MEDIC First Aid 2017 ConnecticutChildDayCareSupplementalPPT

Child Care Topics
Connecticut Supplement for use with PediatricPlus
1 PediatricPlus CPR, AED, and First Aid-Connecticut Child Day Care Course Supplement ©2017
Child Care Topics
• Child Abuse and Shaken Baby • Daily Health Inspection
Syndrome • Hand-Washing Procedures
• Sudden Infant Death Syndrome (SIDS) • Diaper-Changing Procedures
• Motor Vehicle Passenger Safety
• Surface Sanitation
• Pedestrian and Bicycle Safety
• Food Handling and Nutrition
• Drowning Prevention
• • Field Trips
Poison Prevention
• Fall Prevention • Emergency and Disaster
• Fire and Burn Prevention
Preparedness
• Exposure to Cold Prevention • Fire Extinguisher Operation
• Immunization • Safety Around Animals
• Handling and Administering • Indoor Safety
Medications • Outdoor Safety
• Factors that Contribute to the Spread of • General Safety
Disease
Child Abuse
Connecticut Child Abuse and Neglect Hotline: 1-800-842-2288
National Hotline:1-800-4ACHILD
• Physical Abuse
– Can be mistaken for injuries
– Be suspicious of injuries that are:
• Unexplained
• Recurring
• Presenting multiple stages of healing
– Abuse injuries:
• Show distinct shapes (hand, belt, etc.)
• Show patterns (both palms or feet)
Child Abuse
• Physical Abuse
– Behavior responses in abused children:
• Wary of adult contact
• Wince or jump at sudden movement or noise
• Apprehension when other children cry
• Aggression
• Withdrawal
• Anticipating bad things happening
• Difficulty learning or concentrating
– Parental behaviors that can indicate abuse:
• Unrealistic demands
• Blaming the child
• Denial
• Referring to child as worthless
Child Abuse
• Neglect
– Physical signs of neglect include :
• Consistent hunger
• Poor hygiene
• Inappropriate or inadequate clothing
– Behavioral Responses:
• Begging for or stealing food
• Extended stays at school (early or late departures)
• Constant fatigue
• Listlessness or falling asleep in class
• Alcohol or drug abuse
• Delinquency
• Theft
• Being shunned by peers
Child Abuse
• Neglect
– Parental behaviors indicating possible neglect include :
• Exhibiting indifference towards child
• Behaving irrationally
• Displaying signs of alcohol or drug abuse
• Appearing chronically depressed
Child Abuse
• Emotional and Psychological Injury

– Displayed by:
• Speech disorders
• Delayed emotional development
• Failure to become engaged in regular activities
• Sucking, biting, rocking
• Destructive or antisocial
• Sleep disorders or inhibition
• Hysteria, obsessions, compulsion, phobias
• Behavior extremes
• Inappropriately adult or infantile
Child Abuse
• Emotional and Psychological Injury

– Parental behavior indicating possible emotional or
psychological injury to the child:
• Puts child down
• Blames child
• Appears unconcerned about child
• Refuses help
• Is cold, indifferent, openly rejects child
Child Abuse
• Sexual Abuse:
– Physical signs:
• Difficulty in walking or sitting
• Torn, stained, or bloody underclothing
• Pain or itching in genital area
• Fear of being left alone with someone
• Poor self-image and peer relationships
• Withdrawal, fantasy, or infantile behavior
• Sleeping or eating problems
• Unwillingness to change clothing
• Unwillingness to participate in physical education classes
• Bizarre, sophisticated, or unusual sexual behavior or
knowledge inappropriate to age group
Child Abuse
• Sexual Abuse:
• Runs away
• Under 14 years old:
– Becomes pregnant
– Contracts sexually transmitted disease
– Parental behavior that can indicate sexual abuse:

• Overly protective
• Limits child’s contact with others
• Isolates child and self
• Jealous and/or controlling
Child Abuse
• Sexual Abuse:
– If child shows signs and symptoms of sexual abuse:
• Do not bathe
• Do not allow food or drink
• Do not question regarding incident
– If child tell you about incident document the following:

• Who is in the room when child reported incident
• What prompted the child to tell you
• What time the child told you
Child Abuse
• Shaken Baby Syndrome
– Dangerous due to larger head in proportion to body
– Can cause:
• Blindness
• Seizures
• Retardation
• Paralysis
• Death
– Crying is often the trigger
• Understand normal crying
• Know when to call health care provider
– Caregivers
• Know the dangers of shaking
• Not overly stressed
• No alcohol or drug abuse
Child Abuse
• Signs and Symptoms of Shaken Baby Syndrome

(depending on force)
– Minor irritability
– Lethargy
– Tremors
– Vomiting
– Seizures
– Coma
– Death
Mandated Reporting
Connecticut Department of Children and Families (DCF)
Mandated Reporter Training
• Mandatory Reporter Training

– DCF will provide:
• Training to anyone in state who wishes it
• Training and refresher training to school district mandated
reporters
• Training program to all new school employees
Mandatory Report Form
• Within 48
hours of
making an
oral report, a
mandated
reporter must
submit a
written report
(DCF-136).
Sudden Infant Death (SIDS)
• Key Points
– Unexplained death of baby under 1 year of age
– Also described as crib or cot death
– Cause not yet known
– Most SIDS deaths occur between 2 and 4 months
– Babies who sleep on stomach or sides more prone to
SIDS
– African-American and Native-American babies twice as
likely to die from SIDS as Caucasian babies
– More info at www.nichd.nih.gov/sids
– Call 800-505-2742
Sudden Infant Death (SIDS)
• Recommended Actions
– Place babies on backs to sleep (even for naps)
– Place infants on their stomachs:
• Awake
• Being watched
• To strengthen muscles and reduce flat spots on back of head
– Gently turn head to reduce flat spots
– Firm mattress
– No blankets or loose bedding
– Prevent overheating
• Face and head stay uncovered
Motor Vehicle Passenger Safety
• Key Points
– Motor vehicle crashes are leading cause of death to
children
– Proper use of safety seats and seatbelts reduce risk
– Do not leave child in car unattended
– Car seats or booster seat
• Federally approved
• Installed and used per manufacturer’s instructions
• Secured in back seat only
• Key Points
– Car seats
• Infants and toddlers ride facing the back of the car
– Until one year old and twenty pounds
– Booster seats
• A booster child safety seat used
– Until a child is seven years of age and 60 pounds
– Seat Belts
• Children, tweens, and teens must always wear seat belts
– Children must ride in back seat until 13 years of age
• For more information, please contact:

– Safe Kids Connecticut at www.ctsafekids.org or 860-545-
9988.
– Local Safe Kids:
• Fairfield County 203-247-1614
• Greater Naugatuck Valley 203-732-1337
• Greater New Haven 203-946-8186
• Greater Waterbury 203-346-3908
• Litchfield County 860-626-8201
• New London County 860-442-0733
• Windham County 860-456-6978
• Key Points
– Seat belt use
– All children under the age of thirteen should be transported
in the back seat of a car
– Each child not riding in an appropriate child restraint
system should have an individual lap-and-shoulder seat
belt
• Key Points
– Doors locked
– Never leave child unattended in car
• Recommended Actions:
– Field trip policy – safety is top priority
– Field trips need to be age appropriate
– Make sure car seats are in good condition and meet
safety standards
• Teach Your Children
– School bus
• Wait where driver can see you
• Wait for signal to cross street and enter bus
• Stay seated while bus is moving and until it comes to a
complete stop
• Talk quietly; activities must not distract bus driver
• Follow directions
• Use booster seats and seatbelts
• Do not share seatbelts or sit on laps
Pedestrian and Bicycle Safety
• Key Points
– Good habits will increase safety when unsupervised
– Introduce helmets early and require them for use with
any wheeled equipment
– Helmets worn flat, not tipped – chinstrap snug
– Right size tricycle or bicycle
• “Growing into it” can be dangerous
– Enroll children in bicycle safety course
– Check equipment routinely for missing, loose, or
damaged parts
– Bicycles
• Always wear properly fitted, approved helmet
• Wear helmet properly
• Remove helmet when finished
• Use bike path or lane when possible
• Use safest bike routes
• Ride single file on street
• Ride in the same direction as traffic

– Bicycles
• One person per bike
• No riding on handlebars
• Walk the bicycle in a crosswalk to cross street
• Obey traffic signs and symbols
• Follow routes reviewed and approved in writing by the
local police

– Pedestrians
• Look left, right, left again; cross when there is no traffic
• Hold adult’s hand or another child’s when crossing street
• Use sidewalk when possible
• When crosswalk not available, cross at corner
• Dusk or night wear light colors, use reflective tape on
clothes and shoes, carry a flash light, walk facing traffic
• Never run out from between two parked cars
Drowning Prevention
• Key Points
– 2nd leading cause of injury-related death for children 1-14
– Children under 1 most often drown in:
• Bathtubs
• Buckets
• Toilets
– Children 1 – 4 most often drown in backyard pools:
• Last seen in home
• Out of sight < 5 minutes
• In care of parents
Drowning Prevention
• Key Points
– Other hazards
• Creeks
• Ponds
• Drainage ditches
• Construction sites
– Non fatal submersion injuries:
• 5 x that of drowning
• >50% require hospitalization
• Can cause brain damage resulting in longer term disabilities
Drowning Prevention
– Be cautious around rivers and oceans:
• Dangerous currents and tides
• Depth may increase suddenly
• Require flotation devices in boats
– Avoid leaving standing water in buckets, other
containers, and wading pools
– Do not leave children unattended in bathroom:
• Attend bathtubs
• Keep lid on diaper pail
• Keep toilet seat lid down and secured
Drowning Prevention
–Provide swimming lessons
• For you
• For your children
–Watch children around water
–Never let children swim alone
–Five foot high fence around any pool
• Self closing/latching gates
• Gates need to latch securely
• Latches out of reach – 55 inches from ground
Drowning Prevention

– Never swim without an adult around
– Always use a personal flotation device or lifejacket
– Do not ride on the front of a boat
Poison Prevention
• Key Points
– Medications leading cause of ingested poisoning in
children
– If poisoning suspected call: 1-800-222-1222
– Poisonous plants account for many poisoning cases
• See www.poison.org/prevent/plants.asp
Poison Prevention
• Key Points
– Lead poisoning can cause damage to:
• Brain, kidneys, blood cells
– Children can get lead poisoning by:
• Eating old paint chips
• Chewing windowsills
• Chewing furniture
• Chewing toys
Poison Prevention
– Lock up obvious poisons; mark with poison control
stickers
– Use child-resistant bottle caps
– Follow prescription directions
– Return medication to safe location
– Turn lights on when giving/taking medication
– Keep products in original containers
– Don’t treat vitamins or medications like candy
Poison Prevention
– Don’t take medication in front of children
– Keep food and medication separate
– Return unused/expired medicines to parents or back to
pharmacy for disposal (OTC and prescription)
– Get rid of poisonous house or yard plants (label plants)
– Dispose of dead leaves
– Test for lead paint
– Prevent exposure if painting, sanding, or scraping an
older building
Choking Prevention
• Key Points
– Food appropriate to age group
– No gum, gummy candy, small candy, peanuts, or grapes
to young children or infants
– Ensure others do not give inappropriate food
– Keep small objects away from young children or infants
– Supervise closely in areas that are not child-proofed
Choking Prevention
– Check environment
• Crawl on hands and knees
• Remove potential choking hazards
– Provide age appropriate toys
– Sit while eating
– Do not laugh or talk while chewing or swallowing
Fall Prevention
• Key Points
– More likely to fall head first causing serious or fatal
head injuries
• Teaching children good climbing habits reduces risk
• Supervise children around
– Stairs
– Porches
– Balconies
Fall Prevention
• Key Points
– Stairs, porches, and balconies:
• Secure railings for flights of more than three steps and for
porches more than three feet from the ground
• Gates provided at the head or foot of each flight of stairs to
which children have access
• “Pressure gates” or accordion gates should not be used.
Fall Prevention
– Remove potential hazards
– Place gates at top and bottom of stairs
– Place latches and guards on windows
– Open windows from top
– Open windows from bottom no more than 2 – 3”
– Do not place furniture in front of windows
Fall Prevention
– Children’s furniture meets government safety standards
– Do not use cribs with side rails
– Lower mattress once child can stand
– Regular bed when child reaches 35” or can climb out of
crib
– Use non-skid rugs
Fall Prevention
– No standing in bathtub
– No infant walkers
– Ensure soft surfaces under playground equipment
– Monitor climbing activities
– Keep one hand on infant when on:
• Changing table
• Couch
• Bed
– Right size tricycle or bicycle
– Enroll children in bicycle safety programs
Fall Prevention
– Wear a helmet when:
• Riding a tricycle or bicycle
• Skateboarding
• Using roller blades
• Any wheeled activity
– Remove helmet promptly when finished
– Do not stand in bathtub
– Do not run on swimming pool deck
Fire and Burn Prevention
• Key Points
– Each home and facility needs a fire escape plan
specifying a meeting place outdoors
– Well qualified babysitters familiar with your fire escape
plan
– Space heaters kept away from flammable materials
– Close bedroom doors at night to slow the spread of
smoke
– Wiring in your home or day care done by a professional
– Don’t overload electrical circuits or outlets
• Smoke Detectors
– Installed in multi-room day care centers
– Detectors on each story
– In front of doors to the stairway
– In corridors of all floors occupied by the day care center
– Lounges
– Recreation areas
– All sleeping rooms
• Portable Fire Extinguishers

– A-B-C fire extinguishers
• Easily visible
• Readily accessible
• Immediately available
– Located along the normal path of travel
– Type and number approved by local fire official
– Post instructions for use on or near extinguisher
– First remove children safely and quickly
• Fighting fire is secondary
– Develop a fire escape plan and practice
– Thermostat on water heater less than 120
– Replace frayed cords on appliances
– Safety covers on electrical outlets
– Appliance cords out of reach
– Bedrooms and sleeping areas have 2 exits
– Dress children in fire-resistant clothing
– Use back burners on stove; handles away from edge
– Hot liquids away from edge of counters & tables
– Keep children away from fireplaces and wood stoves
– Don’t smoke in bed or on couch
– Keep matches and lighters away from children

– Yell for an adult’s help if there is a fire
– If you think there is a fire behind a door:
• Test for heat with back of hand
• If warm or hot, do not open
– Crawl low on floor under smoke to escape fire
– If clothing is on fire –
• STOP running to avoid fanning flames

• DROP to the ground to prevent flames going up into face
and hair
• ROLL from one side to the other to smother the flames
Exposure to Cold Prevention
• Key Points
– Keep room temperature warm
– Feed children nutritious food
– Listen to weather reports; avoid going out in hazardous
conditions
– Dress children in layers
– Keep children’s clothing and skin dry
– Cover the head
– Wrap a scarf around neck
– Use loose fitting gloves, socks, and footwear
– Protect children from wind
Exposure to Cold Prevention
• Key Points
– Caregivers avoid
• Smoking
• Chewing tobacco
• Drinking alcohol or caffeine
– Test for circulation
• Wiggling fingers
• Wiggling toes
• Watch for signs of frost-nip/frostbite (see page 105 of
PediatricPlus Student Guide)
– Check extremities for color and warmth every 15 minutes
– Dry children after swimming: body heat loss 25 x greater
in water than air
Immunization
• Key Points
– Children in child care need to be current on vaccinations;
keep files updated for children under 2
– Near universal vaccinations have caused certain diseases
to become rare:
• Diphtheria
• Tetanus
• Polio
– Immunity
• Active immunity: acquired through vaccines or having the
disease
• Booster shots: periodic reinforcement
Immunization
• Key Points
– Illness or religious or philosophical beliefs may
delay/prevent vaccinations
• Illness: keep a physician’s statement on file
• Religious/personal beliefs: keep a parent waiver on file
– If enough children are not immunized, it may be
necessary to notify parents that the risk of spread of
preventable diseases exists
• Immunization Requirements Schedule For Day Care,
Family Day Care, and Group Day Care Homes is available
from the Department of Health
Immunization
– Review immunization records for all children
– Identify any immunizations that are not current
Handling & Administration of
Medications
• Key Points
– Be familiar with state regulations regarding
administration of medicines
– All prescription medication should be stored:
• In a safe place, inaccessible to children
• With an unaltered printed label
• In a refrigerator (if required)
– Must have written approval from the child’s parent
– Administer according to physician's direction
Handling & Administration of
Medications
• Key Points
– Keep written approval and directions in child’s record
– Return unused medicine to child’s parents
– Never give a child aspirin or aspirin-containing
medications (Reye’s syndrome)
– Do not give a child products or foods containing
salicylates or salicylic acid
Handling & Administration
of Medications
– Read all labels and directions
– Store medications separate from food
– Do use expired medications; dispose according to FDA
– Avoid taking medications in front of child
– Keep written record of administered medication
Factors that Contribute
to the Spread of Disease
• How Infection Occurs
– Pathogen must be present
– Adequate quantity to overwhelm immune response
– Suitable entry site
– Susceptibility
• Direct and Indirect Disease Transmission
– Direct Transmission
• Infected person to susceptible person
• Direct physical contact with blood or body fluids
– Touching
– Kissing
– Sexual contact
– Oral secretions
– Contact with body lesions
– Indirect Transmission
• No human-to-human contact
• Contaminated surfaces or objects
• Vectors
– Mosquitos
– Fleas
– Rodents
– Dogs
• Illnesses spread through contact transmission:
– Chicken pox
– Common cold
– Conjunctivitis (Pink Eye)
– Hepatitis A and B
– Herpes simplex (cold sores)
– Influenza, measles
– Mononucleosis
– Fifth disease
– Pertussis
• Prevention
• Frequent and thorough hand washing
• Regular disinfection of frequently touched surfaces
– Doorknobs
– Handles and handrails
– Restroom surfaces
– Medical instruments
– Computer keyboards
– Phones
– Office supplies
– Toys
• Infectious vs. Communicable
– Infectious
• Caused by pathogens that enter body and cause harm
– Diseased animals
– Insects
– Communicable
• Spread from person to person
• Airborne and Droplet Transmission
– Size of particles
– Distance traveled
– Airborne: smaller particles, suspended in air, inhaled
• Tuberculosis
– Droplet: larger particles, shorter distance
• Direct or indirect
• Intestinal Tract Transmission
– Bacteria and parasites:
• Salmonella (food poisoning)
• Shigella (person-to-person)
• E Coli (person-to-person, food, manure)
• Giardia (water, person-to-person)
• Cryptosporidium (drinking/recreational water)
– Signs and symptoms of intestinal tract infections:
• Fever
• Loss of appetite
• Vomiting
• Weight loss
• Dehydration
• Mucus or blood in stool
• Key Points
– Situations that contribute to the spread of disease:
• Staff who care for children and prepare food
• Staff who circulate among age groups
• High child-to-caregiver ratio
• Limited bathroom facilities
• Children in diapers with children not in diapers
• Toddlers in diapers who put things in their mouths
• Diaper changing areas without sinks
• Improper disposal of soiled diapers
• Key Points
– Situations that contribute to the spread of disease:
• Large number of children in a single room, or small room
size compared with the number of children
• Wading pools
• Handling of pets
• Uncovered sand boxes
• Diaper changing areas lacking sinks
• Improper disposal of soiled diapers
• Recognizing Ill Children
– Common signs and symptoms:
• Fever
• Rash
• Vomiting
• Diarrhea
• Lethargy
– Children with fever may need to be seen by a health
care professional before being admitted to day care:
• Oral temperature of 101° or greater
• Rectal temperature of 102° or greater
• Armpit temperature of 100° along with other signs
• Temperature Taking Guidelines
– Rectum
• Rectal thermometer (bulb is fatter than oral thermometer)
• Clean with cool, soapy water and rinse
• Shake so mercury is below 36 °C/96.8 °F
• Cover silver tip with petroleum jelly
• Place baby on back with knees bent
• Gently insert in rectum about 1 inch while holding it with fingers
• Wait at least 2 minutes
• Remove thermometer and read
• Clean thermometer
– Mouth
• Carefully place under child’s tongue
• Wait 3 to 4 minutes
– Armpit
• Use a rectal thermometer or oral thermometer
• Place tip in the center of armpit
• Tuck child’s arm snugly to his body
• Wait at least 4 minutes
– Ear
• Use a clean probe tip each time
• Follow the manufacturer’s instructions carefully
• Gently tug on the ear, pulling it up and back
• Gently insert the thermometer until the ear canal is fully
sealed off
• Squeeze and hold down the button for one second
• Remove the thermometer and read the temperature
– Measurement Method Normal Temperature Range
• Rectum 36.6°C to 38°C (97.9°F to 100.4°F)
• Mouth 35.5°C to 37.5°C (95.9°F to 99.5°F)
• Armpit 34.7°C to 37.3°C (94.5°F to 99.1°F)
• Ear 35.8°C to 38°C (96.4°F to 100.4°F)
• Rashes
– Change in skin
• Color
• Appearance
• Texture
– Localized or covers the body
– Can be indicator that child is sick
– See the Child Care Topics supplement for detailed
information about the illnesses that are indicated by
rashes
• Communicable Disease Guidelines
– Communicable (Person-to-Person)
– Understand the disease
• Incubation
• Symptoms
• Transmission
• When communicable
• Restrictions
• Transmission prevention
– See the Child Care Topics supplement for information

regarding common childhood communicable diseases
• Prevention
– The following sections in the supplement
provide information on how to prevent the
spread of disease:
• Daily Health Inspection
• Hand-Washing Techniques
• Diaper-Changing Procedures
• Surface Sanitation
• Food Handling and Nutrition
Daily Health Inspections
• Key Points
– A brief check of child conducted upon
arrival
• And when change in appearance or behavior
is observed
– Early detection minimizes disruption
– Early detection minimizes severity of illness
– While the parent is still with the child quickly check:
• Skin: color, bites, or bruises
• Face: hot/warm/cool to touch
• Eyes: clear, runny, or swollen eyes
• Nose: excessively runny, stuffy, or sneezing
• Mouth & Throat: throat reddened, white patches, sore
• Ears: draining, hard of hearing, child pulling on them
– While the parent is still with the child quickly check:
• Chest & Neck: wheezy breathing, swollen neck glands
• Mood: happy, sad, cranky
• Ask parent about hidden symptoms: diarrhea, unusual
bowel movements, vomiting
• Ask child how they feel
– Record child’s daily health
and note differences
– If you suspect a child is ill,
separate the child from the
rest of the children
Hand-Washing Procedures
• Key Points
– Hand-washing is simplest, most effective way to reduce
the spread of disease
– You need to wash your hands when:
• You arrive
• Moving from one child care group to another
• Moving a child from one care group to another
• Key Points
– You need to wash your hands :
• Before
– Serving food
– Giving medications
• After:
– Serving food
– Giving medications
– Breaks
– Changing a diaper or cleaning up bodily fluids
– Wiping a nose
– Cleaning bodily fluids
– Using the restroom
– Assisting a child in the restroom
– Cleaning or handling garbage
• Key Points
– Children need to wash their hands when:
• They arrive
• Before they eat or drink

• After:
– Use of restroom
– Having their diaper changed
– Touching a sick child
– When they leave your care
• Recommended
Actions
– Purchase or create your
own hand washing
station
– Encourage parents and
other adults to follow
the same hand washing
routine
• Hand-Washing Technique
– Use liquid soap and warm
water, rub hands vigorously
• Hands outside of water stream
• Wash back of hands, wrists,

between fingers and under
fingernails
• Maintain for 20 seconds
• Hand-Washing Technique
– Rinse hands well while leaving water running
– Dry hands with single use towel
– Use towel to turn off the water
– Dispose of towel without touching trash container
• Alcohol Based Hand Sanitizers

• Hand sanitizers do not need to be
locked but must be maintained
inaccessible to children.
• All children must be supervised by
a staff member when using hand
sanitizers.
• For programs that serve school
age children only, hand sanitizer
dispensers that are mounted to the
wall are acceptable.
Diaper Changing Procedures
Never leave a baby unattended!
• Key Points
– Types of diapers
• Disposable with absorbent material
• Cloth (if medically required)
– Handling cloth diapers
• Do not rinse
• Do not take to toilet
• Store in labeled sealed container
• Launder by commercial service or send home in plastic bag
– Need to change diapers
• Check hourly
• Behavior indicates
• Change wet or soiled diapers immediately
• Key Points
– Make sure supplies are ready
– Place paper or disposable towel on changing surface
– Lay child down, holding child only with your hands if
diaper is soiled
– Remove soiled diaper/clothes, place in plastic lined
receptacle or plastic bag
– Clean child’s bottom with moist disposable towel, then
dispose
– Remove paper towel from under child, then dispose
– Wipe hands with moist disposable towel, then dispose
• Key Points
– Diaper and/or dress child
– Wash child’s hands, return to group
– Disinfect the diapering area, equipment and supplies
you touched using an EPA registered disinfectant
– Wash your hands
Surface Sanitizing and Disinfecting
• Key Points
– Understand the difference between clean, sanitize, and
disinfect
Clean Remove all dirt and contamination
Sanitize Reduce germs
Disinfect Destroy or inactivate most germs
• Key Points
– Wash everything accessible to children daily with soap and
water
– Disinfect with EPA registered disinfectant*
*The concentration of some bleach solutions sold in stores is now higher

than it has been in the past. With multiple concentrations available, it is
no longer possible to provide a generic bleach recipe for sanitizing and
disinfecting. Use an Environmental Protection Agency (EPA) registered
product (including bleach) and follow the label instructions for use.
For more information, visit: http://cfoc.nrckids.org/bleach/bleach.cfm
– Follow cleaning, sanitizing, and disinfecting guidelines
• Clean diaper-changing area, toilets, and potty chairs after
every use with soap and water to remove visible soil; spray
with sanitizing solution and air dry
• Clean bathroom and kitchen areas one or more times daily
• Wash and disinfect floors, low shelves, and refrigerator
weekly
• Wash and sanitize all mouthed toys daily or between uses
by more than one child
– Follow cleaning, sanitizing, and disinfecting guidelines
• Maintain toys of ill children separately
• Stuffed toys need to be machine washable
• Sanitize wading pools after each use
• Disinfect cribs and cots weekly
• Change linen when wet or soiled
• Remove food and litter from play areas
• Vacuum daily
• Recommended
Actions
– See “
Tips for Cleaning Child
Care Facilities the Safe
& Healthy Way
”
Food Handling and Nutrition
• Key Points
– Leading factors relating to food borne illness:
• Poor personal hygiene
• Incorrect temperatures
• Preparation of food
– Improper temperatures cause 90% food borne illness
• Bacteria growth highest between 40-140° Fahrenheit and
(4-60° Celsius)
– Some germs do not change the look, smell, or taste of
food
– Wash hands in different sink than food prep
– Do not prepare food when ill or with open sores
– Keep fingers out of nose, eyes, mouth
– Restrain hair
– Do not touch eating/drinking surface of clean plates/glasses
– Do not directly handle food that will not be cooked
– Keep children off of food preparation surfaces
– Use meat and drinking water from approved facilities
– Store foods:
• Below 40°F (4°C)
• Above 140°F (60°C)
– Offer nutritious meals and snacks to children
– Child’s diet may be modified due to allergies, food
idiosyncrasies, or other medical issues
– Obtain and follow written instruction for modification
– Keep written instruction in child’s record
Field Trips
• Key Points
– Field trips should be age appropriate
– Transport children in vehicles designed and equipped
with child safety restraints installed
• Restraints must be used at all times during transportation
– Vehicle and driver have proper licensing, insurance
– Signed permission from parents before transporting
children
– Staff/child ratio must be maintained at all times
Field Trips
• Key Points
– Child/staff ratios are established to ensure the safety of
all children.
– A child must never be left unsupervised.
– Group size may not exceed twenty children.
– Group size must be maintained at all times.
Field Trips
• Key Points
– Preschool age or younger exit vehicle on same side of
street as the building they will enter
– Driver remains until child has been received by an
authorized person
– Children never left unattended in vehicle
– Vehicle breakdown or accident plan
Field Trips
– Signed permission slips and emergency medical forms for each
child
– Carry a cell phone or two-way radio
– Use durable name tags on children with contact info
– Written attendance sheet prior to departing and returning
– Have adequate food and water
– Each vehicle has first aid kit
– Emergency care plans and supplies available to children with
chronic medical conditions
– Responsible adult trained in first aid
– Vehicles locked when not in use, checked after use
Portable First Aid Kit
• Connecticut Requirements
– Assorted sizes of non medicated adhesive strips;
– Sterile, individually wrapped, three (3) or four (4) inch gauze squares;
– A two (2) inch gauze roller bandage;
– One (1) roll of adhesive tape (hypoallergenic);
– Scissors;
– Tweezers;
– Two (2) instant cold packs;
– Non-glass thermometer to measure a child's temperature with plastic covers for the thermometer or
alcohol to clean the thermometer, or single use tempa dots;
– Two (2) triangular bandages with safety pins;
– Disposable, nonporous gloves;
– Current (less than five (5) years in print) first aid manual, chart or guide provided by an approved first
aid course for children and adults
– CPR mouth barrier (face shield).
– First aid supplies for field trips shall also include:
• Water;
• Reliable communication device;
• Liquid soap;
• Emergency contact numbers for each child;
• Medications, as needed, if the program administers medications; and
• Plastic bags, for storage.
Emergency and Disaster Preparedness
• Safety Stickers/Posters
– All phones have 911 sticker
– Poison control posters displayed prominently
– 1-800-222-1222 (entire US)
• Call this number 24/7 to reach poison expert
• Call 1-800-222-1222 to order stickers, magnets, brochures
• Key Points
– Emergency supplies:
• Water
• Food
• First aid kits
• Flashlights
• Radios
• Batteries
– Mark turn off valves:
• Gas
• Water
• Electric
• Key Points
– Pack vital documents in a lightweight carry case:
• Emergency contact
• Transportation releases
• Medical forms
– Practice emergency drills in accordance with state
regulations
– Leave low lying areas if there is a risk of flooding
• Key Points
– Secure loose articles outside
– Open door or window on wind-protected side of buildings
– Tornados:
• Seek shelter underground
• Room in center of building
• Ditch or ground depression
• Key Points
– After earthquake
• Do not use matches, lighters, or open flames and do not
operate electrical switches until confirmation that there is
no natural gas leak
– Never burn charcoal, propane, or kerosene heaters
indoors due to carbon monoxide poisoning
– Have written, posted evacuation plan
• Indicate location of room, building exits, and designated
outdoor meeting place
– Notify family members if you evacuate, including where
you are going
– Check all appliances, make sure they are all secured from
movement; fuel source has flexible lines
– Install latches on doors, cabinets in bathroom and kitchen
to hold door closed during heavy shaking
– Identify, move poisons, toxic substances, or solvents in
breakable containers from high or dangerous places
Fire Extinguisher Operation
• Key Points
– Only use in situations where safety of user is ensured
– Provide only limited extinguishing capability
– Classified for use on specific fire types
– Train all staff on use
– Inspect at least once a year
Fire Extinguisher Operation
– Notify and evacuate first
• Call 911 or activate emergency plan
– Leave if fire is large or won’t extinguish within 1 minute
– Use PASS:
• P - Pull and remove pin in handle
• A - Aim nozzle at base of fire
• S - Squeeze handle to begin flow of contents through nozzle
• S - Spray contents from side to side at base of flame
– Never turn your back on extinguished fire
• Always back away, observing the situation
Outdoor Safety
• Key Points
– Be alert to child with respiratory diseases
• Asthma triggers:
– Cool air
– Pollutants
– Rapid changes in air temperature
– Play areas:
• Fences protect children from hazards
• Free of debris and electrical hazards
• Proper ratio of adults to children
Outdoor Safety
• Key Points
– Playground Surfaces
• Check impact absorbing materials at least monthly
• Turn over or rake up to increase softness
• Inspect every day for glass and other debris
• Hose down and rake loose fill surfaces
• Sand is not an appropriate surface
– Can accumulate animal waste
Outdoor Safety
• Key Points
– Remove
• Garbage
• Glass
• Sharp rocks
• Stumps/roots
• Toxic plants
• Anthills, beehives, wasp nests
• Unprotected utility equipment
• Any other material that may be harmful or cause injury
Outdoor Safety
• Key Points
– Check playground equipment regularly for:
• Missing or broken parts
• Protrusion of nuts and bolts
• Rust and chipping or peeling paint
• Sharp edges, splinters, and rough surfaces
• Stability of handholds
• Visible cracks
• Stability of non-anchored large play equipment (e.g.
playhouses)
• Wear and deterioration
– Remove broken, worn, or decaying equipment or
structures
Outdoor Safety
• Key Points
– Equipment is size appropriate
• Climbing heights are limited to reduce falls, injury
• No openings that trap a child’s head
– Swings:
• Constructed properly
• Away from walls, fences, other play spaces
– Playground equipment has:
• No protruding pieces
• Moving parts that aren’t worn
• No defects that pinch, shear, or crush
• Safety bars, railings, and rungs
Outdoor Safety
• Key Points
– Plants, shrubs, trees:
• Non-toxic
• Not attractive to dangerous insects
– Sandboxes need to contain sterilized sand or pea gravel
Outdoor Safety
• Key Points
– If the facility has a water play area, the area should:
• Conform to all state and local health regulations
• Not include hidden or enclosed spaces
• Have a non-slip surface
• Not have sudden changes in depth of water
• Not have drains, streams, water spouts, or hydrants that
create strong suction or water-jet forces
• Have toys and equipment made of sturdy plastic or metal
• Be regularly inspected for glass, trash, animal excrement,
and other foreign material
Outdoor Safety
– Allow outdoor play time each day
• Make sure children are properly dressed
– Check local air quality advisories (if a factor)
– Ensure safe access for children to play equipment
– Check equipment for sharp edges, protruding elements,
broken parts, and toxic materials
Safety Around Animals
• Key Points
– Ensure all pets and caged animals are healthy and
disease free
– An animal may lash out to protect itself while being
played with
– Mother animals may attack if they sense that their
offspring are endangered
– Wash hands immediately after contact
– Never leave a child unattended with an animal
– When visiting a farm, use common sense and follow all
directions
– Teach children to treat animals with respect
– Do not allow children to approach wild/domestic animals
that are on their own
– Animals could:
• Be carrying diseases
• Cause injury
– Ask permission
– Stay away from running, chained up, or fenced dogs
– Stay away from eating or sleeping dogs
– Do not tease or play tug-of-war with animals
– Let the dog sniff back of hand to see if it’s friendly
before petting
– Stay away from playing or fighting dogs
Indoor Safety
• Key Points
– Facilities need to be structurally sound, hazard-free; local
building codes need to be followed
– Equipment and furnishings placed to avoid collisions
– Floors and walls easy to clean and free from:
• Cracks
• Bare concrete
• Dampness
• Splinters
• Sliding rugs
• Uncovered telephone jacks
• Uncovered electrical outlets
Indoor Safety
• Key Points
– Carpeting must be:
• In good condition
• Clean
• Nonflammable
• Nontoxic
– Must be ADA accessible
• Provisions in evacuation plan for disabled children
– Separate toxic or hazardous material from child care
areas
Indoor Safety
• Key Points
– Doors should have finger-pinch protection
• National Standard 5.1.3.5: Finger-Pinch Protection Devices (
http://nrckids.org/CFOC3/)
– Windows should have guards

• National Standard 5.1.3.2: Possibility of Exit from Windows (
http://nrckids.org/CFOC3/)
– Follow
• U.S. Consumer Product Safety Commission, Recalls and Product
Safety News (www.cpsc.gov)
Indoor Safety
• Key Points
– Emergency exits and lighting:
• Labeled and visible at all times
• Installed in hallways, stairwells, and at building exits
• Corridors and pathways leading to exits kept clear
• Have proper signs
• Each floor having not less than 2 exits
• Dead ends not exceeding 20 ft.
• Travel distance between any point in a room and exit not
exceeding 150 ft.
Indoor Safety
• Key Points
– Electrical Safety
• Outlets and fixtures up to code and certified
• Safety covers and shock protection devices on all
electrical outlets accessible to children not yet of school-
age
• Use safety covers that are spring-loaded
• Use GFCI receptacles
• Keep electrical devices unplugged
• Keep electrical devices away from water sources
Indoor Safety
• Key Points
– Electrical Safety
• Extension cords are discouraged
• Electrical cords out of reach
• Electric space heaters must:
– Not be accessible to children
– Have protective covering
– Be certified by testing laboratory (UL)
– Be kept 3 feet from any flammable object
Indoor Safety
• Key Points
– Bathroom area walls have impervious surface up to
height of 5 feet to:
• Prevent deterioration
• Prevent mold
• Ensure clean, sanitary surfaces
– Floors and toilet areas:
• Keep clean
• Free of filth
• Disinfected (destroy disease producing germs)
Indoor Safety
• Key Points
– Supplies
• Bathrooms supplied with:
– Liquid soap
– Hand lotion
– Paper towels
• Single use cloth or disposable paper towels
– Other hand drying device
– Toilet paper
Indoor Safety
• Key Points
– Supplies
• Potential harmful supplies should be locked away
– Prescription and over the counter medications
– Poisons
– Cleaning supplies
– Harmful chemicals
– Equipment and tools
– Any substance with a warning label to keep out of the reach
of children
Indoor Safety
• Key Points
– Refrigerated medication stored in secure container
– Electric fans kept away from children
• Safety certification mark of UL (Underwriters Laboratories)
or ETL (Electro-technical Laboratories)
– Ventilation systems provide fresh air
– Maintain temperature 65° – 72° Fahrenheit in winter
– Maintain temperature 74° – 82° Fahrenheit in summer
Indoor Safety
• Key Points
– No cigarette smoke
exposure
– Heating systems :
• Are inspected annually
• Cleaned annually
• Certified by a heating
contractor annually
• Have protective screen in
place
Indoor Safety
• Key Points
– Children have no access to
fireplaces or fireplace inserts
– Fireplaces/inserts:
• Must be properly drafted
• Equipped with safety screen
• Chimney needs to be cleaned
annually
• Adult must be present for use
Indoor Safety
• Key Points
– Equipment, materials, furnishings, play areas are
• Sturdy
• Kept in good repair
• Review safety Information from
U.S. Consumer Product Safety Commission
Indoor Safety
• Key Points
– Use separate sleeping and resting areas:
• No sharing of bed or bedding
• Individual bed, crib, or cot for child spending 4+ hours at
facility
• Clean bedding
• No plastic material used for covering
• Sleep spaces must be 3 feet apart unless separated by a
screen
– Position screens so that staff can see around them
– Additional standards: http://nrckids.org/CFOC3/
Indoor Safety
• Key Points
– Furniture safe and free from defects
– All furniture durable and child-sized
– Tables at waist height of children
– Smooth surfaces; no protruding staples or hardware
that can harm
– Caps or plugs on tubing firmly in place
– Toy chests with attached lids prohibited
Indoor Safety
• Key Points
– Bassinets or cradles have:
• Study bottoms
• Wide bases
• Strong leg locks
– Changing tables have:
• Be equipped with railings or barriers that extend at
least six inches above the change surface
Indoor Safety
• Key Points
– Cribs:
• Have crib slats:
– Without damage
– Spaced no more than 2 3/8 inches apart
• Mattress fits snugly with less than 2 fingers width between crib side
• Securely attached head and footboards
• Minimum height from top of mattress to top of crib rail: 20”
• No cribs with drop sides
• Drop side latches secure
Indoor Safety
• Key Points
– Highchairs:
• Waist and crotch straps independent from tray
• Tray must lock securely
• Hook on chairs have restraining strap and a clamp that
locks onto table
• Never place chair where child can push chair off with feet
Toy Safety
• Key Points
– Age appropriate toys
– Avoid:
• Sharp edges/points: glass, metal toys may expose sharp
edges/points
• Small parts: may be swallowed or lodged in child’s windpipe,
ears, nose
• Loud noise: damage to child’s hearing
• Cords/Strings: become caught/wrapped around child’s neck
• Propelled Objects
• Electricity: use with caution and under adult supervision
– Routinely check for splinters, sharp edges, rust, damage
Toy Safety
– Not appropriate for children under 3 years of age:

• Toys or objects with small removable parts
• Balls that are smaller than 1 inch in diameter
• Toys with sharp points and edges
• Plastic bags
• Styrofoam objects
• Coins
• Rubber balloons
• Safety pins
• Marbles
Toy Safety

– Put away toys after use to prevent trips and falls
General Safety
• Notification of Parent/Guardian
– In an emergency:
• Give first aid
• Call EMS
– Call parent/guardian or emergency contact person as
soon as practical
– Staff member goes with child to hospital and stays until
parent/guardian or emergency contact person arrives
General Safety
• Notification of Parent/Guardian
– Notify parent/guardian or emergency contact person in
the event of:
• Blood not contained in an adhesive strip
• Head injury
• Human bite which breaks the skin
• Any animal bite
• An impaled object
• Broken or dislodged teeth
• Injury requiring professional medical attention
General Safety
• Identification of Children
– Child Enrollment Form:
• The provider shall maintain the confidentiality and security of
all children's records
• This form must be kept on file for one year after the child is no
longer enrolled in the child care home
Child Enrollment Form
Part One
Part Two
Part Three
First Aid
• All required first aid topics can be found in the
MEDIC First Aid PediatricPlus Student Book
Sudden Illness
• All required sudden illness topics can be found in

the MEDIC First Aid PediatricPlus Student Book
Questions?

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Child Care Topics

Connecticut Supplement for use with PediatricPlus

• Emotional and Psychological Injury

• Emotional and Psychological Injury

– Parental behavior that can indicate sexual abuse:

– If child tell you about incident document the following:

• Signs and Symptoms of Shaken Baby Syndrome

• Mandatory Reporter Training

• For more information, please contact:

• Teach Your Children

• Teach Your Children

• Teach Your Children

• Portable Fire Extinguishers

• Teach Your Children

• STOP running to avoid fanning flames

• ROLL from one side to the other to smother the flames

– See the Child Care Topics supplement for information

– Early detection minimizes disruption

– Early detection minimizes severity of illness

• Face: hot/warm/cool to touch

• Eyes: clear, runny, or swollen eyes

• Nose: excessively runny, stuffy, or sneezing

• Mouth & Throat: throat reddened, white patches, sore

• Ears: draining, hard of hearing, child pulling on them

– Children need to wash their hands when:

• Before they eat or drink

• Wash back of hands, wrists,

• Maintain for 20 seconds

• Alcohol Based Hand Sanitizers

Clean Remove all dirt and contamination

Sanitize Reduce germs

Disinfect Destroy or inactivate most germs

*The concentration of some bleach solutions sold in stores is now higher

– Windows should have guards

– Additional standards: http://nrckids.org/CFOC3/

– Not appropriate for children under 3 years of age:

• Teach Your Children

• All required sudden illness topics can be found in

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