Health and Safety

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.

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.

If you have further questions about this topic, please consider enrolling in the training "Caring for the Abuse Affected Child and Family" that is offered by ACAP RDC every other year.  For information about this class, please call (207) 768-3045.

• Slats not spaced more than 2-3/8 inches apart, and not loose, cracked, or missing
• Mattress fits crib snugly
• No pillows, bumpers, or fluffy comforters or objects in crib
• All bolts, screws, and other hardware present and tightly attached to crib
• Drop-side latches securely hold the side of crib in raised position
• No cutouts in the headboard or footboard of crib
• Corner posts no more than 1/16 inch higher than top rail edges
• Babies put to sleep on their backs, not on their stomachs (to help prevent SIDS)

Crib Toys

• No strings or cords dangling into the crib; crib gyms or mobiles removed when children can push up on hands and knees or when children are five months old
• All parts of toys are too large to be a choking hazard.

High Chairs

• Crotch strap keeps children from sliding out of chair; restraining straps are independent from tray
• Tray locks securely
• Buckles on straps easy to fasten and unfasten
• A wide base for stability
• Caps or plugs on ends of tubing firmly attached to chair

Playpens

• The top rails lock automatically in the normal use position
• No rotating hinge in the center of the top rails
• Mesh playpen or crib with drop-side should never be left with the side down (suffocation hazard); mesh weave should be no more than 1/4 inch, with no loose threads or tears, and is securely attached to frame, top rail, and floor plate

Rattles, Squeeze Toys, and Teethers

• Teething devices securely molded out of one piece of hard rubber or medium plastic, with no smaller pieces that can be dislodged and choke child
• Handles too large to become lodged in baby's throat
• Teething toys checked regularly and replaced if showing signs of disintegration
• No detachable squeakers in squeeze toys (choking hazard)

Changing tables

• Safety straps to prevent baby from falling (but always keep your hand on baby)
• Shelves or drawers easily accessible so that baby not left unattended
• One hand kept on child on a high surface

Hook-on Chairs

• Safety strap to secure child
• Clamp that locks onto table for added security
• Caps or plugs on ends of tubing firmly attached (choking hazard)
• Chair never placed where child can push off with feet

Pacifiers

• No yarn, ribbon, or string attached (strangulation hazard)
• Shield large enough so that it cannot fit into baby's mouth
• Shield has ventilation holes so that baby can breathe if the shield does go into the mouth
• Nipple free of holes or tears that could cause it to break off in baby's mouth (choking hazard)

Strollers and carriages

• Wide base for stability
• Seat belt and crotch strap attached securely to frame
• Seat belt buckle easy to use
• Brakes firmly lock wheels
• Extra baskets or pockets are low on the back and located directly over or in front of rear wheels

Poison Control
There is a new national toll-free poison center telephone number 1-800-222-1222. This number uses a sophisticated system that identifies where the caller is and then automatically directs the call to the appropriate regional poison center.
Parents, providers, and others who care for children should call their regional poison center and obtain a telephone sticker or refrigerator magnet which has the new national phone number.

• Always have children wash hands before and after snacks and meals.
• Observe safe food preparation and handling practices.
• Include items from the four major food groups: vegetables and fruits, cereals and breads, milk products and milk equivalents, and meat and meat substitutes.
• Allow enough time for snacks and meals so that children don’t feel rushed.
• Serve snacks and meals at regularly scheduled times.
• Serve a variety of textures, colors, and temperatures of food.
• Have the children take part in food preparation, which builds skills in many areas such as math, science, language, and social studies.
• Let children take part in serving the food (e.g., passing around a basket of crackers, or carrying a tray of fruit to a table).
• Serve food from a diversity of cultures, especially those of children in the program.
• Serve small portions, particularly if it’s a new or unfamiliar food.
• For infants, talk to parents about daily feeding schedules, formula or breast milk preparation, and when and how to introduce solid food.
• Talk to parents about any allergies or special diets their children may have. It’s helpful to keep a list posted in the eating area for staff reference. Some allergic reactions can be very severe, so attentiveness is important.
• To prevent choking, do not serve popcorn, nuts, raisins, grapes, raw carrots, or hot dogs (unless cut up into half-inch pieces) to children under the age of five.
• Do not use an excess of sugar or salt when preparing any food.
• Post your snack and meal menus on your program’s main bulletin board and website.

• Children are supervised constantly in playgrounds.
• Play equipment bolted securely in place
• Surfaces are twelve inches of soft sand or wood chips, or rubber matting approved for playground use. Soft surfaces extend six feet from the edge of any structure (wider if the structure is higher than four feet).
• Structures for children under three years old are not taller than the child's height, and do not have railings or slats more than 2-3/8 inches apart.
• Structures checked regularly for sharp edges, loose bolts or screws, splinters, cracks, or other damaged areas that could catch or hurt children. All sharp edges should be cushioned to reduce injury.
• Structures painted with lead-free paint only. Peeling paint is removed and structure repainted.
• Drawstrings removed from children's hooded sweatshirts, snowsuits, etc. (choking hazards)
• Yard kept free of toxic plants

• 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

• Monthly checks that smoke detectors are in working order
• All exits clear at all times
• Quick-opening locks on windows
• Monthly fire safety drills, and "stop, drop, and roll" drills with all staff and children

Electrical Safety

• Electrical outlets have clear, childproof covers
• Electrical appliances free of loose plugs, fraying cords, or bare wires
• Wires and extension cords do not run under rugs or carpeting or across floor in traffic areas

Kitchen Safety

• Children supervised closely in the kitchen
• Extreme care used if heating baby bottles in microwave: content can be alternately scalding and cool, and should be shaken well and tested before given to baby
• Household cleaners, abrasives, products, and toxins kept in original, clearly marked containers, and kept locked out of children's sight and reach

Bathroom Safety

• Hot water heater set below 120 degrees Fahrenheit to prevent scalding
• Medications and other hazardous items kept in locked cabinets out of children's reach
• Young children supervised in the bathroom; toilets have lid locks if children are three or younger
• Sturdy non-tip stepstool provided if the toilet or sink is high

Classrooms/Child Care Areas

• Electrical outlets covered with clear, childproof plastic covers
• Radiators covered with secure radiator covers
• Toys have no sharp edges, and are not a choking hazard
• Safety gates (not accordion-style) installed at the top and bottom of stairs
• Houseplants kept out of children's reach; plants are not poisonous
• Curtain cords, Venetian blind cords, etc., fastened up out of children's reach
• Jumpers or swings used instead of walkers

Pet Safety

• Children taught to keep faces away from pets' mouths, beaks, or claws, and to wash hands after handling or playing with pets
• Many reptiles carry salmonella (a dangerous bacteria) and are inappropriate pets for children

Window Safety

• Window guards or stops installed in all rooms where young children spend time
• Windows opened from the top, not the bottom
• Furniture kept away from windows to discourage climbing near windows

Water Safety

• Children never left alone near a wading pool, bathtub, or other body of water
• Children under three never left alone, even near a bucket of water or a toilet
• Adults keep constant eye on children playing in or around water: drowning can occur in less than two minutes
• Wading pools emptied after each use
• Five-foot fence with a locking gate encircles pool; gate kept locked at all times

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.

SIDS
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.

Warning Signs -- 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.

Vehicle Safety
Whether it's for an occasional field trip or daily pick-up trips, you're likely to have children in and out of your vehicles. Here's what to do to make it a safe ride.
The rear seat is the safest place for children of any age to ride! Always buckle children up in the vehicle: use car seats, boosters, and/or lap belts, according to the child's age and size. Babies should ride in rear-facing infant car seat until they are at least one year old and weight more than twenty pounds, and should be securely strapped into the back seat of the car. Be sure the seat is approved for infants and has not been recalled by the Consumer Product Safety Commission. Children over a year, weighing between 22 and 40 lbs., can use a forward-facing car seat, securely strapped into the back seat. Make sure that you are using an approved car seat for the correct weight and height of the child. Children over 40 lbs. should travel in the back seat of the vehicle with buckled seat and shoulder belts, or a securely strapped booster seat.
Air bags can be hazardous to children sitting in the front seat. Read your car's owner's manual carefully on air bag safety. When used with lap or shoulder belts, airbags work well to protect older children and adults who ride in the front seat, facing the front of the car. Make sure that everyone in the front seat is properly buckled up and seated as far back from the air bags as is reasonably possible.
Never leave a child unattended in a vehicle. The inside can become dangerously hot very quickly. Unattended children are also targets for abduction. Moreover, children may accidentally release the brake and the vehicle may begin to roll.

For additional information, contact the National Highway Traffic Safety Administration at 1-888-DASH-2-DOT.

Weapon and Tool Safety
If you plan to have a child care business and you or a family member own guns, you should disclose this information to parents, along with the safety precautions you have taken.

• Store unloaded guns in a locked cabinet at all times. Guns should be kept out of sight.
• Store ammunition separately from firearms in a locked cabinet. Ammunition should be stored out of sight.
• All sharp objects, including knives, scissors, letter openers, sharp tools, etc., should be stored out of reach and out of sight, preferably in locked cupboards or locked drawers.