HSN4 Healthy Environments for Children

1. HSN4 Healthy Environments for Children Dr. Lea Folds

2. Implement strategies to teach children health and sanitation habits. Research and demonstrate an understanding of standard health practices in 
an early childhood care and education setting. Describe appropriate methods of distributing and storing medications. Compare and contrast age-appropriate toys and equipment. Adapt activities to the early childhood surroundings. Evaluate sanitation in an early childhood care and education setting including 
equipment, furniture, and toys. Demonstrate strategies to promote good physical and mental health in children. Describe and discuss proper procedures for hand washing, diapering and toileting, limiting cross infections in the childcare setting. EDU-HSN-4. Students will provide a healthy environment for children.

3. 591-1-1-.07 Children's Health Exclusion of Sick Children Exclusion is the practice used to keep children who have contagious symptoms from possibly infecting the children and staff at the child care center.

4. 591-1-1-.07 Children's Health Exclusion of Sick Children A child shall not be accepted or stay at the center if temperature is 101 or higher and has another contagious symptom such as but not limited to, a rash, diarrhea or a sore throat. When a child shows symptoms of illness during the day, the child shall be moved to a quiet area away from other children where the child shall be supervised and provided the necessary attention until such time as the child leaves the center or is able to return to the child's group.

5. 591-1-1-.07 Children's Health

6. Communicable Diseases Communicable diseases are illnesses that can be transmitted from one person to another through direct contact with the person or indirect contact (spread through coughing, sneezing, etc.) The Department’s current communicable disease chart of recommendations for exclusion of sick children from the center and their readmission shall be followed. Parents of all children enrolled shall be notified in writing of the occurrence of any of the illnesses on the communicable disease chart, as provided by the Department, within twenty-four (24) hours after the center becomes aware of the illness or the next working day. 591-1-1-.07 Children's Health

7. Communicable Diseases Lice are not a disease but are parasitic insects found on people’s heads and bodies spread through direct and indirect contact. Lice are spread through sharing hair utensils and through close contact with someone who has lice. Head lice develop within 2-3 days after contact. 591-1-1-.07 Children's Health

8. Medical Emergencies A center shall have a written plan which outlines how emergency medical services will be obtained, including place(s) the child will be taken for emergency care. When a medical emergency arises involving a child, the center staff shall seek prompt emergency medical treatment and provide any certified or licensed emergency medical persons with immediate access to the child. 591-1-1-.07 Children's Health

9. Hazardous Items Children shall not be permitted to wear around their necks or attach to their clothing pacifiers or other hazardous items. 591-1-1-.07 Children's Health

10. Bathtubs and Showers • If used, bathtubs and showers shall be cleaned with a disinfectant after each use. • Children's Hygiene • To the extent possible, personnel shall keep children clean, dry and comfortable. • Children's Personal Items • Children's combs, toothbrushes and cloth towels shall be kept clean. • Contagious Diseases • Staff or any other persons being supervised by the staff, shall not be allowed in the center who knowingly have or present symptoms of a fever or diarrhea. 591-1-1-.17 Hygiene

11. Drinking Fountains and Cups • Drinking fountains, if available, • shall be safe and kept clean • have regulated pressure • not be mounted on sinks used for diaper changing activities • have an angle jet with an orifice guard above the rim • Single-service drinking cups shall be provided when appropriate drinking fountains are not available, and cups shall be discarded after each use unless the cups are sanitized in a dishwasher between each use. 591-1-1-.17 Hygiene

12. Garbage • Garbage and organic waste shall be stored in containers that are lined with plastic liners and have tight-fitting covers. • Trash and garbage shall be removed from the building daily or as often as necessary to maintain the premises in a clean condition. 591-1-1-.17 Hygiene

13. Handwashing, Children • Children's hands shall be washed with liquid soap and warm running water: • Immediately upon arrival for care, when moving from one child care group to another, and upon re-entering the child care area after outside play; • Before and after eating meals and snacks, handling or touching food, or playing in water; 591-1-1-.17 Hygiene

14. Handwashing, Children - continued • Children's hands shall be washed with liquid soap and warm running water: • After toileting and diapering, playing in sand, touching animals or pets, and contact with bodily fluids such as, but not limited to, mucus, saliva, vomit or blood; • After contamination by any other means; and • Washcloth handwashing is permitted for infants when the infant is too heavy to hold for handwashing or cannot stand safely to wash hands at a sink and for children with special needs who are not capable of washing their own hands. • An individual washcloth shall be used only once for each child before laundering. 591-1-1-.17 Hygiene

15. Handwashing, Staff • Personnel shall wash their hands with liquid soap and warm running water: • Immediately upon arrival for the day, when moving from one child care group to another, and upon re-entering the child care area after outside play; • Before and after diapering each child, dispensing medication, applying topical medications, ointments, creams or lotions, handling and preparing food, eating, drinking, preparing bottles, feeding each child, and assisting children with eating and drinking; and • After toileting or assisting children with toileting, using tobacco products, handling garbage and organic waste, touching animals or pets, and handling bodily fluids, such as, but not limited to, mucus, saliva, vomit or blood; and • After contamination by any other means. 591-1-1-.17 Hygiene

16. Laundry • If laundry is done on center premises, the laundry area shall be located outside the children's activity rooms or areas and not used as a passageway by children to travel from one area to another whenever any soiled or clean laundry is exposed. • Potty Chairs • If used, toilet potty chairs shall after each use be emptied by disposal in a flush toilet, cleaned with a disinfectant, and stored in the bathroom. If a sink is used, the sink shall also be disinfected. 591-1-1-.17 Hygiene

17. Soiled Containers and Items • Separate containers shall be used for storing soiled disposable items, such as disposable diapers, disposable washcloths and soiled non-disposable items such as cloth diapers, washcloths and bed linens. Such containers shall be waterproof or equipped with a leak-proof disposable liner, covered, easily cleaned and maintained in such a manner so as the contents of the container are never accessible to the children. • Wet Clothing • Children's wet or soiled clothing shall be stored in individual plastic bags immediately after being removed from the child. 591-1-1-.17 Hygiene

18. Adequate hand washing • Staff takes action to cut down on germs • Washes hands according to guidelines • Disinfects toys, equipment, surfaces, and eating/cooking utensils according to guidelines. • Smoking does not take place in center • Procedure used to minimize spread of contagious disease • Exclusion policy • Immunizations • Staff follows same policy • Alerting parents to presence of communicable disease HSN4-b. Standard health practices in an early childhood care and education setting

19. Children dressed properly for conditions Staff good models of health practices Care given to children’s appearance Children taught to manage independent health practices Individual toothbrushes and paste labeled and stored, used at least once during full-day programs Children should be instructed to cover their mouths when the sneeze or cough using their elbows and to wash their hands thoroughly after coughing or sneezing. HSN4-b. Standard health practices in early childhood care and education settings

20. 591-1-1-.20 Medications • Parental Authorization • Except for first aid, personnel shall not dispense prescription or non-prescription medications to a child without specific written authorization from the child's physician or parent. • Such authorization will include when applicable, date; full name of the child; name of the medication; prescription number, if any; dosage; the dates to be given; the time of day to be dispensed; and signature of parent. • Dispensing Medication • Written authorization to dispense medications shall be limited to two (2) weeks unless otherwise prescribed by a physician. • Medication shall only be dispensed out of its original container which must be labeled with the child's name. c. Describe appropriate methods of distributing and storing medications

21. 591-1-1-.20 Medications • Dispensing Records • The center shall maintain a record of all medications dispensed to children by personnel to include the date, time and amount of medication that was administered; any noticeable adverse reactions to the medication; and the signature or initials of the person administering the medication. • Storage • Medications shall be kept in a locked storage cabinet or container which is not accessible to the children and stored separate from cleaning chemicals, supplies or poisons. Medications requiring refrigeration shall be placed in a leak-proof container in a refrigerator that is not accessible to the children. c. Describe appropriate methods of distributing and storing medications

22. 591-1-1-.20 Medications • Unused Medication • Medicines which are no longer to be dispensed shall be returned to the child's parents immediately. • Non-Emergency Injections • Non-emergency injections shall only be administered by appropriately licensed persons unless the parent and physician of the child sign a written authorization for the child to self-administer the injection. c. Describe appropriate methods of distributing and storing medications

23. Equipment, toys, furniture, bathrooms, etc. must be sanitized routinely in accordance with state guidelines. Food preparation surfaces and utensils must be washed, rinsed, and sanitized after each use. Bathroom and diapering surfaces including sinks used for handwashing must be sanitized after each use. Toys and furniture must be cleaned and sanitized at least daily – more often if a child becomes ill while at the center. HSN 4-f. Evaluate sanitation in an early childhood care and education setting including equipment, furniture, and toys.

24. The Spread of Germs Contamination of hands, toys and other objects such as tables and chairs all play a role in the spread of disease in child care centers. When children put toys in their mouths or touch toys, cribs and furniture and other surfaces with hands that have been in their mouths during play, these items become contaminated with their saliva. Child to child interactions easily spread germs if not supervised properly. The cleaning and sanitizing of all surfaces will help reduce the spread of infection and disease among children and childcare staff. HSN4-f. Evaluate sanitation in an early childhood care and education setting including equipment, furniture, and toys.

25. Know the difference between cleaning, disinfecting, and sanitizing. Cleaning removes germs, dirt, and impurities from surfaces or objects. Cleaning works by using soap (or detergent) and water to physically remove germs from surfaces. This process does not necessarily kill germs, but by removing them, it lowers their numbers and the risk of spreading infection. Disinfecting kills germs on surfaces or objects. Disinfecting worksby using chemicals to kill germs on surfaces or objects. This process does not necessarily clean dirty surfaces or remove germs, but by killing germs on a surface after cleaning, it can further lower the risk of spreading infection. Sanitizing lowers the number of germs on surfaces or objects to a safelevel, as judged by public health standards or requirements. This process works by either cleaning or disinfecting surfaces or objects to lower the risk of spreading infection. HSN4-f. Evaluate sanitation in an early childhood care and education setting including equipment, furniture, and toys.

26. Clean and disinfect surfaces and objects that are touched often. Follow your school’s standard procedures for routine cleaning and disinfecting. Typically, this means daily sanitizing surfaces and objects that are touched often, such as desks, countertops, doorknobs, computer keyboards, hands-on learning items, faucet handles, phones, and toys. Some schools may also require daily disinfecting these items. Standard procedures often call for disinfecting specific areas of the school, like bathrooms. Immediately clean surfaces and objects that are visibly soiled. If surfaces or objects are soiled with body fluids or blood, use gloves and other standard precautions to avoid coming into contact with the fluid. Remove the spill, and then clean and disinfect the surface. HSN4-f. Evaluate sanitation in an early childhood care and education setting including equipment, furniture, and toys.

27. Procedures for Cleaning and Sanitizing Wash vigorously with hot, soapy water. Use a brush to get into all the cracks and crevices Rinse with clean water Immerse in a sanitizer solution for at least two minutes Air-dry or wipe with a clean disposable towel after 2 minutes HSN4-f. Evaluate sanitation in an early childhood care and education setting including equipment, furniture, and toys.

28. Toys are required to be cleaned and sanitized to help reduce the spread of diseases and illnesses. • This needs to be done at least once a week • In infant rooms and rooms where children are not potty-trained, the toys are to be cleaned and sanitized daily. HSN4-f. Evaluate sanitation in an early childhood care and education setting including equipment, furniture, and toys.

29. Handwashing Requirements • Arrival • After touching trash cans/lids or floor • After cleaning • After any contamination • After using sand • After being outside • After paint or glue • After gardening • Before and after cooking activities • After playing with pets • Before and after water play • After sneezing or coughing near hands • After wiping noses • Before and after sunscreen • Before and after dealing with cuts, scrapes, or other health needs • After cleaning body fluid • After toileting

30. Physical Activity: How Much Is Needed? Young Children (2 to 5 years) Children ages two to five years should play actively several times each day. Their activity may happen in short bursts of time and not be all at once. Physical activities for young children should be developmentally-appropriate, fun, and offer variety. g. Demonstrate strategies to promote good physical and mental health in children

31. Children and Adolescents (6 to 17 years) Sixty minutes or more of physical activity each day. Most of the sixty minutes should be either moderate- or vigorous-intensity aerobic physical activity, and should include vigorous-intensity physical activity at least three days a week. Include muscle-strengthening activities, like climbing, at least three days a week and bone-strengthening activities, like jumping, at least three days a week. Children and adolescents are often active in short bursts of time rather than for sustained periods of time, and these short bursts can add up to meet physical activity needs. Physical activities for children and adolescents should be developmentally-appropriate, fun, and offer variety. g. Demonstrate strategies to promote good physical and mental health in children

32. What is Meant by “Age-Appropriate” Physical Activities Some physical activity is better-suited for children than adolescents. For example, children do not usually need formal muscle-strengthening programs, such as lifting weights. Younger children usually strengthen their muscles when they do gymnastics, play outside, or climb on playground structures. Also, the skill and coordination needed for complex physical activities may not allow for younger children to participate safely. It is important for child care facilities to promote a variety of physical activities that are structured and unstructured so children of all ages can enjoy physical activity and increase their likelihood of life-long adherence. Many physical activities fall into several categories (moderate- and vigorous-intensity and muscle- and bone-strengthening), making it possible for children to gain multiple benefits with each type of activity. g. Demonstrate strategies to promote good physical and mental health in children

33. Proper Nutrition Proper nutrition is a key part of a child’s physical development. Childhood obesity in the U.S. is a growing problem. It is a result of poor diet/nutrition and lack of activity. The USDA recently updated the MyPyramid Food Guide to MyPlate. MyPlate focuses on eating more fruits and vegetables, whole grains, lean protein, and low-fat dairy. g. Demonstrate strategies to promote good physical and mental health in children

34. g. Demonstrate strategies to promote good physical and mental health in children

35. Mental Health Provide services including individual and group assessments, interventions, and referrals. Organizational assessment and consultation skills of mental health professionals contribute not only to the health of students but also to the health of the staff and child care environment. For infants and toddlers who learn through healthy and ongoing relationships with primary caregivers/teachers, a relationship-based plan should be shared with parents/guardians that include opportunities for parents/guardians to be an integral partner. g. Demonstrate strategies to promote good physical and mental health in children

36. Good rule of thumb- choose toys that can be easily cleaned and sanitized. This would include: • Plastic Legos- that can be thrown in a mesh bag and put into dishwasher. • Soft, plush toys, dress-up clothes and pillows that are machine washable. • A bin labeled "soiled" or "dirty" may be used for toys that have been placed in the mouth or otherwise contaminated with bodily fluids. Toy Selection Tips

37. Toys that cannot be cleaned and sanitized should not be used. Toys that children have placed in their mouths or that are otherwise contaminated by body secretion or excretion should be set aside until they are cleaned by hand with water and detergent, rinsed, sanitized, and air-dried or in a mechanical dishwasher that meets the requirements of Standard 4.9.0.11 through Standard 4.9.0.13. Play with plastic or play foods, play dishes and utensils, should be closely supervised to prevent shared mouthing of these toys. Machine washable cloth toys should be used by one individual at a time. These toys should be laundered before being used by another child. Indoor toys should not be shared between groups of infants or toddlers unless they are washed and sanitized before be- ing moved from one group to the other. Toy Selection Tips

38. Proper procedures for hand washing, diapering and toileting, limiting cross infections in the childcare setting.

39. Step 1 Prepare for Diapering Before Bringing Child to the Table Changing table paper (if used) to cover the table from the child's shoulders to feet (in case it becomes soiled and must be folded over to create a clean surface during the change) Non-porous gloves (if they will be used), and a dab of diaper cream on a disposable paper towel if cream is being used Enough wipes for the diaper change (including cleaning the child's bottom and the child's and teacher's hands after taking the soiled diaper away from the child's skin) A clean diaper, plastic bag for soiled clothes and clean clothes Diapering Procedures

40. STEP 2 - Avoid Contact with Soiled Items and Always Keep a Hand on the Child Place the child on diapering table. Remove clothing to access diaper. If soiled, place clothes into a plastic bag. Remove soiled diaper and place into a lined, hands-free trash container. (To limit odor, seal in a plastic bag before placing into trash container.) STEP 3 - Clean the Child’s Diaper Area Use wipes to clean child's bottom from front to back. Use a wipe to remove soil from adult's hands. Use another wipe to remove soil from child's hands. Throw soiled wipes into lined, hands-free trash container. Diapering Procedures

41. STEP 4 - Put on a Clean Diaper and Wash Child’s Hands Put on a clean diaper and redress child Place the child at the sink and wash hands following the proper handwashing procedure. STEP 5 - Clean and Disinfect the Diapering Area Clean any visible soil from the diapering table. Spray the diapering surface with bleach-water solution and wait more than 10 seconds before wiping with a disposable towel or allow to air dry. The recommended practice is to wait for 2 minutes to allow the solution to kill germs. However, if there is a delay of more than 10 seconds before the solution is wiped from the surface, this is considered adequate. The surface cannot be sprayed and immediately wiped. The diapering surface must be sanitized after each diaper change with a bleach-water or other approved sanitizing solution Diapering Procedures

42. STEP 6 - Wash Your Hands and Record in the Child’s Daily Log Adult washes hands using the proper hand washing procedure without contaminating any other surfaces. All surfaces must be able to be sanitized- e.g., no quilted pads or safety straps, no containers that are stored on the diapering surface. Toys that are played with or objects that are touched while children's diapers are changed must be put aside to be sanitized. Follow the same guidelines for children wearing pull-ups or cloth underwear. Diapering Procedures