It's natural to worry a little. Parents know that young children need constant supervision. They take steps to "childproof" their homes. And still, children's energy and curiosity can bring them into contact with safety hazards every day.
Parents with children in child care also wonder about their children's health. Most caregivers, whether in centers, family child care homes, or in your home, would consider a child's health and safety their top priority. Most child care licensing requirements focus on health and safety, but since the regulations set the minimum standard for each state, parents should not rely on them to guarantee health and safety.
Work With Your Child Care Provider On Health And Safety
Look carefully at your child care setting to determine whether it offers:
- Careful supervision
- A good ratio of adults to children
- Clean air and good hygiene
- Child-proof space indoors and out
Pay attention when choosing child care and work with your child care provider to make health and safety a priority once your child begins care.
Keeping Children Healthy Can Be Challenging
Every child gets sick occasionally. You may be surprised to learn that the primary recommendation for reducing infection and illness is very simple... wash your hands! Frequent hand-washing is the most effective defense against illness and the spread of germs at home and in child care. Parents, caregivers and children should wash hands:
BEFORE... preparing food or bottles, meals or snacks, giving medications or first aid.
AFTER... using the bathroom, diapering, coughing or sneezing, administering first aid.
Some child care centers and family child care providers teach children a new method for covering their mouths when they cough: Cough into the crook of the arm so germs are not transferred onto the hands.
Remember that child care is not the only place where germs exist. All surfaces, including those in shops, restaurants, public transportation and playgrounds can harbor germs. A recent child care health study measured the number of germs on children's hands throughout the day. In many cases, the researchers found the highest number of germs when children arrived at child care in the morning!
Be Prepared for When Your Child is Sick
Parents and child care providers agree that that sick children often want to be home. But young children get sick an average of ten times a year, and one parent can't always miss work on all those days. Some parents have few -- or no -- sick days to use when children are ill. How can parents cope?
State regulations require that children with certain illnesses be excluded from care. However, there may be room for flexibility depending on the illness and the child care arrangement.
The information on the following table is an example of guidelines prepared by the health department in one state. It is presented here to help you plan for typical children's illness. Discuss this information with your child care provider. Use it to help your supervisor at work understand why your child can't go to care once in a while. Check with your own doctor or nurse to see if she has other ideas to help you balance your concern about your child's health with the pressure to be at work.
How Sick Is Too Sick for Child Care?
| Condition | Guidelines for Time Away from Child Care |
| Pink eye/ Conjunctivitis | Out of care for 24 hours after treatment begins |
| Diarrhea | Out of care as long as child has a watery stool that cannot be contained by diaper or if child can't get to the toilet, or if stool contains blood or mucus or child also has a fever. |
| Head lice | Out of care until morning after treatment begins; check head daily for next week |
| Impetigo | Out of care for 24 hours after treatment begins |
| Mouth sores | Out of care only if child can't control his saliva |
| Rash | Out of care if child has fever or until a doctor determines that it is not contagious |
| Ringworm | Out of care until treatment begins |
| Scabies | Out of care until treatment is completed |
| Strep throat | Out of care for 24 hours after treatment begins and child has no fever for 24 hours |
| Tuberculosis | Out of care until doctor approves return to care |
| Vomiting | Out of care if child has vomited more than twice in 24 hours or is in danger of dehydration |
Adapted from Health & Safety in Child Care: A Guide for Providers in Massachusetts, MDPH, 1995
Plan ahead for some number of days when your child can't attend care because of one of the conditions mentioned above. Check with friends or neighbors to arrange back-up child care. Check on the policy at work on using employee sick days when your child is sick. Call your local child care referral service to get additional ideas on how parents manage this difficult dilemma.
Safety at Each Stage of Development
Infants
Shaken Baby Syndrome: A baby's neck is too weak to support the weight of his head, so if he is shaken -- even playfully - he is at risk for serious injury and even death. Babies under the age of six months are most vulnerable, but children up to the age of two years can still be injured. Discuss the risks of shaking a young child with your child care provider so that she knows never to do it.
Sleeping Positions: Doctors now advise parents to place infants on their backs to sleep in order to reduce the risk of sudden infant death syndrome (also known as SIDS). Remove crib bumpers, pillows and stuffed animals from the crib, to avoid any risk of suffocation. Studies show that millions of parents have followed this advice, and that the incidence of SIDS is on the decline.
If your child care provider is not up-to-date on the current practice, talk to her. Demonstrate the preferred sleeping position for your baby, and remove soft objects from the crib. If your provider already encourages a back sleeping position, let her know that you appreciate it.
Toddlers
Toddler-Proofing: As babies begin to crawl and walk, their world expands. As your child grows, ask your child care provider for advice and tips on childproofing. Note special measures that she has taken such as corner guards, child proof locks on cabinets or safety covers for electrical outlets.
Choke Hazards: Young children may explore objects by putting them in their mouths, and are therefore at special risk for choking. Check at home and at child care for small toys. Learn infant CPR and the Heimlich maneuver, a special technique for dislodging objects from a choking child's windpipe. The recommended technique is different for infants and young children than for adults. Ask your child care provider if she has a pamphlet to share, or can recommend a CPR trainer. In case of choking, the training helps a parent or caregiver react quickly.
Preschoolers & older children
Safety Education: As children grow, they can learn simple safety practices, such as how to dial "911" in an emergency. Give them guidelines on how to cross the street safely. Teach them to wear a helmet and safety gear when roller-skating or riding a bike.
Without frightening your child, talk to him about "good and bad" touching, and give him basic rules about talking to strangers and never getting into a stranger's car. Be sure your child understands what do in case of a fire, earthquake or tornado. Find out what safety issues are covered in child care and at school, and reinforce these concepts at home.
Quick Safety Tips:
Indoor safety
Watch for:
- Potential poisons, cleaning solutions, etc.
- Broken toys
- Open doors or windows
- Wet or slippery floors
- Clutter that could trip a child
- Sharp objects (scissors, knives)
- Open containers of water
- Exposed electrical outlets or cords
- Small items that could present a choking hazard
- Non-secured TV or video equipment on movable carts
If you see a hazard, ask the caregiver how you can help fix it.
Outdoor safety
Children need and enjoy outdoor time every day. Outdoor play space should include the following:
- Soft surface beneath play
- Equipment that is sturdy, well maintained and free-of-splinters.
- Good adult supervision.
- Fenced-in area protected from the street.
- Outdoor toys in good co
- Helmets for children who use tricycles, bikes, roller-skates or scooters.
- In winter, check for icy surfaces or sharp icicles.
Transportation
One of the most important things you can do to help keep your child safe is to leave a car seat with the provider.
- Make sure she knows how to use it.
- If your child rides a school bus, ask about seat belts and safety rules.
- Make sure your child wears the safety belt in the stroller every time.
Crib safety
- The bars in the crib should be no more than 2 3/8" apart.
- Make sure your child can't climb out of the crib.
- Be sure there are no dangling cords near the crib.
Quick Health Tips:
Cleaning
- Wash plastic toys at least once a day in a dishwasher or with disinfectant.
- Wash toys that have been in a child's mouth before they are used by another child.
- Disinfect tabletops and diaper areas after each use.
- If anyone has a cold, wash toys and hands more often.
Mix this simple, safe and inexpensive bleach solution in a clearly labeled spray bottle: For disinfecting toys and surfaces, use 1 tablespoon of bleach in one quart of water. For bathroom and diaper areas, strengthen the solution to 1 part bleach to 10 parts water.
Tummy troubles
Stomach ailments are common in young children. Children in child care may get diarrhea more often than children cared for at home. Children with vomiting, diarrhea and/or fever should be kept away from other children in the child care setting. Wash hands more often when illness is present.
Lice, pinworm and rashes
No one likes to talk about them, but lice, pinworm and impetigo are common in child care and schools across the country. Although they rarely pose a health threat, they are unpleasant and can be hard to control. These conditions spread quickly because of the way children play together - head to head or hand in hand!
- If there is an outbreak in child care, check your child carefully.
- Teach children that some stuffed animals, hats, and blankets are not shared.
- If you find signs of lice, pinworms or a rash, act promptly.
- Inform your child care provider and find out when your child can return to care.
For More Information on Health and Safety
The American Red Cross publishes material on infant and child safety, first aid and CPR in both English and Spanish.
Healthy Child Care America is a project promoted by the Department of Health and Human Services Maternal and Child Health Bureau and the Office of Child Care and administered by the American Academy of Pediatrics (AAP) to promote the healthy development of children in child care settings.
The National Pediculosis Association has information for parents and child care providers about treatment of lice.
National Resource Center for Health and Safety in Child Care and Early Education
The Daily Parent is prepared by NACCRRA, the National Association of Child Care Resource and Referral Agencies.
© 2012 NACCRRA. All rights reserved.
