or exceptions are identified on this form.

________________________________________ _____________

Per AAP Guidelines* or Age:_____

Signature of Health Care Provider (certifying from was reviewed) Date

Of�ce Stamp: Or write Name, Address, Phone Number

The Colorado Chapter of the Academy of Pediatrics (AAP), Healthy Child Care Colorado, and Headstart have approved this form 04/04. * The APP recommends that children from 0-12 year have health appraisal visits at: 2, 4, 6 ,9, 12, 15, 18 and 24 months, and age 3, 4, 5, 6, ,8, 10 and 12 years. ** Required by Head Start program only per state EPSDT schedule © Copyright 2004 Colorado Chapter of the American Academy of Pediatrics.

This form from the Colorado Department of Public Health and Environment is an example of the kind of standardized form used by state licensing agencies. Source: Used with permission of Colorado Academy of Pediatrics.

CHAPTER 6Section 6.6 Health

In most early childhood programs, arranging for the doctor visit and the completion of the health form is the responsibility of the parents. In some programs, such as Head Start, health services are provided by the program or the program has a partnership with a health care provider. The services may include physicals, dental checkups, and vision and hearing screenings. Programs that offer these supplemental services are usually those that receive public funding to provide sup- ports for low-income families.

The preenrollment health assessment benefits the child who is enrolling by providing an opportu- nity for a doctor to identify any health issues that might need attention or treatment. The assess- ment also benefits the children and staff who are already part of the program, as it diminishes the likelihood that the new child will introduce an illness that could be passed along to other children or staff members.

The prevalence of food allergies among young children is another reason that a new child’s medical history must be carefully documented and communicated to staff at the time of enroll- ment. Program staff should be aware of the child’s allergy, the possible symptoms of an allergic reaction, and instructions for how to respond, such as administering an epi pen.

Immunizations Vaccines requirements help ensure that children are protected from certain contagious dis- eases, such as polio and chicken pox, through immunizations. An immunization record is an important part of each child’s health documentation. In most states, children must have a complete and up-to-date vaccination record in order to enroll and participate in an early child- hood program.

Although most pediatricians advise parents to immunize their children and the American Acad- emy of Pediatrics (AAP) recommends a complete immunization schedule (Figure 6.4), some parents choose not to immunize their children for a variety of reasons including health issues, religious beliefs, and concerns about the side effects of vaccinations. All 50 states allow vac- cination exemptions for medical reasons and most allow exemptions for religious reasons. As of 2012, only 19 states allow exemptions for philosophical reasons (National Network for Immunization Information, 2012). If a family wishes to apply for an exemption, parents may submit alternative health forms that document their decisions not to immunize their children and, if approved by state health officials, exempt them from the immunization requirements.

Unvaccinated children are at greater risk of catching and spreading the diseases that can be prevented through vaccination. If there is an outbreak of vaccine-preventable disease, children who have not had the disease and who have not been vaccinated may be excluded from school or day care until the risk of contracting the disease is over. It is the responsibility of the early childhood administrator to become familiar with the policies regarding immunizations in the state where the program is located.

CHAPTER 6Section 6.6 Health

The Centers for Disease Control in the United States recommends children receive the following vaccinations before the age of seven. Source: Centers for Disease Control and Prevention (CDC)

Policies and Strategies to Prevent Illness Many health policies in early childhood programs are based on the idea expressed in the adage, “Prevention is the best medicine.” It’s better to direct our attention and resources toward limiting illnesses rather than responding to symptoms and illnesses after they develop.

Children are especially vulnerable to getting sick in day care and preschool environments because they play together in groups, often holding hands and interacting with each other in physical ways, and are therefore more likely to be exposed to children who might have infectious disease (AAP, 2006). One child with a contagious illness, such as a cold or flu, can quickly pass that infection to other children in the group when she coughs, sneezes, touches other children or toys, or uses contaminated hands to play in a sand or water table.

To help prevent spread of germs, classrooms must be kept very clean. Daily maintenance of the classroom must include the disinfection of surfaces, including floors, equipment, toys, and objects that children might put in their mouths (such as pacifiers and teething toys).

The regulations for the cleaning of surfaces and toys are defined by the state licensing agency or by local health codes. In most states, spraying surfaces with a solution of one tablespoon bleach to one quart of water is the most effective and economical option. The sanitizing solution must be made fresh each day. After spraying, surfaces can be left to air dry or, after at least 10 seconds, wiped with a dry paper towel. The early childhood administrator is responsible for training staff to follow these guidelines. Instructions reminding staff of proper procedures should be posted in classrooms, bathrooms, and diaper changing stations.

Developing and implementing strict policies for hand washing can also help reduce the spread of germs. State and local health regulations usually include mandates that children and adults wash their hands at specific times and situations, such as before meals and after using the toilet. The American Academy of Pediatrics recommends that children and adults wash their hands with

Figure 6.4: Recommended Immunizations for Children

Birth 1month 2

months 4

months 6

months 12

months 15

months 18

months 19-23

months 2-3

years 4-6

years

HepBHepB HepB

DTaP

Hib

PVC

IPV

Influenza (Yearly)

Varicella

HepA

MMR

DTaP

Hib

PCV

DTaP

Hib

PCV

IPV

DTaP

Hib

PCV

IPV

DTaP

IPV

MMR

Varicella Shaded boxes indicate the vaccine can be given during shown age range.

CHAPTER 6Section 6.6 Health

soap under warm running water for a full 10 seconds (AAP, 2006). If faucets do not shut off auto- matically, children and adults should be trained to use a paper towel to turn the faucet, rather than touching the potentially contaminated handle with clean hands.

Using hand sanitizers or protect- ing hands with disposable gloves is not as effective as washing hands under running water. Health and sanitation regula- tions for early childhood pro- grams at both the state and local level, as well as NAEYC accredita-

tion criteria, require that staff and children wash hands with running water. There may be times, however, on playgrounds or on field trips, when running water is not immediately available, and staff or children may use hand sanitizers. Children must be directly supervised when using hand sanitizers to ensure they use only a small amount and rub their hands thoroughly until their hands are dry.

Staff members should also be trained to use universal or standard precautions any time they come in contact with children’s bodily fluids, including blood, saliva, vomit, and urine or fecal mat- ter (Daily, 2004). Standard precautions include washing hands or wearing latex gloves, sanitizing the environment, and proper disposing of waste materials.

Exclusion Policies No matter how thoroughly a program’s health policies are implemented, children will still occa- sionally get sick. Symptoms of illness may develop while the child is at school, or they may develop later at home. To prevent the spread of illness among the rest of the children, early childhood programs develop exclusion policies.

An exclusion policy describes the circumstances under which a child would not be allowed to attend the program due to illness. The policy should be included in the program’s family handbook so that families are aware of the policy at the time their children are first enrolled. The program’s personnel policies may also include an exclusion policy for staff as well.

Here is an example of a typical exclusion policy for an early childhood program that serves pre- school-age children:

If a child is exhibiting signs or symptoms of a contagious illness, the parent or guard- ian will be contacted to pick up the child at school. The child will be excluded from school until he/she is evaluated by a physician and given written clearance to return to school or until signs and symptoms of the condition are gone. The following are common signs and symptoms that generally require temporary removal from school:

iStockphoto/Thinkstock

Washing hands is the single most important thing children and adults can do to reduce the spread of germs.

CHAPTER 6Section 6.6 Health

• Fever (body temperature over 100.5 F). For return to school, the fever should be absent for 24 hours without the use of fever-reducing medication

• Diarrhea • Vomiting (two or more episodes in 24 hours) • Sore throat with fever • Severe coughing • Eye discharge (thick mucus or pus) • Body rash with fever • Head lice (live lice only, not excluded for nits) • Child is irritable, continuously crying or too lethargic to participate in routine activities

(signs that illness may be developing)

Early childhood administrators can refer to the policy whenever parents have questions about whether or not their child is well enough to come to school. Administrators can also use the policy to train staff to recognize symptoms that might warrant exclusion. For example, if a teacher notices that a child, after waking from nap, has a thick discharge around one eye, the teacher should alert the administrator. After checking the child and verifying the symptom, the adminis- trator would then call the parents and ask them to come and pick up their child.

Reporting Communicable Diseases In some states and communities, early childhood programs are required to report instances of cer- tain communicable disease. For example, in the state of Arizona, school and child care administra- tors are required to report cases of illnesses such as measles, mumps, pertussis (whooping cough), rubella, and varicella (chicken pox) to local health departments within 24 hours after detecting a case, which usually comes about when a parent reports to the administrator the results of a doc- tor visit (Arizona Department of Human Services, 2008).

For more common conditions, such as strep throat or head lice, reporting requirements may include sending a notice to each family enrolled, informing them that a child at the program has been diagnosed with the condition and listing the possible symptoms to look for. The policy regarding when children can return to school will vary according to the condition or illness. For example, most early childhood programs require that children who have had head lice must be “nit free” before they can return to the program. Often it is the role of the administrator to do a health check or, in this case, a nit check, when the parent brings the child to the program in the morning, to ensure that the child is indeed ready to return to the program. Administrators must keep abreast of the recommendations and requirements of local and state health agencies and create and revise program policies whenever these recommendations and requirements are updated or changed.

Ongoing Screenings Regular health screenings are an important part of monitoring and maintaining children’s health. Informal screenings can take place daily as staff members observe children’s physical appearance and behavior. When teachers or caregivers notice changes in appearance or behavior, such as a child who seems unusually sleepy or lethargic, symptoms that might indicate a potential health issues, those changes should be documented and shared with parents (Nalle, n.d.).

CHAPTER 6Section 6.7 Safety

More formal health screenings can be conducted by partner agencies or through parent refer- rals. Early childhood screenings may include general health screenings (conducted by a physician), developmental screenings (conducted by a trained professional such as a school psychologist), or issue-specific screenings such as vision and hearing screenings (conducted by a physician or other trained professional).

When screenings are conducted on-site, parents should be informed in writing prior to the screen- ing date, and they’ll usually need to provide permission. Also, parents should receive results of all screening. A screening is a general assessment and does not involve a diagnosis; if the screening indicates a possible issue, such as a hearing impairment, the family will be referred for additional evaluation by the agency that has conducted the screening. It is the role of the administrator to serve as a liaison between the screening agency and the families, facilitating communication as needed.

Whenever possible, the children should be told in advance what the screening will entail. For example, preschool children who will participate in a vision and hearing screening could practice the process ahead of time by pretending they are screening their teachers.

Mental Health Early childhood programs promote children’s mental health by providing a safe and secure haven where children can learn and grow. Social-emotional development is supported through the rela- tionships between staff and families and through the curriculum activities that provide opportuni- ties for children to interact with others and develop a positive sense of self.

Early childhood administrators should be knowledgeable about mental health issues in young children and families, such as stress and anxiety, and train staff members to recognize signs of child neglect or abuse. All staff should understand their obligations as mandated reporters—that is, they are required by law to report any suspicions or knowledge of child abuse or neglect to the appropriate authorities. Administrators should also be familiar with mental health agencies and resources in their community and be prepared to make confidential referrals when families are in need of services, such as family counseling.

Questions to Think About 1. Why is it important that an administrator collect and review health documentation for

each child prior to enrollment? 2. Suppose you are the director of a preschool, and one morning you observe a parent

bringing a child to school who is coughing quite a bit and clearly not feeling well. How would you approach the parent and start a conversation about whether the child should come to school that day?

6.7 Safety

An early childhood program could have a beautiful facility, excellent teachers, and an excit-ing curriculum; but if there are no practices in place to keep children safe from accidents and injury, the program quality is compromised and children are at risk. The role of the

CHAPTER 6Section 6.7 Safety

administrator is to develop and implement policies and procedures that will reduce the risks of harm to children to the greatest possible extent.

This important work is ongoing. The safety of the physical environment as well as the policies and procedures that are in place must be continually assessed. Teachers and staff must be trained to fol- low policies and procedures, and their training must be updated on a regular basis. For example, most licensing agencies require that early childhood pro- grams create a written document any time a child is injured, even if the injury is very small or minor, such as a scraped knee. A copy of the document, sometimes called an incident report, can be shared with the child’s parents to keep them fully informed about what happened to cause the injury. Admin- istrators are responsible for overseeing this docu- mentation process.

Risk Management The term risk management is frequently used in business to describe the process of identifying, assessing, and prioritizing risks of different kinds. The term is often used in early childhood educa- tion to describe the process used by administrators for a similar process. In business, the risks are related to the loss of assets. In early childhood education, the risks are related to possible harm to children. Although the two kinds of risk are worlds apart, the process for identifying, assessing, and prioritizing is a valuable structure to follow.

There are various tools—usually consisting of questionnaires, checklists, and observations—avail- able for identifying and assessing risk in an early childhood program (Figure 6.5). Some state licensing agencies require that certain tools are used to document and assess risk in an early childhood program. In some cases, a program may use a tool provided by an insurance agency. In general, a risk management assessment tool will evaluate the screening and training of employ- ees, the transportation and transitions of children to and from the program, and the facility and equipment, with special attention given to playgrounds.

BananaStock/Thinkstock

Any time a child is injured, even if it is just a small cut, staff should carefully document what happened in an incident report.

CHAPTER 6Section 6.7 Safety

Figure 6.5: Sample Risk Management Checklist

Prince William County School Division Playground Safety Program

Monthly Playground Safety Checklist

School: Date:

Person Completeing Checklist:

Yes No Problem

(Retain original on file at school)

1. Area surrounding playground barrier free and clear?

2. Have all debris or other foreign objects been removed from the playground surface?

3. Is the depth of surfacing material consistently 12 inches under and around the equipment?

4. Is the surfacing material loose and not compacted?

5. Is there sufficient drainage?

6. All nuts and bolts tight?

7. All nuts and bolts recessed or capped?

8. All pipe ends capped?

9. All steps, landings, and railings secure?

10. All steps non-slipping?

Administrators in this school district are required to complete a thorough playground inspection once a month.

Source: Prince William County Public Schools

Screening and Training New Employees In most states, staff members working directly with children in licensed early childhood programs are required to complete a criminal background check prior to the first day of work. Individuals with a criminal history, especially crimes against children, should not be employed.

Staff must also be trained to follow safety procedures and policies. Most state licensing agencies require that at least one staff member in each program who works directly with the children is trained in administering first aid and cardiopulmonary resuscitation (CPR). Some licensing agen- cies and local health departments also require that the staff member responsible for overseeing meal preparation and food service, often either the administrator or the food service aide, com- plete a food safety and sanitation course.

CHAPTER 6Section 6.7 Safety

Focus On: Security Systems Many early childhood programs are equipped with electronic security systems to ensure that the only people who enter the facility are those who are authorized to do so, such as staff members and parents (Wisconsin Department of Children and Families, 2011). Currently, early childhood programs are not required to equip their facilities with electronic security sys- tems, but this is a significant trend in the field.

When an electronic security system is in place, all doors to the building or area of the building are kept locked at all times. Staff members and parents must be informed that they should never prop the doors open or hold the doors open for someone they do not know or recognize.

With an electronic security system, the doors will be equipped with some kind of device such as a key pad where an entrant must enter a pass code in order to access the building, or a

card swipe where he or she must swipe a key card to enter. Some facilities may also have some kind of doorbell, combined with a camera or window that allows people on the inside to screen visitors before they enter the building.

The administrator is often in charge of creating and safeguarding system passwords and maintaining regular communication with the technicians and support teams who oversee these systems. He or she would also be responsible for overseeing the contract with the security company and the mainte- nance of the system.

Brand X Pictures/Thinkstock Administrators are responsible for setting up a plan for the use of the security system. For example, administrators may develop a plan where only certain staff members are authorized to admit visitors to the building.

Transportation and Transitions of Children In many early childhood programs, parents or family members bring children to the program and provide their own transportation. However, some programs, such as many federally funded Head Start centers, provide bus transportation. If the program contracts with a bus service for trans- portation, the contractor must be able to demonstrate compliance with safety regulations. State licensing code provides minimum requirements for monitoring children during transportation, but the administrator is responsible for making sure that there is enough supervision on the buses to ensure children are safely buckled in and supervised.

Regardless of how children are transported to the program, the transitions to and from the facility are times when children are vulnerable to falls or accidents. The administrator should monitor the parking lots and walkways, and entrances of the facility must be free of hazards such as icy surfaces.

An administrator must set up clearly defined policies and procedures for how to document and confirm who is allowed to pick up a child from the program. If someone other than a parent is pick- ing up the child, the parents must authorize the pickup in writing. Staff may also require that the pick-up person show identification to verify that he or she is the person authorized by the parent.

CHAPTER 6Section 6.7 Safety

Facility and Equipment As described in Chapter 5, safety is the primary consideration in all matters involving the design and maintenance of an early childhood facility as well as in decisions involving room arrangement and the selection and maintenance of equipment. As part of this, playground safety is a priority because of the increased risks of injury when children are running and climbing.

Playgrounds Every year thousands of children are seriously injured on playgrounds in the United States (Caesar, 2004). The risks of injury, even death, are so great on playgrounds because children are moving faster and at greater heights than during the rest of their day. Children can be injured by a fall or

by colliding with each other or with the play equip- ment (slides, swings, etc.). Research has shown that a third of all playground injuries can be avoided if playgrounds are properly inspected and maintained (Caesar, 2004). The steps toward ensuring a safe playground in an early childhood program include documentation, inspection, and supervision.

Inspection Every playground should be inspected on a daily basis prior to its being used by children. Teachers and care- givers can be trained to do this each day, though the administrator should also conduct regular inspec- tions. The inspection should include checking for and removing any debris or hazards such as rocks or sharp sticks, picking up litter, and checking any loose surfacing materials, such as wood chips, to make sure it is evenly distributed under climbing equipment.

The playground should also be checked for standing water or ice, and the equipment should be checked for signs of wear, rust, or rot. If the inspection indi- cates hazards that can’t be immediately resolved, the children should not use the playground until the hazard has been eliminated.

iStockphoto/Thinkstock

Public parks and playgrounds that are frequently used for outdoor play should be regularly inspected by program staff members.

CHAPTER 6Section 6.7 Safety

Supervision Before children are allowed to play on a playground, teachers and caregivers must make sure everyone understands the playground rules. For example, an appropriate rule for young children would be that they must go down the slide feet first rather than head first. Rules can be discussed during story time or circle time, when the teachers have the children’s full attention. Picture books, drawing, or dolls can be used to demonstrate the rules. Young children will often need reminders of the rules, as needed, from teachers during playground play.

The adults supervising the children should position themselves so that every area can be well supervised. Areas where children climb, such as the ladder of a slide, should have an adult nearby, prepared to assist as needed. Teachers and caregivers should be in positions that are spread out across the playground area, not clumped in one place.

In some early childhood programs, especially those that use a playground space that is not imme- diately adjacent to the building, the adults supervising the playground carry cell phones or two- way radios to ensure that if they needed to ask for assistance it would be easy to communicate with someone inside the building.

Documentation Records related to the purchase and installation of a playground should never be discarded. Admin- istrators should keep a file documenting the name and contact information of the manufacturer of every piece of equipment as well as the company that installed the playground surface. Documenta- tion should also include all records of inspection and certification.

For reference, administrators should also keep a current copy of the United States Consumer Products Safety Commission Handbook for Public Playground Safety. Playground documentation should also include copies of reports of accidents and injuries that occur on the playground (Figure 6.6). These accident reports should be reviewed on a regular basis to determine if there are patterns that indicate certain pieces of equipment or certain kinds of situations are more likely to cause an injury.

http://www.cpsc.gov/PageFiles/116134/325.pdf

CHAPTER 6Section 6.7 Safety

Figure 6.6: Sample Incident Report Form

NEW YORK STATE OFFICE OF CHILDREN AND FAMILY SERVICES

INCIDENT REPORT FOR CHILD DAY CARE

(Accident, Illness, etc.)

(Kitchen, Playground, etc.)

*This form may be used to maintain a record of each child’s illness, accidents, injuries, signs of abuse, etc. *Share a completed copy with parents.

*If death of a child occurs, you must immediately notify the Division of Child Care Services (DCCS) 1-800-732-5207

Name of Child __________________________________________________________ DOB: ______________

Name __________________________________ Date _____/___/________ Time _________

Describe Incident ___________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________

Injuries ___________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________

Describe Medical Services or Treatment Provided ________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________

Date _____/___/___________

Time ____________________

Type _________________________

Place _________________________

Details of Incident

Parent/Guardian/Other Notified

Witnesses

Am Pm

Name __________________________________ Date _____/___/________ Time _________

Name _______________________________________________________

Staff ________________________________________________ Date _____/___/______________________

Staff Signature: ________________________________________________ Date _____/___/_____________

Am Pm

(Print Name)

If you need additional space for describing incidents, injuries, or services, please attach additional sheets of paper

An incident report form should also document when the parent was informed of the incident.

Source: New York State Office of Children and Family Services

CHAPTER 6

Risk Management Plan Risk management plan is a document created by the early childhood administrator to describe how the program staff will proactively work to reduce the risk of injury in the early childhood program. How an administrator documents the risk management plan will vary depending on the requirements of licensing agencies and funders. For example, a risk management plan for a Head Start program asks the administrator to document any previous incidents of accidents or injuries, create an action plan to address how the risk of those kinds of incidents might be reduced in the future, and set a date for assessing the action plan in the future (United States Department of Health and Human Services, 2004).

The Role of Teacher Training in Risk Management Most of risk management boils down to two categories: things and people. The things are the mate- rials, equipment, and elements of the facility that must be maintained for safety. The people are the teachers and other employees in the program. Regardless of their credentials and experience, every person involved in the care and supervision of the children will require orientation, training, and ongoing supervision in order to ensure the children’s safety and reduce or eliminate risk of harm to children.

Some of the training will be universal for any program, such as first aid and CPR training as required by state licensing agencies. Other training will be specific to the program and the site. For example, teachers and caregivers must be trained to safely evacuate the children in the event of a fire. Each facility, as well as each room in that facility, will have an exit path that is specific to that location. Other emergency procedures may include a tornado plan or an earthquake plan. Some programs now have an active shooter plan as well, which stipulates how to lock down the building if someone enters with a gun and begins shooting.

Setting Limits On an ordinary day, one of the most important things teachers and caregivers can do to keep children safe is to set clear limits. Setting limits means establishing rules that are realistic and easy for children to under- stand and remember. Setting limits also means using reminders, redirection, and gentle consequences to teach children to follow the rules, especially when breaking a rule may mean a child might get hurt. The role of the administrator or supervisor is to train staff members to communicate limits clearly by speaking to children clearly and respectfully and to respond consis- tently when children test the limits or break the rules.

The responses of teachers and caregivers when a child breaks a rule should be appropriate to the seriousness of the situation. For example, if a child shouts out dur- ing story time there is very little danger to other chil- dren, but if a child runs away from the teacher when the class is crossing the street, the child is in dan- ger and the teacher must take immediate and strict action. When children are supervised with care and

iStockphoto/Thinkstock

Setting limits on the playground means making sure children use the equipment in the manner it was intended. For example, a slide is for sliding, not for jumping off.

Section 6.7 Safety

CHAPTER 6Post-Test

the rules are clearly communicated and consistently enforced, the risks to the children are signifi- cantly reduced (Thompson, Hudson, & Mack, 1999).

Questions to Think About 1. Note that professionals use the term risk management rather than risk elimination. Why

is it not possible to eliminate every possible risk to children? 2. Imagine that an early childhood administrator is training a new teacher. They are standing

on the playground together. What are some topics the administrator might discuss with the trainee at that time?

Chapter Summary • Federal, state, and local agencies, such as the Child and Adult Care Food Program, pro-

vide guidelines and requirements for early childhood programs regarding the frequency of meals, the variety of foods served, and the sanitation requirements for food service.

• Decisions about menu planning should be based on considerations such as the age and development of the children, the time of day the meal or snack will be served, the cul- tural backgrounds, preferences, and dietary restriction needs of the children and fami- lies, cost, and capacity.

• Health policies and procedures usually begin with the requirement of a preenrollment health form documenting the child’s current health status and immunization history. Administrators must be familiar with and follow the policies of local and state health agencies regarding immunization exemptions.

• Strategies that help prevent the spread of illness include maintaining a clean and sani- tary environment, enforcing an exclusion policy when children become ill, and reporting cases of communicable diseases to health authorities.

• To help keep children safe, administrators must have a risk management plan, a process for continually assessing and addressing the possible risks in the environment, in the training and supervision of the staff, and in the operations of the program.

• Playgrounds must be carefully maintained and supervised because of the significant risks of injury to children when they are climbing and playing on playground equipment.

Post-Test

1. Infants and young children usually need to eat a meal or snack a. upon waking. b. every 2–3 hours. c. every 6 hours. d. three times a day.

2. Children are at a higher risk for obesity if they are a. female. b. an only child. c. in a low-income family. d. living in a rural area.

CHAPTER 6Post-Test

3. USDA nutrition guidelines focus on which of the following two concepts: a. Maintaining caloric balance and consuming nutrient rich foods. b. Reducing the consumption of sugars and increasing the consumption of proteins. c. Promoting an active lifestyle and reducing childhood obesity. d. Washing hands and preventing the spread of germs.

4. The Child and Adult Care Food Program subsidizes early childhood programs’ a. staff salaries. b. tuition payments. c. parent meetings. d. food costs.

5. Children are more likely to eat well at meals when the food is served in a a. large colorful bowl. b. culturally consistent manner. c. well-lit, large classroom. d. container stored at room temperature.

6. Administrators are responsible for training staff to a. prepare vegetarian soups. b. distinguish between the taste of skim milk and whole milk. c. recognize signs of an allergic reaction. d. find a grocery store that sells organic foods.

7. Before a child’s first day in the program, the administrator must ensure the family has a. kept the child at home with a fever. b. submitted all the required health documents. c. looked for signs of communicable illness. d. washed the child’s hands with soap and water.

8. The most important thing staff can do to reduce the spread of germs is a. wear latex gloves. b. wash the toys. c. use a hand sanitizer. d. wash their hands.

9. Administrators should train their staff to complete an incident report every time a child a. cries for no reason. b. is injured in any way. c. demonstrates a developmental milestone. d. breaks a playground rule.

10. The most dangerous places for children in an early childhood program are a. the kitchen and the bathroom. b. the classrooms and the hallways. c. the closets and the locker rooms. d. the playground and the parking lot.

Answers: 1 (b); 2 (c); 3 (a); 4 (d); 5 (b); 6 (c); 7 (b); 8 (d); 9 (b); 10 (d)

CHAPTER 6Additional Resources

Discussion Questions

1. Local, state, and federal guidelines for nutrition, health, and safety are often under review and are frequently updated. What plans or systems could an administrator put in place to ensure that he or she keeps current on any regulatory changes?

2. Which of these areas—nutrition, health, and safety—do you think would be most diffi- cult for an early childhood administrator to manage? Which would be most time con- suming? Which would be most stressful?

3. What do you imagine as a “worst case scenario” for an early childhood administrator regarding children’s health and safety? How might an administrator prepare for that situation?

Answers and Rejoinders to Pre-Test

1. False. Administrators develop systems, policies, and procedures that help ensure that the children enrolled in the program are healthy and safe.

2. True. Through strategies such as modeling healthy menu planning and including nutri- tion education in the curriculum, early childhood programs can help reduce the preva- lence of obesity among young children.

3. False. Early childhood programs must comply with local, state, and federal regulations regarding food service and sanitation.

4. False. Though policies vary from state to state, some children are eligible for exemptions from immunizations for medical, religious, or philosophical reasons.

5. False. Not every risk to children can be eliminated, but early childhood administrators are responsible for risk management.

Additional Resources

Web sites Child and Adult Care Food Program http://www.fns.usda.gov/cnd/care/ CACFP reimburses eligible food expenses to institutions that care for children and elderly adults from low-income families. This website serves as a hub for information about the eligibility guidelines and reporting requirements for participation in the CACFP relevant to both child care centers and family child care homes.

National Program for Playground Safety http://playgroundsafety.org/ NPPS is a leader in research, training, and development of S.A.F.E. play areas by providing standards, research, and training resources. NPPS’s mission is to help the public create safe and developmentally appropriate play environments for children.

Smart School Snacks: A Comprehensive Preschool Nutrition Education Program https://eric.ed.gov/?id=EJ768990 By Penny Bernath and Wendi Masi in Beyond the Journal: Young Children on the Web. This article provides an overview of a model preschool nutrition education program that includes the development of snack centers, teacher-made classroom materials, family involvement and education, and teacher education and support.

https://eric.ed.gov/?id=EJ768990

CHAPTER 6

anaphylaxis A full body allergic response that may include cramps, wheezing, and difficulty breathing.

Child and Adult Care Food Program (CACFP) A federal program providing subsidies to orga- nizations that serve meals to children (as well as adults who are elderly or disabled).

epinephrine injector A device used to admin- ister a dose of medication that will help delay the severity of an allergic reaction.

exclusion policy A policy that describes the circumstances under which a child would not be allowed to attend the program due to illness.

highly processed food Food that is typically high in salt, sugar, fat, and often, calories, but low in vitamins, minerals, and fiber.

immunization record A documentation of a child’s vaccination history.

malnutrition Not getting enough of nutrients.

Key Terms

Team Nutrition http://www.fns.usda.gov/tn/ Team Nutrition is an initiative of the USDA Food and Nutrition Service to support the Child Nutri- tion Programs through training and technical assistance for food service, nutrition education for children and their caregivers, and school and community support for healthy eating and physical activity.

United States Consumer Product Safety Commission https://www.cpsc.gov/ The CPSC is committed to protecting consumers and families from products that pose a fire, electrical, chemical, or mechanical hazard or can injure children. The CPSC’s work is to ensure the safety of consumer products such as toys, cribs, power tools, cigarette lighters, and house- hold chemicals.

Further Reading Aronson, S. S., Ed. (2012). Healthy young children: A manual for programs (5th ed.). National Association for the Education of Young Children.

This classic NAEYC publication has been revised and updated a number of times, and the 2012 version includes new information on the relationship between physical activity and reducing the prevalence of childhood obesity. Other resources for administrators include updated standards, procedures, and resources, including sample forms, letters, and checklists.

Smith, C. J., Hendricks, C., & Bennett, B. S. (2007). Growing, growing strong: A whole health cur- riculum for young children. St. Paul, MN: Redleaf Press.

This book offers information and suggestions for developing and implementing curricu- lum activities related to health and safety. The suggested lesson plans are open-ended and can be adapted and tailored to a variety of curriculum structures.

Key Terms

https://www.cpsc.gov/

CHAPTER 6

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American Academy of Pediatrics (AAP) Health and Safety E-News. (2006, April). Healthy child- care. Retrieved from http://www.healthychildcare.org/ENewsApr06.html

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Bottemiller, He. (2012). Study finds organic foods no less likely to be contaminated than conven- tional. Food Safety News. Retrieved January 5, 2013, from http://www.foodsafetynews .com/2012/09/organic-food-not-proven-healthier-or-safer-study-finds/

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Centers for Disease Control and Prevention (CDC). (2011). Obesity among low-income preschool children. Fact Sheet. Retrieved from www.cdc.gov/obesity/downloads/PedNSSFact Sheet.pdf

References

nutrients The substances that our bodies need to live and grow.

obesity The condition in which excess body fat accumulates to the extent that it has a negative effect on health, leading to increased health problems; physicians diagnose obesity based on body mass index (BMI), a measure- ment of the proportion of weight to height.

organic food Food grown without synthetic pesticides or chemicals.

risk management The process of identifying, assessing, and prioritizing risks of different kinds.

standard precautions Guidelines that were developed to reduce the spread of infection when exposed to potentially pathogen- carrying body fluids.

temperature danger zone The range between 40 degrees and 140 degrees Fahren- heit in which food-borne pathogens are most likely to reproduce to levels high enough to cause illness.

United State Department of Agriculture (USDA) The department of the federal gov- ernment responsible for farming, agriculture, forestry, and food; the USDA publishes nutri- tion guidelines.

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http://www.playcare-inc.com/uploads/2/9/4/8/2948746/ensuring_playgroud_safety.pdf

www.cdc.gov/obesity/downloads/PedNSSFactSheet.pdf

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