5
HEALTH
Learning Objective
According the NAEYC Code of Ethical Conduct and Statement of Commitment (2005) the primary responsibility of an educator is to provide care and education in settings that are safe, healthy, nurturing, and responsive for each child. The first principle to guide our conduct and ethical responsibility to children is
P-1.1—Above all, we shall not harm children. We shall not participate in practices that are emotionally damaging, physically harmful, disrespectful, degrading, dangerous, exploitative, or intimidating to children. This principle has precedence over all others in this Code.
Health is a fundamental issue when caring for infants and toddlers. We need to protect children from infection and illness. Some of the practices used in program to keep children healthy include:
- Separate the diapering and toileting areas from food preparation and feeding areas.
- Keep all areas clean.
- Wash hands frequently
- Provide easy to clean and suitable surfaces and covering for the activities in the area
- Heat, light, ventilation, and acoustics impact health. Natural lighting, soft elements to reduce noise, and screened, openable windows are ways to improve health.
Besides providing a healthy environment, there are health issues to consider for infant and toddlers. This chapter will focus on 5 issues:
- Abuse and Neglect
- Lead poisoning
- Asthma
- Unintentional Injuries
- Oral Health
Abuse and Neglect
Anyone who suspects a child is being abused, neglected or exploited can and should file a 51A Report with the Massachusetts Department of Children and Families (DCF), as an early childhood educator you are a mandated reporter. You may be the first person to see signs of or be told about maltreatment. As a mandated reporter you play an integral part in the protection of children.
As of January 2010, mandated reporters who are professionally licensed by the Commonwealth of Massachusetts are required by statute to complete training, which teaches them how to recognize and report suspected child abuse and neglect. From Chapter 2 Toddler Development Review The Youngest Americans: A Statistical Portrait of Infants and Toddlers in the United States to read the statistics for the number of infants and toddlers that suffer abuse and neglect. How does the abuse and neglect of infants and toddlers compare to other age groups? What are the risk factors for child abuse and neglect? What are your responsibilities for reporting?
Lead poisoning
Lead poisoning is one of the most common and preventable pediatric health problems. The Centers for Disease Control states that children are particularly susceptible to lead’s toxic effects. Most lead poisoned children have no symptoms, therefore, go undiagnosed and untreated. No socioeconomic group, geographic area, or racial or ethnic population is spared. To learn more read: Centers for Disease Control and Prevention. Preventing lead poisoning in young children Atlanta: CDC; 2005.
Even low levels of lead can cause a range of chronic conditions from anemia, hearing loss, and kidney problems, to physical and developmental delays; severe exposure to lead can cause seizures, coma, and even death. Massachusetts requires pediatricians to regularly screen children under age three for lead exposure Developmental delays and behavioral problems can be a symptom of lead poisoning. According to the Centers for Disease Control and Prevention (CDC), there are at least 4 million households that have children living in them that are being exposed to high levels of lead. To learn more watch the 3 minute You Tube video Protecting Children from Lead Poisoning (2014)
Asthma
Asthma is the most prevalent chronic condition of childhood in the U.S.; with about five million children under age 18 diagnosed. Things in the environment trigger an asthma attack such as cold air, dust mites, mold, pollen, animal dander or cockroach debris, and some types of viral infections. Many of these triggers are associated with inadequate housing and with exposure to pollutants that are disproportionately found in low-income neighborhoods.
One of the most common causes of asthma symptoms in children five years old and younger is a respiratory virus. Viruses are the most common cause of acute asthma episodes in infants six months old or younger. Infants and toddlers have much smaller bronchial tubes than older children and adults. Their airways are so small that even small blockages caused by viral infections, tightened airways or mucous can make breathing extremely difficult for the child. This is why preventing infections in your programs is essential.
Resource to Review
Read the guide: Commonwealth of Massachusetts Department of Public Health (2013). Caring for Kids with Asthma: A Guide for Massachusetts Child Care Programs (2013) What are your experiences with asthma? How will you use the Asthma Action Plan (AAP) and individual health care plan (IHCP) described in the document
Unintentional Injuries
For infants, injuries are the fourth leading cause of death; for toddler deaths, they lead all causes. Non-fatal injuries are much more common than fatal ones. The majority of nonfatal injuries are from falling, being struck by or against an object, and animal bites or insect stings. Schnitzer[1] (2006) identified the injuries most common for each age group of children. For infants, suffocation and falls are the most common. For toddlers, falls and poisonings are the leading causes of nonfatal injuries, followed by scald burns and motor vehicle–related injuries. There are many regulations designed to prevent injuries such as regular building inspections, use of guardrails and protective barriers, safety covers for electrical outlets, the requirement for an integrated pest management policy, use and storage of toxic substances, fire and carbon monoxide detectors, CPR and first aid training, and the use of injury reports. How many of these practices have you seen in use?
What about toddlers make them accident-prone?
Remember from chapter 2 that some of the developmental characteristics of toddlers include: increased mobility, natural curiosity, inability to delay gratification (I want it NOW) and they can’t anticipate the consequences of their actions. Toddlers may have difficulty judging distances and have trouble concentrating on more than one thing at a time so they’re more likely to focus on what they want rather than how they are getting there. Is critical we anticipate and prevent injuries as much as possible. Here are other developmental considerations from the North Carolina Division of Child Development: Infant Toddler Foundations (2008).
Young toddlers may begin to:
- Experience cause and effect (going downhill fast cause falls; turning the TV up too loud hurts ears).
- Show some caution on uneven ground and heights.
- Notice and imitate adult reactions to dangerous people and situations.
- Respond to warnings and directions from others.
- Understand the difference between what should be eaten and what should not.
Older toddlers may begin to:
- Remember cause and effect experiences and apply their experiences to future situations (avoid touching cold railing, walk slowly down hill where fall happened).
- Increase self-control over their impulses.
- Recognize and avoid situations that might be unsafe.
- Understand what their bodies can do and understand their limits.
- Watch for adult reactions to unfamiliar things or situations that might be dangerous.
- Understand and follow basic health and safety rules. They still require close supervision from caregivers to follow these health and safety rules consistently.
- Feel proud when they follow safety rules and ashamed when they do not (say, “Look, I waited!” at the corner; hang head after trying to reach forbidden item).
Oral Health
Baby teeth play an important role in helping infants and toddlers eat and speak clearly. Healthy oral hygiene habits develop early. To see the importance of oral health watch the YouTube video A Healthy Mouth for Your Baby . This 4-minute video is for families of infants or toddlers. It explains why baby teeth are important, gives tips on how to prevent early childhood tooth decay, and promotes a dental visit around 12 months. (2013)
The regulations require
Effective January 2010, the program must assist children with brushing their teeth if:
- The children are in care for more than 4 hours, or
- They have a meal while in care.
The Office of Oral Health (2009) recommends that for children under 2 years of age educators:
- Use a small smear of fluoride toothpaste
- Spit it all out in the sink
- NOT rinse with water after brushing.
The NAEYC Accreditation Criteria for Health Standards which are used to define best practices; recommends that after each feeding, infant’s teeth and gums are wiped with a disposable tissue (or clean soft cloth used only for one child and laundered daily) to remove liquid that coats the teeth and gums. They also support the MA regulation by suggesting that at least once daily in a program where children older than one year receive two or more meals, teaching staff provides an opportunity for tooth brushing and gum cleaning to remove food and plaque. (The use of toothpaste is not required.)
A Massachusetts core competency at the mid-level is the educator will integrate oral health into curriculum and routines (MA Core Competency 4.A.3) with the advance level indicator stating: establishes linkages with community-based oral health resources to promote oral health screening of all children and youth in care. Integrates oral health into appropriate program policies and procedures. How will you support healthy oral health habits?
A resource: Office of Oral Health. (2009) Growing Healthy Smiles In The Child Care Setting: Implementing a Tooth Brushing Program to Promote Oral Health and Prevent Tooth Decay. Boston: Massachusetts Department of Public Health.
Is the environment healthy for infant and toddlers?
To self-assess the practices you observe or use complete the checklists and report your findings in your discussion of the chapter.
First, complete the infant and toddler indicators on the two-page Let’s Move! Child Care Checklist Quiz. The Let’s Move! Child Care best practices are listed on the left. Please check the box under the statement that best describes the current situation of the program.
Next, complete the 2010 Eco-Healthy Child Care® Checklist developed by the Children’s Environmental Health Network. The checklist reflects best practices for health as described in the Caring for Our Children: National Health and Safety Performance Standards, 3rd Edition. By completing the checklist you will discover 30 ways to benefit the health and well-being of the children in childcare programs.
- Schnitzer, P. G. (2006) Prevention of Unintentional Childhood Injuries. American Family Physician, 74, (11):1864-1869. Available at http://www.aafp.org/afp/2006/1201/p1864.pdf ↵
