Consulting with pediatricians and/or nurses can be very helpful as you formulate your program's health policies, which should start by having a physical health form and immunization form, signed by a pediatrician or family practitioner, on file for each child.
Program Health Policies
Your center's health policy should address:
Parents should inform the center right away if their child contracts any serious communicable disease. The program director should notify all of the families in the program in writing, alerting them to symptoms and precautions. Your health policy should state how long a child with a communicable disease must stay out of child care, and should list restrictions on when a child can return to care (e.g., after three days on an antibiotic, or after the child's physician signs a note stating that the child is no longer contagious).
Daily Health and Illness
Each child's file should contain the name and telephone numbers of the person(s) to contact should the child become ill. Policy should dictate when children need to be sent home due to a fever, vomiting, diarrhea, etc. Any ill child should be removed from the group and be given a quiet place to rest until she goes home. Program health policies should state when children need to be kept out of care and when they can return. Consult a health care consultant or pediatrician for guidance in formulating a medication dispensation policy.
Each staff member must have an annual physical exam and comply with the program's health policies regarding illness and communicable diseases. Staff must have required immunizations and vaccinations, as well.
Proper hand washing practices are very important for prevention of disease in child care programs. Staff will need to wash their hands frequently with soap and running water. Children should be supervised to ensure they wash hands after toileting or nose wiping, and before eating or handling food. Children and staff should use liquid soap from a dispenser, and use paper towels (not cloth) to avoid passing germs.
Times to wash hands:
- After wiping a child's nose, eyes, or mouth; after contact with any bodily fluids, such as blood or saliva (your own or others')
- After changing a child's diaper or soiled clothing, or assisting a child with toileting, or applying any salves or ointments to a child's skin
- After blowing your own nose or using the toilet
- Before handling food, preparing or serving a meal or snack, or administering medications
- After handling animals or birds
- After playing or working outdoors
- After handling any toxins, such as household cleansers
What is SIDS?
SIDS is the diagnosis given for the sudden death of an infant under one year of age for which there is no other cause determined. Because most cases of SIDS occur when a baby is sleeping in a crib, SIDS is commonly known as "crib death." Even though SIDS is the leading cause of death in infants between one month and one year of age, SIDS is a rare event. Only 1.22 of 1000 infants die of SIDS per year.
What causes SIDS?
No one knows the exact cause of SIDS, but there are many theories. Some medical evidence suggests that some SIDS babies are born with brain abnormalities that make them more vulnerable to death during infancy. Such brain abnormalities may be due to a prenatal exposure to a toxic substance or lack of sufficient oxygen. The risk of SIDS may be increased by events occurring after birth, such as lack of oxygen, exposure to high levels of carbon dioxide, or overheating. Infants can have periods of absent breathing for up to twenty seconds, which is normal. They should not turn blue, however, during this period.
What does not cause SIDS?
SIDS is not caused by vomiting and choking.
SIDS is not caused by vaccines or immunizations.
SIDS is not contagious.
SIDS is not caused by child abuse.
What are the risk factors?
Babies who sleep on their stomachs are more likely to die of SIDS than children who sleep on their backs.
Mothers who smoke during pregnancy are three times more likely to have a SIDS baby.
Exposure to secondhand smoke doubles the risk of SIDS.
How can I lower the risk of SIDS?
There is currently no way of predicting which newborns will be SIDS victims. There are a few measures providers can take, however, to lower the risk of a child dying from SIDS:
- Keep babies in a smoke-free environment.
- Babies should be put to sleep on their backs, as opposed to on their stomachs. Studies have shown that placing babies on their backs to sleep has reduced the number of SIDS cases by as much as half.
- Make sure infants sleep on firm mattresses. Avoid using fluffy blankets or coverings and pillows, sheepskins, blankets, or comforters under an infant.
- Babies should be warm, but not too warm. An overheated baby is more likely to go into a deep sleep from which the baby is difficult to arouse.
- The temperature in an infant's room should feel comfortable to you.
Call a physician immediately if:
- A baby is listless or unresponsive.
- A baby stops breathing and turns blue or limp.
- You have any questions or concerns, or are unsure whether a baby's symptoms are worrisome.
Shaken Baby Syndrome
Shaken baby syndrome is the term used for the injuries resulting from someone shaking or throwing a child. Young babies may be shaken by a parent or other caregiver who does not understand that this may cause fracturing of the baby's bones, bruising and bleeding of the brain, and injuries to the spinal cord. Unfortunately, shaken baby syndrome may lead to permanent brain damage, physical disability, or even death.
It is imperative that staff understand that infants are never to be shaken or tossed in the air, even in play. The large skull relative to brain size of infants means that the brain can bleed, become contused, and/or become swollen from shaking or tossing.
It is a good idea to educate all parents in your program about shaken baby syndrome.
Abuse and Neglect
Abuse and neglect are some of the most difficult issues that child care providers face. Your responsibility to the children in your care (as well as state and federal law) requires you to document the situation in the child's file with a written description of what you observed and the dates, and to report suspected child abuse or neglect to the Department of Social Services in your state. If the child is old enough to talk, you may wish to ask him "Can you tell me about this?" (for a bruise, burn, or other physical mark). You should not show alarm, disgust, or anger -- the child may believe you are upset with him, and not share information with you.
If you have reason to believe a child has suffered harm in the parents' care, you should follow the law in every respect, but also make an effort to communicate with the parents if it will not result in further harm to the child. If a child appears to be neglected, talk to the parent about how a child needs to be properly fed, clothed, bathed, and kept clean and safe. Sometimes a parent may need information on parenting, or may need help due to circumstances beyond control, such as severe illness in the family, or poverty due to job loss or divorce.
If you see signs of abuse, again, ask the parent about what you have seen, unless you think the parent will punish or harm the child for "telling." If the parent has a reasonable explanation (which is consistent both with the physical evidence on the child and with the child's behavior), it might have been a real accident and not abuse. However, any child who consistently shows up with burns, bruises, breaks, fractures, or other serious injuries should have his or her case investigated to prevent further injury to the child.