Performance Category —HEALTH

Final Draft Accreditation Performance Criteria

Approved June 15, 2004 by Program Standards/Criteria Commission

 

Performance Category: Health

 

Program Standard:  The program promotes the nutrition and health of all children and staff and protects them from preventable illness and injury.

 

Rationale:  To benefit from education and maintain quality of life, children need to be as healthy as possible. Children depend on adults, who also are as healthy as possible, to make healthful choices for them and to teach them to make such choices for themselves.  While some degree of risk taking is desirable for learning, a high quality program prevents hazardous practices and environments likely to result in adverse consequences for children, staff, families or communities. 

 

Please note: When a state rule/regulation prohibits the performance expectation outlined in the draft criterion, the state rule/regulation takes precedence. When a state rule/regulation exceeds the performance expectation outlined in the criterion, the state rule/regulation again takes precedence.  When state rules or regulations differ in other ways, or mandate a lower threshold of performance, NAEYC’s criteria take precedence.

The following criteria were approved – contingent on receipt of additional public comment – at the March 2004 Commission meeting.

NUMBER

STRAND

FINAL DRAFT CRITERIA

 

Adult and Child Practices for Health Promotion and Protection (Including Measures to Control Infectious Disease)

 

5.1

U

Health information from a documented health assessment completed within 1 year of starting work must be received before a final job offer is made for all paid staff and before volunteers who work more than 40 hours per month have contact with children. All employees and volunteers must receive health assessments every two years after this initial assessment. This documented health assessment includes

·         immunization status;

·         physical ability to perform duties (history, physical exam, oral health assessment, vision and hearing screening);

·         emotional status;

·        documentation of TB skin testing using the Mantoux method and freedom from active TB disease by a licensed health professional. For those who have positive TB skin tests and those who have increased risk of TB according to the Centers for Disease Control (CDC), documentation of freedom from active TB disease by a licensed health professional is required annually.

 

5.2

U

Within 6 weeks after a child begins the program, and as age-appropriate thereafter, health records document the dates of services to show that the child is current for routine screening tests and immunizations according to the schedule recommended, published in print, and posted on the Web sites of American Academy of Pediatrics, Centers for Disease Control of the United States Public Health Service (CDC-USPHS), and the Academy of Family Practice.

When a child is overdue for any routine health services, parents and/or legal guardians provide evidence of an appointment for such services prior to the child’s entry into the program and as a condition of remaining enrolled in the program, except for any immunization for which parents are using religious exemption.

Child health records include

·         current information about any health insurance coverage required for treatment in an emergency;

·         results of health examination, showing up-to-date immunizations and screening tests with an indication of normal or abnormal results and any follow-up required for abnormal results;

·         current emergency contact information for each child that is kept up-to-date by a specified method during the year;

·         individuals authorized by the family to have access to health information about the child;

·         instructions for any special health needs of the child, such as allergies or chronic illness[1]

·         Staff have evidence in their child’s files if any child is under-immunized because of a medical condition (documented by a licensed health professional) or the family’s beliefs. They implement a plan to exclude the child promptly if a vaccine-preventable disease to which children are susceptible occurs in the program.

 

5.3

U

The program has and implements a written agreement with a health consultant who is either a licensed pediatric health professional or health professional with specific training in health consultation for early childhood programs.

·         The health consultant visits at least two times a year and as needed. Where infants and toddlers are in care, the health consultant visits the program at least four times a year and as needed.

·         The health consultant observes program practices and reviews and makes recommendations about the program’s practices and written health policies to ensure health promotion and prevention of infection and injury. The consultation addresses physical, socioemotional, nutritional, and oral health, including the care and exclusion of ill children.

·         Unless the program participates in the United States Department of Agriculture’s Child and Adult Care Food Program, a registered dietitian or pediatric public health nutritionist evaluates the menus for nutritional content; portion sizes; nationally recommended limits on juice, sugar, sodium, and saturated fats; food service operations; special feeding needs to be met by the program; and procedures used for food brought from home.

·         The program documents compliance and implements corrections according to the recommendations of the consultant(s).

 

5.4

U

At least one staff member who has a certificate of satisfactory completion of pediatric first-aid training, including management of a blocked airway and providing rescue breathing for infants and children, is always present with each group of children. When the program includes swimming and wading and when a child in the group has a special health condition that might require CPR, one staff person who has successfully completed training in CPR is present in the program at all times.

 

5.5

U

The program makes the child comfortable in a location where the child is supervised by a familiar caregiver and if is suspected of having a contagious disease, will not expose new individuals, until the child can be picked up by the child’s family if

·         an illness prevents the child from participating comfortably in activities;

·         an illness results in a greater need for care than the staff can provide without compromising the health and safety of other children; or

·         a condition is contagious and requires exclusion as identified by public health authorities.

The program immediately notifies the parent, legal guardian, or other person authorized by the parent when a child has any sign or symptom that requires exclusion from the program.

A program that allows ill children or staff to remain in the program implements plans that have been reviewed by a health professional about what level and types of illness require exclusion; about how care is provided for those who are ill, but who are not excluded; and about when it is necessary to require consultation and documentation from a health care provider for an ill child or staff member.

 

5.6

U

Staff and teachers provide information to families verbally and in writing about any unusual level or type of communicable disease to which their child was exposed, signs and symptoms of the disease, mode of transmission, period of communicability, and control measures that are being implemented at the program and that families should implement at home.

The program has documentation that it has cooperative arrangements and has at least annually made contact with local health authorities to keep current on relevant health information and to arrange for obtaining advice when outbreaks of communicable disease occur.

 

5.7

I

To reduce the risk of Sudden Infant Death Syndrome (SIDS), infants, unless otherwise ordered by a physician, are placed on their backs to sleep on a firm surface manufactured for sale as infant sleeping equipment that meets the standards of the United States Consumer Product Safety Commission.

Pillows, quilts, comforters, sheepskins, stuffed toys, and other soft items are not allowed in cribs or rest equipment for infants less than 8 months of age. If a blanket is used, the infant is placed at the foot of the crib with a thin blanket tucked around the crib mattress, reaching only as far as the infant’s chest. The infant’s head remains uncovered during sleep. After being placed down for sleep on their backs, infants may then be allowed to assume any comfortable sleep position when they can easily turn themselves from the back position.

 

5.8

T-P-K

At least once daily in a program where children over 1 year of age receive two or more meals, teachers provide an opportunity for tooth brushing and gum cleaning to remove food and plaque. (The use of toothpaste is not required.)

 

5.9

I

After each feeding, infant’s teeth and gums are wiped with a disposable tissue[2] to remove liquid that coats the teeth and gums.

 

5.10

I-T

Infants unable to sit are held for bottle-feeding. All others sit or are held to be fed. Infants and toddlers/twos cannot have bottles while in a crib or bed and cannot eat from propped bottles at any time. Toddlers/twos cannot carry bottles, sippy cups, or cups with them while crawling or walking. Teachers offer children fluids from a cup as soon as the families and teachers decide together that a child is developmentally ready to use a cup.

 

5.11

U

Children of all ages have daily opportunities for outdoor play when weather, air quality, and/or environmental safety conditions do not pose a health risk as defined by local health authorities consistent with local agency or program protocols and the advice of public safety officers. When outdoor opportunities for gross motor activities are not possible because of weather conditions, the program provides similar activities inside; indoor equipment for gross motor activities meets all safety requirements and is supervised at the same level as outdoor equipment.

 

5.12

U

To protect against cold, heat, sun injury, and insect-borne disease, the program ensures that

·     children wear clothing that is dry and layered for warmth in cold weather.

·     when children are in the sun, they wear sun-protective clothing and/or sunscreen or sun block with UVB and UVA protection of SPF 15 or higher that is applied to exposed skin. The children have the opportunity to play in the shade. Program staff apply sunscreen or sun block with written parental permission to do so.

·     when public health authorities recommend use of insect repellents due to a high risk of insect-borne disease, only repellants containing DEET are used, and these are only applied on children over 2 months of age. Staff apply insect repellent no more than once a day, but only with written parental permission.

5.13

U

For children who are unable to use the toilet consistently, the program ensures that

·     staff use only commercially available disposable diapers or pull-ups unless the child has a medical reason that does not permit their use ( the health provider documents the medical reason);

·     for children who require cloth diapers, the diaper has an absorbent inner lining completely contained within an outer covering made of waterproof material that prevents the escape of feces and urine. Both the diaper and the outer covering are changed as a unit. Cloth diapers and clothing that is soiled by urine or feces is immediately placed in a plastic bag and sent home that day for laundering (without rinsing or avoidable handling);

·     staff check children for signs that diapers or pull-ups are wet or contain feces at least every 2 hours when children are awake and when children awaken; diapers are changed when wet or soiled;

·     staff change children’s diapers or soiled underwear in the designated changing areas and not elsewhere in the facility;

·     the changing area is separated by a partial wall or at least 3 feet from other areas that children use and is assigned for exclusive use to one group of children. For kindergartners, the program may use an underclothing changing area designated for and used only by this age group;

·     at all times, caregivers have a hand on the child when the child is being changed on an elevated surface;

·     staff post and follow changing procedures as outlined in the changing procedures table in the changing area and use these procedures to evaluate teachers who change diapers;

·     surfaces used for changing and for placing changing materials are not used for other purposes, including temporary placement of other objects, and especially not for any object involved with food or feeding;

·     containers that hold soiled diapers and diapering materials have a lid that closes tightly and opens using a hands-free device (such as a step can).  These containers are kept closed (except for receipt of soiled materials) and are not accessible to children;

·     staff members whose primary function is preparing food do not change diapers until their food preparation duties are completed for the day.

5.14

U

Staff members and those children who are developmentally able to learn personal hygiene are instructed in and are periodically monitored. Hand washing is required by all staff, volunteers, and children when hand washing reduces the risk of transmission of infectious diseases to themselves and to others.  Staff assist children with hand washing as needed to successfully complete the task. Children wash either independently or with staff assistance.

Children and adults wash their hands

·         after diapering or using the toilet (For infants, the use of wet wipes is acceptable.);

·         after handling body fluids (e.g., blowing or wiping a nose, coughing on a hand, or any touching of mucus, blood or vomit);

·         before meals and snacks, preparing or serving food, or handling any raw food that requires cooking (e.g., meat, eggs, poultry);

·         after playing in water that is shared by two or more people;

·         after handling pets and other animals;

·         when moving from one group to another (e.g., visiting) that involves contact with infants and toddlers.

 

Adults also wash their hands

·         on arrival for the day;

·         before and after feeding a child;

·         before and after administering medication;

·         after assisting a child with toileting;

·         after handling garbage or cleaning.

 

Proper hand-washing procedures are followed by adults and children and include

·         using liquid soap and running water;

·         rubbing hands vigorously for at least 10 seconds, including back of hands, wrists, between fingers, under and around any jewelry, and under fingernails;

·         rinsing well;

·         drying hands with a paper towel, a single-use towel, or a dryer; and

·         avoiding touching the faucet with just washed hands, such as by turning off water by using a paper towel.

 

Except when handling blood or body fluids that might contain blood (when wearing gloves is required), wearing gloves is an optional supplement but not a substitute for hand washing in any situation listed above as requiring hand hygiene.

Staff must wear gloves when contamination with blood may occur.

Staff do not use hand-washing sinks for bathing children or removing smeared fecal material.

Staff clean and sanitize sinks used both for food preparation and other purposes before using these sinks to prepare food.[3]

 

5.15

U

Children are not permitted to play without constant supervision in areas where there is any body of water, including sinks, water tables, tubs, pails, toilets, swimming pools, wading pools, ponds, and irrigation ditches. Children are not permitted to use spas, hot tubs, or saunas.

Precautions are taken to ensure that communal water play does not spread infectious disease.

·         No child drinks the water.

·         Children with sores on their hands are not permitted to participate in communal water play.

·         Fresh potable water is used, and the water is changed before a new group of children come to participate in the water play activity. The water is drained when the group of children allowed to use the table during the activity period completes the activity. Alternately, fresh potable water flows freely through the water play table and out through a drain in the table.

 

5.16

I-T

Infants and toddlers do not have access to large buckets that contain liquid.

 

5.17

U

Staff administer both prescription and over-the-counter medications to a child only if the child’s record documents that the parent or legal guardian has given the program written permission and the record contains instructions from a licensed health care provider who has prescribed or recommended the medication for that specific child. The instructions may be written by the licensed health provider or given by telephone by the licensed health provider’s office to the program staff[4]

·     Any administrator/teacher who administers medication has (a) specific training and (b) a written performance evaluation updated annually by a health professional on the practice of the five rights of medication administration:

(1) verifying that the right child receives the

(2) right medication

(3) in the right dose

(4) at the right time

(5) by the right method with documentation of each right each time the medication is given.

 

The person giving the medication signs documentation of items (1) through (5) above. Teachers who are required to administer special medical procedures have demonstrated to a health professional that they are competent in the procedures and are guided in writing about how to perform the procedure by the prescribing health care provider.

·     Medications are labeled with the child’s first and last names, the date the prescription was filled or the recommendation was obtained from the child’s licensed health care provider, the name of the licensed health care provider, the expiration date of the medication or the period of use of the medication, the manufacturer’s instructions or the original prescription label that details the name and strength of the medication, and instructions on how to administer and store it.

·         All medications are kept in a locked container.

 

Nutrition

 

5.18

U

If the program provides food for meals and snacks (whether catered or prepared on site), the food is prepared, served, and stored in accordance with USDA Child and Adult Care Food Program (CACFP) requirements.

 

5.19

T-P-K

The program prepares written menus and posts them where families can see them and has copies available for families who would like to have one. Menus are kept on file for review by the consultant described in criterion 5.3.