Child Care Provider Training
Background
Programs that provide out-of-home care for infants and young children in general serve two purposes. They provide substitute care--while parents work, and they promote socialization and early education. At least six out of ten-nearly 13 million-infants, toddlers and preschool children--are enrolled in child care according to the National Center for Education Statistics (1). Yet, regulation relating to the health and safety of children in out-of-home child care programs varies widely. Some states have no or minimal regulation for before- and after-school child care, family-based child care, and preschool or nursery school programs, particularly if they operate on a part-time basis or if they are sponsored by a religious institution (2).
Although it is unclear as to whether there is a higher incidence of injuries in out-of-home child care versus in-home care (3), there is evidence nonetheless that many children are injured while in child care settings. In 1997, about 31,000 children four years old and younger were treated in U.S. hospital emergency rooms for injuries that occurred at child care/school settings. The Consumer Product Safety Commission is aware of at least 56 children who have died in child care settings since 1990 (4).
Policies
All staff involved in the provision of direct care at child care facilities, including family home caregivers, should be certified in pediatric first aid that includes rescue breathing and first aid for choking. At least one certified staff person should be with the children at all times and in all places where children are in care.
Quality child care should take place in a safe and healthy setting. Nevertheless, injuries may occur, and all staff should be prepared to handle medical emergencies. In 1992, the American Public Health Association and the American Academy of Pediatrics developed National Health and Safety Performance Standards: Guidelines for Out-of-Home Child Care Programs (5). This policy is part of their recommended standards and should apply both at the regular child care site and when the children are on field trips. The first aid training requirement should be a part of statewide child care regulations. In addition, facilities that serve children with special needs or have a swimming pool or built-in wading pool should require infant and child CPR training for caregivers (6). The National Resource Center for Health and Safety in Child Care, http://nrc.uchsc.edu, can provide information on whether your state regulations mandate this training for all child care staff and family home caregivers.
Effectiveness Data
When an emergency occurs quick, proper action can make the difference between life and death. When a seriously injured child is found, there should be no delay in delivering care. Waiting for a trained person to be found and to arrive can lead to a worsening of the child's condition. In some cases, such as choking, seconds count. A child care center that has been modified and/or designed to ensure the safety of children will help prevent injuries from occurring. Staff with current first aid certification will help ensure that those injuries that do occur are treated promptly and properly. One study found that first aid was sufficient for 84.4 percent of the injuries that occurred in child care centers (7).
Contacts
National Resource Center for Health and Safety in Child Care
UCHSC at Fitzsimons
Campus Mail Stop F541
P.O. Box 6508
Phone: 800-598-5437
Fax: 303-724-0960
E-mail: natl.res.ctr@uchsc.edu
Web site: http://nrc.uchsc.edu
Marsha Sherman
Executive Director
California Child Care Health Program
1322 Webster Street, Ste. 402
Oakland, CA 94612
Phone: 510-839-1195
Fax: 510-839-0339
E-mail: msherman@childcarehealth.org
Web site: http://www.childcarehealth.org
Sarah B. Woo
Program Coordinator
California Child Care Health Program
6505 Alvarado Road, Suite 108
San Diego, CA 92120
Phone: 619-594-4373
Fax: 619-594-3377
E-mail: swoo@projects.sdsu.edu
References
- West J, Wright D and Hausken EG. Child Care and Early Education Program Participation of Infants, Toddlers, and Preschoolers. National Center for Education Statistics, U.S. Department of Education, Washington, D.C., October 1996. Web site: http://nces.ed.gov/pubs/95824.html.
- American Academy of Pediatrics. The Application of Health and Safety Guidelines to Out-of-Home Child Care Programs. Policy Statement RE9417. Pediatrics, 1994. 93 (6) :1016-1017.
- Rivara FP and Sacks JJ. Injuries in Child Day Care: An Overview. Pediatrics, 1994. 94[6(2)] :1031-1033.
- CPSC Staff Study of Safety Hazards in Child Care Settings. U.S. Consumer Product Safety Commission, April 1999. Web site: http://www.cpsc.gov/library/ccstudy.html.
- American Public Health Association and the American Academy of Pediatrics. National Health and Safety Performance Standards: Guidelines For Out-Of-Home Child Care Programs. National Resource Center for Health and Safety in Child Care, 1992. Web site: http://nrc.uchsc.edu/national/index.html.
- Wiebe RA and Fuchs S. Emergency Medical Services in the Child Care Setting. Healthy Child Care America, 1999. 3 (1). Web site: http://nccic.org/hcca/nl/jan99/emergenc.html.
- Chang A, Lugg M and Nebedum A. Injuries Among Preschool Children Enrolled in Day Care Centers. Pediatrics, 1989. 83 :272-277.
Acknowledgements
Leroy Frazier. Jr., M.S.P.H., C.H.E.S., Director, South Carolina Dept. of Health and Environmental Control, Injury & Disability Branch, Columbia, SC.
Chris Hanna, M.P.H., National Children's Center for Rural and Agricultural Health Safety, Marshfield, WI.
Diane Winn, M.P.H., R.N., University of California-Irvine, Pediatric Injury Prevention Research Group, Irvine, CA.
David F. Zane, M.S., Director, Texas State Department of Health, Injury Epidemiology and Surveillance Program, Austin, TX.
We extend special thanks to the California Center for Childhood Injury Prevention (CCCIP) for their extensive contribution and commitment to the production of this publication.
