INSERT CONFERENCE INSERT PRESENTER’S NAME INSERT DATE American Academy of Pediatrics 2007 Choosing Quality Child Care

Overview Terminology –Key words in the child care field and how to use these phrases to find quality child care. Terminology –Key words in the child care field and how to use these phrases to find quality child care. Benefits/Risks – What are they? Benefits/Risks – What are they? Quality Child Care – What is it? Quality Child Care – What is it? Resources – Access AAP resources. Resources – Access AAP resources. Questions – How to get your child care questions answered. Questions – How to get your child care questions answered.

Types of Child Care Parent only care Parent only care Relative care (kith/kin) Relative care (kith/kin) Nannies/babysitters Nannies/babysitters Friend/neighbor care Friend/neighbor care Family child care home Family child care home Child care center Child care center Specialized care Specialized care Most families use a combination of care types. The “best” care is the arrangement that works for your family and meets your child’s needs.

US Children in Child Care A majority of children are in child care in the US (60-70% of children less than 6 years old; by the age of 6, 84% of all children have been enrolled at some time). A majority of children are in child care in the US (60-70% of children less than 6 years old; by the age of 6, 84% of all children have been enrolled at some time). Most health issues (caries [cavities], obesity, mental health issues) have their basis in early childhood, so focusing on this audience maximizes health promotion for many kids at a critical age! Most health issues (caries [cavities], obesity, mental health issues) have their basis in early childhood, so focusing on this audience maximizes health promotion for many kids at a critical age!

US Children in Child Care 12 million children: more than 9 million are in licensed child care facilities. 12 million children: more than 9 million are in licensed child care facilities. 105,444 child care centers. 105,444 child care centers. 213,966 family child care homes. 213,966 family child care homes. 16,110 other licensed facilities. 16,110 other licensed facilities. About 3 million children are cared for in unlicensed and unregulated care. About 3 million children are cared for in unlicensed and unregulated care.

Helpful Terms and Tools Child Care Resource & Referral Agencies Online Child Care Resource & Referral Agencies Online Accredited/Accreditation Accredited/Accreditation NAEYC NAEYC NAFCC NAFCC Child Care Regulations by State Online Child Care Regulations by State Online

Helpful Terms and Tools Day Care, Child Care, Early Care and Education, Early Education and Child Care Day Care, Child Care, Early Care and Education, Early Education and Child Care Licensed, Regulated, Monitored Licensed, Regulated, Monitored Early Learning Guidelines/Quality Rating and Improvement Systems Early Learning Guidelines/Quality Rating and Improvement Systems

Benefits of High Quality Child Care Safety first. Safety first. Health is the foundation of quality care. Health is the foundation of quality care. First few years are key due to brain development. First few years are key due to brain development. Promotes development (physical, cognitive, social-emotional). Promotes development (physical, cognitive, social-emotional). Improves school performance (better math, language, cognition, social skills, relationships, and self-regulation). Improves school performance (better math, language, cognition, social skills, relationships, and self-regulation).

Risks Related to Child Care: Children exposed to a poor quality environment (whether at home or at school) are less likely to be prepared for school demands and more likely to have their socio-emotional development derailed. Children exposed to a poor quality environment (whether at home or at school) are less likely to be prepared for school demands and more likely to have their socio-emotional development derailed. Sudden Infant Death Syndrome (SIDS). Sudden Infant Death Syndrome (SIDS). Infectious diseases and illness. Infectious diseases and illness. Injuries. Injuries.

SIDS in Child Care SIDS is the unexplained death of seemingly healthy babies 12 months or younger. SIDS is the unexplained death of seemingly healthy babies 12 months or younger. Experts don’t know what causes SIDS; cannot predict or prevent SIDS (only reduce the risk). Experts don’t know what causes SIDS; cannot predict or prevent SIDS (only reduce the risk). About 20% of deaths attributed to SIDS occurred while the infant was in the care of a non-parental caregiver. About 20% of deaths attributed to SIDS occurred while the infant was in the care of a non-parental caregiver. 60% in family child care. 60% in family child care. 20% in child care centers. 20% in child care centers.

SIDS in Child Care About 1 / 3 of SIDS deaths in child care occur in the first week, 1 / 2 of these on the first day. About 1 / 3 of SIDS deaths in child care occur in the first week, 1 / 2 of these on the first day. Something intrinsic to child care? No. Something intrinsic to child care? No. Unaccustomed tummy sleeping? Yes. Unaccustomed tummy sleeping? Yes. Caregivers challenged by parents? Yes. Caregivers challenged by parents? Yes. Best practices: Best practices: Child care policies, training, and regulations. Child care policies, training, and regulations. Back to sleep, tummy to play, no soft bedding. Back to sleep, tummy to play, no soft bedding.

State Child Care Regulations Should REQUIRE: Written “Safe Sleep” policy, shared with all Written “Safe Sleep” policy, shared with all Training for a child care professionals before they start work and regularly thereafter Training for a child care professionals before they start work and regularly thereafter Caregivers should place all babies up to 12 months to sleep on their backs, in a safety- approved crib, with no soft bedding (bumpers, comforters, quilts, toys etc) Caregivers should place all babies up to 12 months to sleep on their backs, in a safety- approved crib, with no soft bedding (bumpers, comforters, quilts, toys etc)

Baby in a Safe Crib

Infectious Diseases and Illness Increased illness before age 1. Increased illness before age 1. Increased illness first year of child care. Increased illness first year of child care. Children in care with 6 or more have a higher incidence of: Children in care with 6 or more have a higher incidence of: Infections (ear and respiratory). Infections (ear and respiratory). Antibiotic use. Antibiotic use. Diarrhea (Salmonella, Shigella, Giardia, Hepatitis A). Diarrhea (Salmonella, Shigella, Giardia, Hepatitis A).

Infectious Diseases and Illness Good news: Good news: Most infections are mild, are present in the general community, and resolve without treatment. Most infections are mild, are present in the general community, and resolve without treatment. More common colds in preschool years, but protected against colds (and asthma) between the ages of 6-11 (same number of colds at age 13). More common colds in preschool years, but protected against colds (and asthma) between the ages of 6-11 (same number of colds at age 13).

Exclusion and Prevention State regulations not based on medical evidence. State regulations not based on medical evidence. Programs are allowed to adopt stricter standards. Programs are allowed to adopt stricter standards. Evidence shows: Evidence shows: Children may be infectious before symptoms. Children may be infectious before symptoms. Exclude if a) child too ill to participate, b) child needs greater care than caregivers can offer, or c) child has a harmful infectious disease. Exclude if a) child too ill to participate, b) child needs greater care than caregivers can offer, or c) child has a harmful infectious disease. Parents, caregivers, pediatricians equally misinformed about evidence, when to exclude. Parents, caregivers, pediatricians equally misinformed about evidence, when to exclude.

Exclusion and Prevention The Keys to Prevention The Keys to Prevention Immunizations Immunizations Hand washing Hand washing Sanitation of toys and surfaces Sanitation of toys and surfaces Resources Resources Article: Equipment in Child Care Centers Can Reduce Illness Article: Equipment in Child Care Centers Can Reduce IllnessEquipment in Child Care Centers Can Reduce IllnessEquipment in Child Care Centers Can Reduce Illness Health and Safety E-News: Infectious Diseases Health and Safety E-News: Infectious DiseasesInfectious DiseasesInfectious Diseases Handout: Preventing the Flu Handout: Preventing the FluPreventing the FluPreventing the Flu

Injuries Children in: Children in: Child care centers fewer injuries than those only at home. Child care centers fewer injuries than those only at home. Child care centers fewer injuries when they are at home than those who receive care only at home. Child care centers fewer injuries when they are at home than those who receive care only at home. Family child care programs have more injuries than either children in centers or those who only at home. Family child care programs have more injuries than either children in centers or those who only at home. May be due to increased supervision in child care or more risk-taking behaviors among children transitioning from care to home. May be due to increased supervision in child care or more risk-taking behaviors among children transitioning from care to home.

Injuries Most common and severe injuries happen when children fall from climbing equipment that don’t have appropriate cushioning materials under them. Most common and severe injuries happen when children fall from climbing equipment that don’t have appropriate cushioning materials under them.

13 Indicators of Quality Care Appropriate supervision/discipline. Appropriate supervision/discipline. Nurturing care. Nurturing care. Staff to child ratio and group size. Staff to child ratio and group size. Immunization requirements. Immunization requirements. Hand washing and diapering sanitation. Hand washing and diapering sanitation. Staff director qualifications. Staff director qualifications. Staff teacher qualifications. Staff teacher qualifications.

13 Indicators of Quality Care Staff training. Staff training. Medication administration. Medication administration. Emergency plan/contact. Emergency plan/contact. Fire drills. Fire drills. Appropriate outdoor playground. Appropriate outdoor playground. Safe storing of toxic substances. Safe storing of toxic substances.

Developed by AAP. Includes rationale for why standards are important; based on evidence where possible. Available online at Print copies from: AAP, APHA, NAEYC.

Managing Infectious Diseases Written for parents, caregivers, teachers and health professionals. Signs/Symptoms chart. Quick Reference Sheets for more than 50 common infections.

Healthy Child Care Web site Existing Web site – originally designed to support the national Healthy Child Care America Campaign

HEALTHY KIDS, HEALTHY CARE: Parents as Partners in Promoting Healthy and Safe Child Care Available in Spanish –

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