CCHP Healthline FAQs
The Healthline staff answers hundreds of calls every year on a wide variety of topics related to health and safety in early care and education programs. Below please find the answers to questions frequently asked of Healthline staff. Don't hesitate to call us at (800) 333-3212 (California Only) with your questions, or email us your question through the "Ask a Question" page.
Food Fight! Conflict Over Food Issues
Question: What are some useful strategies for resolving conflicts between child care providers and parents about food issues?
Answer: Food issues are extremely common. When differences come up, it's often useful to explore the reasons why a parent has made a request with which you disagree. They may hold a very strong cultural belief, or are following child-raising advice passed on to them by older adults in their family. It's very important that you honor the family's cultural practices and respect their right to make decisions about their child.
However, as a child care provider you are also responsible for following best practices and making sure the children in your care are safe. Ask yourself: will the behavior in question cause harm? If you believe it will, then share written materials with the family which support your perspective, and ask for advice from the family's medical care provider. If not, it is probably preferable to abide by the family's wishes. While you may believe the current feeding recommendations are best, if the behavior is not going to cause the child any harm, the family's wishes must be understood or at least negotiated.
One food issue that comes up very frequently is when to introduce solid foods to an infant, so let's use that as an example. Some parents believe that a child sleeps better with early introduction of solid foods, or will be hungry without solids. However, the American Academy of Pediatrics recommends breast feeding exclusively until a baby is 6 months old and for at least one year with the gradual introduction of solids. This schedule reduces the risk of food allergies and ensures that the baby is physically ready to digest solid foods. So what should you do if a family requests that you feed the baby cereal at 4 months of age?
After reviewing your materials, you could sit down with the family and discuss your concerns. In this instance, developmental readiness and food allergies are the biggest issues. If babies are not developmentally ready for the introduction of solid foods they may be at risk for choking. Babies' swallowing and digestive systems are not developmentally ready to handle solid foods until they are 4 to 6 months old. Ask the family to help you assess whether the baby is ready. Have they observed signs of physical readiness for solid food? The baby should be able to hold her neck steady and sit with support. She should be able to draw in her lower lip as a spoon is removed from her mouth, and swallow the food rather than push it back out.
Then there is the issue of food allergies. Solid foods should not be introduced into the diet of allergy-prone infants until 6 months of age, with dairy products delayed until 1 year, eggs until 2 years, and nuts and fish until 3 years of age. Infants with a family history of allergy may be two to four times more likely to develop a food allergy by the age of 2. Discuss with parents whether there is a family history of food allergies to help them determine whether a child is allergy-prone and caution about food introduction is indicated.
If a baby is developmentally ready, there is no history of family allergies and after discussion the family still wants you to feed
their baby cereal—go ahead.
Resources
To find out more about food allergies check out the Food Allergy & Anaphylaxis Network, (800) 929-4040, www.foodallergy.org or call Healthline at (800) 333-3212 (California Only).
by Judith Calder, RN, MS
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Infant Feeding: When to Introduce New Food
Question: How can a child care provider best respond to a request from a parent to introduce a potentially inappropriate food to an infant's diet?
Answer: Food introduction guidelines have changed over the years. It is now believed that introducing foods too early can trigger food allergies or intolerance. An infant's capacity to digest complex protein foods such as eggs may not be fully developed. Encourage the parent to discuss nutrition and feeding at the next visit to the child's health care provider, which should occur at 6 months of age. Suggest that the parent consider avoiding introducing the food in question until that visit, and ask the parent for a note from the doctor giving permission to add the food to the infant's diet.
Child care providers can look to several sources for guidance on this topic, beginning with the Healthline at (800) 333-3212 (CA Only) and the Community Care Licensing regulations. There is no mention of infant feeding in the family child care regulations, but the regulations for infant centers provide some excellent guidelines and are based on the American Academy of Pediatrics recommendations:
| Birth–12 months | breast milk or iron fortified formula |
| At 4–6 months | infant cereal |
| At 5–7 months | vegetables, fruits and their juices |
| At 6–8 months | protein foods (cheese, yogurt; cooked beans, meat, fish and chicken; egg yolk) |
| At 10–12 months | whole egg |
Another source of information on proper nutrition for young children is the Women, Infants and Children (WIC) program, which can be located through the local health department. They have excellent nutrition information materials in several languages which child care providers can request and pass on to parents. Their phone number is in the county listings in the phone book. Child care providers can also join the Child Care Food Program by calling California Nutrition Services at (800) 952-5609. This program provides financial aid and education to licensed child care centers and family child care homes to improve nutrition and eating habits for young children.
by Judith Calder, RN, MS
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Excluding Children with a Rash
Question: When should child care providers exclude a child with a rash from their program?
Answer: It depends on the rash. Sometimes a rash signals that the child is ill and contagious, while with other illnesses it means the contagious period is over. Fever and other symptoms may appear before, during or after the rash. The illnesses associated with rash are spread through respiratory droplets, hands which have been in contact with noses, eyes, mouths or contaminated surfaces, or in some cases direct contact with fluid-filled lesions or scabs. Some rashes are caused by irritants like metal, chemicals or foods and others by viruses, insect bites or infestations such as scabies or lice. Some types of rashes always require exclusion while others do not.
A rash is any eruption of the skin. Most rashes are red and can appear in different shapes and sizes. They may be flat, bumpy, all over or in just one place on the body. Some rashes last an hour or two while others continue for weeks. There is a rare but dangerous type of illness associated with a rash which looks like tiny flat pinpoints of reddish purple on the skin. When you press on the skin the red dots do not blanch (lose color). The child may also have a fever and sore throat. A child with this type of rash needs to be seen immediately by a health care provider. In addition, any child who has a rapidly spreading red or purple rash needs to be seen within the hour as this may signify a medical emergency.
Exclusion of and evaluation by a health care provider is necessary for any child who has a rash with fever or behavioral change until it is determined that these symptoms do not indicate a communicable disease. Children who appear well, behave normally and have a mild rash which is not spreading may stay in your care unless you have specific concerns or are uncomfortable for any reason. If the child does visit the health care provider, ask the parent to obtain a note stating what is causing the rash. The note may say "non-specific rash", which is acceptable. It's okay sometimes not to know what the rash is as long as we know what it isn't!
To help describe the rash to the parent or health care provider in order to determine if there is a need for exclusion, use this list of questions:
- Is the rash red?
- Is it all over the body or only in certain areas?
- When did it start?
- Is it getting better or worse?
- Is the rash flat or bumpy?
- Are the spots big or little? (such as pinpoint, dime size or various sizes)
- Are the borders round or irregular and blotchy?
- Are there blisters?
- Is the rash itchy? (in an infant this may be observed as irritability)
- Has there been a fever or other symptoms?
- Has anyone else at home had similar symptoms recently?
Call the Healthline at (800) 333-3212 (CA Only) for an Information Exchange Form and Health & Safety notes and fact sheets on specific diseases to share with families and their health care providers.
Reference
Those Irritating Rashes, Don Palmer, MD, FAAP. Healthy Child Care Magazine/June-July, 2002.
by Susan Jensen, RN, MSN, PNP
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Varicella and Rashes
Question: What are the different types of rashes associated with the varicella (chicken pox) vaccine and should children with these rashes be excluded from child care?
Answer: A child with a rash within two to three weeks of having the chickenpox vaccine may be considered to have a vaccine-related rash. It is extremely rare for someone to get chickenpox from a person with vaccine-related rash. The rash is usually mild with some red bumps (without fluid in them) and no other symptoms. Attendance at school or child care need not be restricted.
Most people who get the chickenpox vaccine will not get the chickenpox. If a child has been diagnosed with a case of "breakthrough" chickenpox it is usually very mild. He or she usually has less than 50 lesions and possibly a mild fever. Children should be excluded until the lesions have crusted over and parents and staff need to be notified that they have had an exposure in the child care setting.
It can be difficult to distinguish a vaccine-related rash from a breakthrough case. It depends on the appearance, location and timing of the rash, and therefore a consultation with a health care provider may be necessary. Laboratory testing is not done routinely.
Even if a parent has a note from a health care provider clearing the child to return to care, remember that the final decision always rests with the child care provider. But it is not necessary to exclude every child with a rash or require them to see a doctor. Consider writing a policy regarding this issue and share this information with parents as part of your enrollment procedure to help avoid confusion and frustration.
Resources
Centers for Disease Control Immunization Hotline at (800) 232-2522 (English) or (800) 232-0233 (Spanish)
National Immunization Program at www.cdc.gov/nip.
References
Ask the Experts: Measles, Mumps, Rubella & Varicella, by William L. Atkinson, MD, MPH. www.immunize.org
by Susan Jensen RN, MSN, PNP
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Infants and Milk
Question: What are some of the issues to consider related to giving milk or milk substitutes to infants and toddlers?
Answer: Infants under 1 year of age should receive only breast milk or iron-fortified formula as their milk source unless there is documentation from the health care provider that recommends something different. Condensed milk is not recommended for infants, because it does not meet their nutritional needs for growth and development. In addition, condensed milk contains a high percentage of sugar, which can cause diarrhea.
Most toddlers between 1 and 2 years of age, if not allergic or intolerant, should receive whole, pasteurized cow's milk. This is because brain development at this age requires a certain amount of fat in the diet, part of which is supplied by whole milk. Toddlers are naturally more interested in solid food, which should be their primary source of nutrition. If toddlers drink more than 8 to 16 ounces of whole milk in a 24-hour period they may not have much of an appetite for solid foods. Too much milk at this age may also cause toddlers to become anemic.
There are children who need to stay on formula a few extra months or who need soy or other types of nondairy milk because of allergies. Soy formulas are fortified with iron, calcium and vitamin D, which are very important in supporting bone and tooth development in infants and children. Be aware that not all non-formula soy milk is vitamin fortified with calcium and vitamin D. A lack of vitamin D and calcium can lead to rickets, a disease of the bones. This is rare but still occurs.
Other guidelines to keep in mind:
- Raw milk from dairy animals should never be given to any child.
- Honey, imitation milk (such as rice, soy or almond milk), nondairy creamers, and goat's milk are not appropriate for infants under 1 year of age.
- Low-fat and non-fat milk are not recommended for infants or toddlers under 2 years of age.
For more information call the Healthline at (800) 333-3212 (CA Only).
References
Caring for Our Children: National Health and Safety Performance Standards: Guidelines for Out-of-Home Child Care Programs (Second Edition, 2002).
Fact Sheet: Nutrition Recommendations for Young Children. California Dept. of Education; Nutrition and Training Program.
by Susan Jensen, RN, MSN, PNP
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Encouraging Car Seat Use
Question: What are my responsibilities to make sure that parents use appropriate car safety seats, and what can I do to encourage them to use such seats?
Answer: When a parent or guardian signs a child out of a child care program they are resuming full responsibility for the child, so a child care provider cannot be held liable for negligence regarding lack of a car seat in the family's personal car. Yet this is also a difficult moral issue because there is a clearly stated law regarding the use of car seats for children and families who don't use car seats are putting their young child at risk for serious injury or even death.
To address this, child care providers should make sure they have the car seat law posted in a prominent place where everyone can see it upon entering or leaving the child care setting. Remind parents of the law and the fines imposed for breaking it. Provide them with information about the reason for the law, which is to protect children from serious injury and death. For free posters (including one which states the California law about car seat use) or brochures about car seat safety, visit www.safelyonthemove.sdsu.edu or call toll-free (866) 700-7686.
If families cannot afford a car seat, refer them to local resources for free or low-cost car seats. Car seats for rent, borrow or sale may be available through the local Resource and Referral Agency, WIC, teen prenatal programs (if eligible), or the county (call your Child Passenger Safety Coordinator for local availability). Your local hospital, police or fire department may have resources as well. Healthline also has basic information on car seats.
Child care providers can also help families find safety technicians to teach about how to safely install and use car seats. If the car seat is used in more than one vehicle, the seat installation should be checked in both vehicles.
Resources
Parent information: www.boostamerica.org
Download California Child Passenger Safety Coordinators (by county): www.dhs.ca.gov/epic/documents/cpsc.pdf
Download information on car seat programs: www.dhs.ca.gov/epic/documents/wgcs.pdf
Healthline at (800) 333-3212 (CA Only).
by Susan Jensen, RN, MSN, PNP
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Hand-Foot-and-Mouth Disease
Question: What is Hand-Foot-and-Mouth Disease?
Answer: Hand-Foot-and-Mouth Disease, a mild illness caused by a virus (coxsackievirus A 16), commonly affects toddlers and school-age children. It occurs frequently in child care settings and is a different illness than Foot-and-Mouth disease of cattle, sheep and swine. Symptoms generally last for a few days to a week. Adults usually get only mild symptoms if infected. A person cannot get this exact same virus again, but there are other viruses which cause similar symptoms, although they occur much less commonly than A16. Peak times for this virus are summer and early fall.
The virus is highly contagious and is spread by direct contact with nasal/oral secretions and stool. The incubation period averages three to five days. The child may then feel poorly for one or two days before the appearance of mouth sores and/or a body rash.
Common symptoms are fever, sore throat, stomachache, and tiny fluid-filled bumps or "vesicles" on the palms, soles, and in the mouth. These appear tiny and grayish with a circular red base. A rash may appear on the upper thighs, arms, and buttocks and may be tender. The fever and vesicles usually go away without crusting or scarring. Children with painful mouth sores may not want to drink or eat. Ask parents to call their health care provider if a child is not taking enough fluids. Treatment is for symptoms only; antibiotics do not help. The child's appetite will return as he or she feels better. The virus is shed through the stool for weeks following the infection.
Most at risk are infants less than 2 to 3 months of age, people with weak immune systems and pregnant women. An exposure notice should always be posted and sent home when the virus occurs in your program, and those at most risk should notify their health care providers.
Children with this virus do not need to stay home as long as they feel well enough to participate. Exclusion may not prevent additional cases since children will have been exposed before the symptoms appear, and many children will not have any symptoms with the virus. Reasons to exclude would include if the child feels too unwell to participate, or if the child is unable to take sufficient fluids because of mouth sores.
Limit the spread of the virus by following strict handwashing guidelines. Always wash after bathroom use or diapering, and before eating or handling food. Wash and sanitize all articles and surfaces contaminated with stool or mucus.
References
Enterovirus Infections, Zaoutis, T. M.D. and Klein, J. M.D. Pediatrics in Review, Vol. 19, Number 6, June 1998.
Hand-Foot-and-Mouth Disease (Coxsackie A) in the Child Care Setting. California Childcare Health Program, 2003.
by Susan Jensen RN, MSN, PNP
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Getting Ready for Flu Season
Question: How can child care providers best protect their programs from the flu?
Answer: The peak of flu (influenza) season in the U.S. can occur any time from late December through March. Each season is unique and it is difficult to predict how bad it will be. The best time to get flu shots is October or November. But getting immunized in December and beyond can still protect you against the flu.
The exact types of flu viruses expected to occur every season change slightly every year, as does the vaccine. The vaccine's protection lasts about three months, so it is important to get a flu shot every year. This is the single best way to protect yourself from getting the flu.
Between 35 and 50 million Americans get the flu each year, and more than 20,000 people die. Anyone 6 months of age or older may be eligible for the flu shot. Children aged 6 to 23 months are at greatly increased risk for flu-related hospitalizations, so influenza vaccination of all children in this age group is encouraged when possible. Also, the Centers for Disease Control recommends that women beyond the first three months of pregnancy should receive a flu shot. It is safe to receive a flu shot if you are breastfeeding.
The Federal Food and Drug Administration recently approved the use of Flumist (Influenza Virus Vaccine Live, Intranasal) in healthy children from 5 to 17 years old and healthy adults from ages 18 to 49. It is not currently recommended for use in children under 5 years of age, for people with immune deficiency diseases, asthma, or anyone who has had an allergic reaction to eggs or to a previous dose of the vaccine. The most common side effects have been nasal congestion, runny nose, sore throat and cough.
There are a lot of myths about the flu vaccine. Educate yourself and your families. To learn more call the Healthline at (800) 333-3212 (CA Only) or check the Centers for Disease Control Web site at www.cdc.gov/nip/Flu/gallery.htm.
Resources
First Nasal Mist Flu Vaccine Approved. FDA News, June 17, 2003.
www.kidsource.com/kidsource/content3/news3/vaccine.influenza.html
Influenza Vaccine Information 2003-2004. National Center for Infectious Diseases, July 30, 2003. http://www.cdc.gov/flu/protect/whoshouldget.htm
by Susan Jensen RN, MSN, PNP
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How Do Death and Grief Affect Children?
Question: How can child care providers best care for a child who has lost a parent or other loved one?
Answer: The death of an important person in a child's life is among the most stressful events that a child can experience. Children often do go through a grieving period when a family member dies. It is important to recognize the general stages of grief: denial and shock, emotional release, panic, guilt, hostility, inability to resume business as usual, depression, reconciliation of grief, and hope.
These stages vary for each person and not every person or child goes through this process exactly the same. Children can react differently from adults when a family member dies. It is essential to recognize the developmental age of the child and to respond accordingly.
Preschool children usually see death as temporary and reversible, a belief reinforced by cartoon characters who "die" and "come to life" again. They are also still within the stage where they see themselves as the center of everything. When there is a death they may feel it is their fault. For example, they may think that if they had been better behaved or kissed their grandfather goodnight, maybe he would not have died. They need a great deal of reassurance that the death had nothing to do with them.
Children between 5 and 9 years of age begin to think more like adults about death, yet they still believe it will never happen to them or anyone they know. A child's shock and confusion at the death of a family member may be compounded by the unavailability of grieving family members.
Some children have difficulty coping with their grief, so watch for the following signs of potential serious problems:
- Inability to sleep, loss of appetite, prolonged fear of being alone.
- Acting inappropriately for their developmental stage for an extended period.
- Intentionally injuring themselves or others.
- Displays of intense anger and frustration.
- Changes in their characteristic behavior for an extended period of time.
- Extended depression, where the child loses interest in daily activities.
- Excessively imitating the dead person.
- Repeated requests of wanting to join the dead person.
- Withdrawal from friends and family members.
- Sharp drop in school performance.
These signs indicate the child needs adult involvement. While the family deals with their own grief, they may not see their child's needs. Help them reach out and give their child reassurance. You can also give that child extra attention, reassurance and affection. Create a safe place for him/her to talk and play out feelings. Be sure to keep the parent or other caregiver informed. If the behaviors persist for more than a few weeks, professional help for the child and family is advised.
References
The Pediatrician and Childhood Bereavement, Pediatrics, Vol. 105, N. 2, Feb. 2000, p. 445-447.
Children and Grief, AACP Facts for Families #8, American Academy of Child and Adolescent Psychiatry; www.aacap.org/publications/factsfam/grief.htm
by Tram Trinh, MSN, RN, BS
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Nutrition and Oral Health
Question: In what ways can good nutrition decrease the incidence of dental problems in children?
Answer: Good nutrition is not only necessary for good physical health, it also plays a key role in the development and protection of a healthy mouth, especially the teeth and gums.
Dental caries (also called tooth decay) and dental cavities can occur as soon as teeth appear in the mouth and may cause a host of problems in later years. Baby teeth maintain space for the secondary or permanent teeth to grow into, so early extractions of decayed baby teeth can cause the permanent teeth to come in crooked. Decay can cause painful tooth abscesses. Severely decayed teeth can cause problems with jaw position, eating, language development, and the child's behavior because of discomfort. Dental extractions may be traumatic for children and expensive for parents. All of these problems are preventable with good oral care starting from infancy.
Child care providers and parents need to know about behaviors that increase the risk of early childhood tooth decay, such as inappropriate use of bottles and frequent consumption of sticky foods (such as caramel candy) or foods rich in carbohydrates (such as crackers). Here are some suggestions about nutrition that you can share with parents:
Infants: Bottle-fed babies should be weaned to a cup by one year and should have juice only from a cup (not a bottle) and only at mealtimes. Let parents know that breastfeeding decreases the chance of tooth decay in infants. Food preferences that are established when children are infants will continue to affect their eating habits, and their oral health, as they get older; infants who eat a lot of sweet foods are more likely to prefer sweet foods when they are toddlers.
Toddlers: Make sure children eat healthy, balanced meals as much as possible. Children may reject a new food many times before accepting it, so keep offering nutritious, low-sugar foods from all parts of the food pyramid. Remember that what they eat is more important than how much they eat; healthy children will never starve.
Pre-Schoolers: Discourage slow-dissolving sweet foods such as suckers and hard candy, and avoid keeping these foods in your child care program. Choose snacks that are low in sugar.
For a copy of a fact sheet for families on Tooth and Mouth Care, or more information about oral health and additional resources, call the Healthline at (800) 333-3212 (CA Only).
Information adapted from the Oral Health Forum, June 2002. Oakland, CA.
by Susan Jensen RN, MSN, PNP
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Temperament and Regularity
Question: How can child care providers best meet the needs of children with widely varying temperaments?
Answer: It can certainly be difficult to manage children with widely different temperaments. Regularity is one of the traits which define temperament. Children who are regular and predictable in their daily routines like to eat, sleep, and have bowel movements (BMs) at about the same time almost every day. If children are extremely regular, then you can practically set your watch by when they do things every day.
If a child is irregular, then it is hard to predict when he or she will want to eat, nap or have a BM. The child's biological schedule may be different every day. Maintaining a consistent routine between child care and home (even on the weekends) may help this child to regulate, but do not expect that the child will be as predictable as the more regular child.
Regular and irregular temperaments each bring their own challenges, especially if an irregular child is matched with a child care provider or parent who is regular, or vice versa. It can be frustrating for a regular child care provider or parent to try and predict the needs of an irregular child around such routines as mealtime, naps and elimination.
It's easy to plan outings, snack times, and diapering needs for regular children because their habits are predictable. However, very regular children can be dramatically thrown off their schedules for a short period of time by changes such as daylight savings time. They may feel a little disoriented, almost as if they have jet lag.
While irregular children are more difficult to predict, they are also less likely to be upset by changes in routine. Irregular children are more likely to adapt to variable routines without much of a problem. However, if a child is consistently refusing to eat at lunchtime, sleeps without a pattern of consistency, and has three BMs today and none tomorrow, this child may have a very irregular temperament. Ask the parent about the child's routines at home and if there are ways that consistency can be promoted in the child care setting. Parents may not be aware that their child's body can't be as routine-oriented as the other children, and they may see the irregularity of the child's response as deliberate or manipulative.
You may hear from parents whose children respond regularly at child care due to the consistency of the child care environment, but are irregular at home. This is a great opportunity to share your knowledge of temperament with them so that you can work together to meet this child's needs. Be sensitive when sharing information with parents who are frustrated by their child's irregularity, as it may seem to reflect on their parenting abilities.
For more information please call the Healthline at (800) 333-3212 (CA Only).
by Susan Jensen, RN, MSN, PNP
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Requirements for CPR and First Aid Classes
Question: What are the Community Care Licensing requirements for CPR and First Aid classes?
Answer: State law requires all licensed child care providers to complete 15 hours of course work, which includes CPR/First Aid (7 hours) and Health and Safety (8 hours). The CPR/First Aid classes for child care providers are usually offered together. The 8 hours of Health and Safety instruction must include specific topics such as Preventative Health Practices, Identification and Prevention of Child Abuse, Nutrition and Injury Prevention. The Department of Social Services issued an update on acceptable Health and Safety Courses for Child Care providers:
- As of January 1, 2000, all pediatric first aid courses must include a training component on the use of asthma medications given by nebulizers or metered-dose inhalers (MDIs) in child care settings.
- Effective January 1, 2000, the Emergency Medical Services Authority (EMSA) defines "pediatric" as applying to children 0 to 18 years old. To meet the needs of older children, EMSA-approved pediatric CPR courses now include adult CPR. Effective July 1, 2000, the American Red Cross and the American Heart Association will also define "pediatric" as applying to children 0 to 18 years old for the purposes of providing CPR training to child care providers.
Some courses require an EMSA sticker, while others do not, to show that the courses are approved by statute. The courses below meet the current requirements.
For further information on licensing requirements surrounding CPR and health and safety courses, please call your county Community Care Licensing Number, your local Resource and Referral agency, or our Healthline at (800) 333-3212 (CA Only).
by Tram Trinh, BS, RN, MSN, PHN
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Water Temperature: Too Hot or Not Hot Enough?
Question: What are the safest water temperatures for use around children?
Answer: The safety of water temperature in a child care setting is important because tap water burns are the leading cause of nonfatal burns in children under 5 years of age. A difference of only a few degrees of water temperature can give you time to prevent a child from being seriously injured.
Water heated to 140º F takes only six seconds to burn the skin, while water at 130º F takes 30 seconds to burn the skin. By comparison, water heated to 120º F takes two minutes to burn the skin, which allows significantly more time to remove a child from a hot water source and avoid a burn.
Do you know the temperature of your hot water? Community Care Licensing Child Care Center Regulations (101239e) require that "hot water temperature controls shall be maintained to automatically regulate temperature of hot water used by children to attain a temperature of not less than 105º F and not more than 120º F. Taps delivering water at 125º F or above shall be prominently identified by warning signs."
There are no specific regulations regarding water temperature safety for Family Child Care Homes or Infant Centers, but these guidelines will help keep the children you care for safe.
- Adjust the thermostat on your water heater to 120º F. Call the gas company if you need help.
- To see how hot your water is now, use a candy or meat thermometer directly under the tap. The best times to check are either first thing in the morning or after at least two hours of use.
- There is no magic number for bath water temperature, but bath water should be slightly warmer than room temperature. Run cold water first and last when putting water in the tub to avoid scalding and always check water temperature with your elbow before putting a child into the tub.
- Turn hot water off completely in areas where children have easy access.
For more information and answers to commonly asked questions and concerns visit the Web sites below or call the Healthline at (800) 333-3212 (CA Only).
by Susan Jensen RN, MSN, PNP
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Is Talcum Powder Safe? The Baby Powder Controversy
Question: Is it safe to use talcum powder around infants and small children?
Answer: The use of talcum powder has been a very common practice among parents, although many have switched to alternative products for diaper rash. Parents have used talc because they felt it provides better absorption, and therefore can prevent diaper rash. However, the use of powders has been researched and proven potentially harmful for infants.
The tiny particles in talcum powder are carried in the air like dust and can be easily inhaled by the infant. If talc is inhaled in large amounts, it can dry the mucous membranes and affect the child's breathing. Some infants have also suffered from shortness of breath, wheezing and complete obstruction of the airways. In some cases, infants died due to respiratory failure from breathing of the powder, while others developed pneumonia. Using baby powder is also not advised around adults and children with asthma due to the powder's irritating effect when inhaled.
For these reasons, it is recommended that you do not use talcum powder or cornstarch, due to the aspiration and irritation risks. There is no clinical benefit to using talc. Try using an alternative cream-based product for diaper rashes, such as over-the-counter diaper creams or petroleum jelly. (Using creams and medicated powders requires parent permission as a medication.)
If you can't give up talcum powder, exercise these precautions:
- Apply powder by shaking it on your hands as far away from the baby's head as possible. Don't sprinkle the powder directly onto the infant's body. This prevents the creation of the cloud of smoke which occurs when one shakes the powder directly from the container.
- Keep talcum powder in child-proof containers. Toddlers and young children often want to help change an infant's diaper. They can grab open powder bottles overzealously and cause spillage, or accidentally smother the infant with powder.
Over all, talcum powder does pose a risk to infants and small children due to the irritating effects and possible inhalation. Providers should exercise caution and develop safe practices.
References
Hazards of Baby Powder (1984), T. J. Wagner, Pediatric Nursing, March-April; 1(4): pgs. 124-125
Aspiration of Baby Powder (1985), W. H. Cotton, P.J. Davidson, The New England Journal of Medicine, Dec 26; 313 (26): 1662
by Tram Trinh, RN, MS
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Fall and Winter Seasonal Allergies
Question: What should child care providers know about seasonal allergies that occur in fall and winter?
Answer: Pollen season may be nearly over by fall, but the emergence of mold spores should be recognized and not ignored, and dust never really goes away. Children are more at risk for frequent upper respiratory infections and eczema during the fall and winter months. Special attention to children with asthma is needed because of the increase in mold spores due to dampness from rain and seasonal climate changes, possibly dramatic temperature changes, and increased exposure to indoor triggers, such as cockroach droppings, pet dander and dust mites.
CCHP makes the following recommendations for child care providers and parents to help make fall and winter safer and more comfortable for children:
- Keep the humidity in your center or home below 35 to 50 percent by using exhaust fans while cooking or taking showers. Increased humidity is a breeding ground for mold, which aggravates allergies in some children.
- Keep children from playing outdoors in areas where mold likes to grow, such as dark, wooded areas.
- Try to avoid carpets and rugs in sleeping areas, upholstered furniture and bedding. Dust mites and mold can multiply in rugs and carpets because dampness accumulates between the pad and carpet.
- Providers with pets should take note that due to the colder fall and winter weather, animals are forced to spend more time indoors, which can increase pet dander and allergy symptoms in children with allergies.
- Providers and children with asthma should get an annual flu shot. Children and providers are more susceptible to viral respiratory infections, such as the flu or the common cold.
- Providers should wash their hands frequently to avoid exposure to germs that could be spread to children.
- Wash linens weekly and other bedding such as blankets every two to three weeks in hot water. Then dry them on the hottest clothes dryer cycle. Choose blankets and pillows made of synthetic materials.
There is no way to avoid all allergy triggers, but providers can greatly assist children by altering the child care and play environment while children are in your care.
References
www.aafa.org/templ/display.cfm?id=410
www.nycornell.org/news/press/1998/allergies.html
http://healthandenergy.com/winter_allergies.htm
by Tram Trinh, RN, MSN top of page
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