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Stepping Stones to Caring for Our Children

National Health and Safety Performance Standards: Guidelines for Early Care and Education Programs

By American Academy of Pediatrics, American Public Health Association and National Resource Center for Health and Safety in Child Care and Early Education
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Must-have collection of selected standards from Caring for Our Children, 3rd Edition which, when put into practice, are most likely to prevent serious adverse outcomes in child care and early education settings.

Contents include:

*Staffing

*Program Activities for Healthy Development

*Health Promotion and Protection

*Nutrition and Food Service

*Facilities, Supplies, Equipment, and Environmental Health

*Play Areas/Playgrounds and Transportation

*Infectious Disease

*Children with Special Health Care Needs and Disabilities

*Policies

*Licensing and Community Action

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  1. Page xii
    Acknowledgements
  2. Page xiii
    Introduction
  3. Page xv
    Advice to Users
  4. Page 1
    1. Staffing
    1. Page 1
      Ratios for Small Family Child Care Homes
    2. Page 1
      Ratios for Large Family Child Care Homes and Centers
    3. Page 3
      Ratios for Facilities Serving Children with Special Health Care Needs and Disabilities
    4. Page 3
      Ratios and Supervision During Transportation
    5. Page 3
      Ratios and Supervision for Swimming, Wading, and Water Play
    6. Page 4
      Background Screening
    7. Page 5
      General Qualifications of Directors
    8. Page 6
      Qualifications of Lead Teachers and Teachers
    9. Page 6
      General Qualifications of Family Child Care Caregivers/Teachers to Operate a Family Child Care Home
    10. Page 7
      Pre-service Training
    11. Page 9
      Orientation for Care of Children with Special Health Care Needs
    12. Page 11
      Orientation Topics
    13. Page 11
      First Aid and CPR Training for Staff
    14. Page 12
      Topics Covered in First Aid Training
    15. Page 13
      CPR Training for Swimming and Water Play
    16. Page 13
      Training of Staff Who Handle Food
    17. Page 13
      Child Abuse and Neglect Education
    18. Page 14
      Employment of Substitutes
    19. Page 14
      Orientation of Substitutes
    20. Page 16
      Child Care Health Consultants
  5. Page 19
    2. Program Activities for Healthy Development
    1. Page 19
      Monitoring Children’s Development/Obtaining Consent for Screening
    2. Page 20
      Personal Caregiver/Teacher Relationships for Infants and Toddlers
    3. Page 21
      Methods of Supervision of Children
    4. Page 21
      Supervision Near Bodies of Water
    5. Page 22
      Discipline Measures
    6. Page 24
      Preventing Expulsions, Suspensions, and Other Limitations in Services
    7. Page 26
      Prohibited Caregiver/Teacher Behaviors
    8. Page 27
      Using Physical Restraint
    9. Page 28
      Parents’/Guardians’ Provision of Information on their Child’s Health and Behavior
  6. Page 29
    3. Health Promotion and Protection
    1. Page 29
      Routine Health Supervision and Growth Monitoring
    2. Page 29
      Active Opportunities for Physical Activity
    3. Page 31
      Playing Outdoors
    4. Page 32
      Safe Sleep Practices and SIDS/Suffocation Risk Reduction
    5. Page 34
      Routine Oral Hygiene Activities
    6. Page 34
      Diaper Changing Procedure
    7. Page 37
      Situations that Require Hand Hygiene
    8. Page 38
      Handwashing Procedure
    9. Page 39
      Assisting Children with Hand Hygiene
    10. Page 39
      Prevention of Exposure to Blood and Body Fluids
    11. Page 41
      Routine Cleaning, Sanitizing, and Disinfecting
    12. Page 41
      Use of Tobacco, Alcohol, and Illegal Drugs
    13. Page 41
      Emergency Procedures
    14. Page 42
      Response to Fire and Burns
    15. Page 42
      Recognizing and Reporting Suspected Child Abuse, Neglect, and Exploitation
    16. Page 42
      Preventing and Identifying Shaken Baby Syndrome/Abusive Head Trauma
    17. Page 43
      Sun Safety Including Sunscreen
    18. Page 44
      Strangulation Hazards
    19. Page 44
      Care Plan for Children with Special Health Care Needs
    20. Page 45
      Caring for Children Who Require Medical Procedures
    21. Page 46
      Inclusion/Exclusion/Dismissal of Children
    22. Page 52
      Staff Exclusion for Illness
    23. Page 53
      Infectious Disease Outbreak Control
    24. Page 53
      Medication Administration
    25. Page 54
      Labeling, Storage, and Disposal of Medications
    26. Page 55
      Training of Caregivers/Teachers to Administer Medication
  7. Page 56
    4. Nutrition and Food Service
    1. Page 56
      Use of USDA - CACFP Guidelines
    2. Page 56
      Availability of Drinking Water
    3. Page 56
      Feeding Plans and Dietary Modifications
    4. Page 57
      Care for Children with Food Allergies
    5. Page 59
      Preparing, Feeding, and Storing Human Milk
    6. Page 61
      Preparing, Feeding, and Storing Infant Formula
    7. Page 62
      Warming Bottles and Infant Foods
    8. Page 62
      Introduction of Age-Appropriate Solid Foods to Infants
    9. Page 62
      Adult Supervision of Children Who Are Learning to Feed Themselves
    10. Page 63
      Hot Liquids and Foods
    11. Page 63
      Foods that Are Choking Hazards
    12. Page 63
      Food Preparation Area
    13. Page 64
      Maintenance of Food Service Surfaces and Equipment
    14. Page 64
      Staff Restricted From Food Preparation and Handling
    15. Page 65
      Precautions for a Safe Food Supply
  8. Page 67
    5. Facilities, Supplies, Equipment, and Environmental Health
    1. Page 67
      Inspection of Buildings
    2. Page 67
      Compliance with Fire Prevention Code
    3. Page 67
      Environmental Audit of Site Location
    4. Page 67
      Possibility of Exit From Windows
    5. Page 68
      Alternate Exits and Emergency Shelter
    6. Page 68
      Guards At Stairway Access Openings
    7. Page 68
      Guardrails and Protective Barriers
    8. Page 69
      Fresh Air
    9. Page 69
      Gas, Oil or Kerosene Heaters, Generators, Portable Gas Stoves, and Charcoal and Gas Grills
    10. Page 69
      Portable Electric Space Heaters
    11. Page 70
      Safety Covers and Shock Protection Devices for Electrical Outlets
    12. Page 70
      Location of Electrical Devices Near Water
    13. Page 70
      Smoke Detection Systems and Smoke Alarms
    14. Page 71
      Testing for Lead and Copper Levels in Drinking Water
    15. Page 71
      Storage and Disposal of Infectious and Toxic Wastes
    16. Page 71
      Integrated Pest Management
    17. Page 73
      Use and Storage of Toxic Substances
    18. Page 74
      Use of a Poison Center
    19. Page 74
      Informing Staff Regarding Presence of Toxic Substances
    20. Page 75
      Radon Concentrations
    21. Page 75
      Carbon Monoxide Detectors
    22. Page 75
      Testing for Lead
    23. Page 76
      Safety of Equipment, Materials, and Furnishings
    24. Page 76
      Availability and Use of a Telephone or Wireless Communication Device
    25. Page 77
      Cribs
    26. Page 78
      Inaccessibility to Matches, Candles and Lighters
    27. Page 78
      Storage of Plastic Bags
    28. Page 78
      Firearms
    29. Page 78
      First Aid and Emergency Supplies
    30. Page 80
      Inaccessibility of Hazardous Equipment
  9. Page 81
    6. Play Areas/Playgrounds and Transportation
    1. Page 81
      Location of Play Areas Near Bodies of Water
    2. Page 81
      Enclosures for Outdoor Play Areas
    3. Page 81
      Entrapment Hazards of Play Equipment
    4. Page 82
      Prohibited Surfaces for Placing Climbing Equipment
    5. Page 82
      Trampolines
    6. Page 82
      Inspection of Indoor and Outdoor Play Areas and Equipment
    7. Page 83
      Enclosure of Bodies of Water
    8. Page 84
      Safety Covers for Swimming Pools
    9. Page 84
      Pool Drain Covers
    10. Page 84
      Lifesaving Equipment
    11. Page 84
      Hot Tubs, Spas, and Saunas
    12. Page 85
      Water in Containers
    13. Page 85
      Inaccessibility of Toys or Objects to Children Under Three Years of Age
    14. Page 85
      Balloons
    15. Page 85
      Helmets
    16. Page 86
      Competence and Training of Transportation Staff
    17. Page 87
      Qualifications for Drivers
    18. Page 87
      Child Passenger Safety
    19. Page 89
      Interior Temperature of Vehicles
    20. Page 89
      Passenger Vans
  10. Page 90
    7. Infectious Disease
    1. Page 90
      Unimmunized Children
    2. Page 90
      Immunization of Caregivers/Teachers
    3. Page 91
      Influenza Immunizations for Children and Caregivers
    4. Page 92
      Influenza Control
    5. Page 92
      Recommended Control Measures for Invasive Meningococcal Infection in a Child Care Center
    6. Page 92
      Control of Enteric (Diarrheal) and Hepatitis A Virus (HAV) Infections
    7. Page 94
      Staphylococcus Aureus Skin Infections Including MRSA
  11. Page 95
    8. Children with Special Health Care Needs and Disabilities
    1. Page 95
      List of related standards
  12. Page 96
    9. Policies
    1. Page 96
      Content and Development of the Plan for Care of Children and Staff Who Are Ill
    2. Page 97
      Infant Feeding Policy
    3. Page 97
      Written Plan and Training for Handling Urgent Medical Care or Threatening Incidents
    4. Page 99
      Disaster Planning, Training and Communication
    5. Page 102
      Emergency and Evacuation Drills/Exercises Policy
    6. Page 103
      Sign-In/Sign-Out System
    7. Page 103
      Authorized Persons to Pick Up Child
    8. Page 104
      Documentation of Parent/Guardian Notification of Injury, Illness or Death in Program
    9. Page 104
      Record of Valid License, Certificate or Registration of Facility
    10. Page 105
      Contents of Medication Record
  13. Page 106
    10. Licensing and Community Action
    1. Page 106
      Frequency of Inspections for Child Care Centers, Large Family Child Care Homes, and Small Family Child Care Homes
  14. Page 128
    Gloving
  15. Page 108
    Recommended Adult Immunization Schedule
  16. Page 113
    Selecting an Appropriate Sanitizer or Disinfectant
  17. Page 120
    Routine Schedule for Cleaning, Sanitizing, and Disinfecting
  18. Page 122
    Care Plan for Children with Special Health Care Needs
  19. Page 129
    America’s Playgrounds Safety Report Card
  20. Page 132
    Contributors
  21. Page 138
    Methodology
  22. Page 140
    Conversion Charts

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