1. Child Care Basics
Module 7

2. Module 7: Healthy Practices: Nutrition and Fitness
Outcome A
The student will demonstrate healthy practices: hand-washing, diapering, food-handling and meal/snack procedures.
Content Area VIII: Health, Safety and Nutrition:
Knowledge of Regulations
1a. Verbally explains and locates the safety and health policies for the setting.
1d. Follows regulations regarding health and safety.
Nutrition:
1b. Practices safe food handling and observes general sanitation practices.

3. Module 7: Healthy Practices: Nutrition and Fitness
Outcome B
The student will describe basic daily nutrition, exercise, and sleep needs of children.
Content Area VIII: Health, Safety and Nutrition:
Responding to Health Needs of Children
2a. Promotes good health and provides an environment that contributes to the prevention of illness.
Nutrition
1d. Monitors eating habits to ensure a healthy diet, including the need of children to eat frequently.

4. Module 7: Healthy Practices: Nutrition and Fitness
Outcome C
The student will identify signs of and care for basic childhood illnesses and injuries
Content Area VIII: Health, Safety and Nutrition: Responding to Health Needs of Children
1f. Responds to children’s injuries… while assuring the comfort and care of other children.
1g. Demonstrates knowledge of basic childhood illnesses.

5. Required Reading
Child Care Center Licensing Guidebook (2nd ed., DEL 2006) Outcome A, B & C: Section 4, pp
Accessed online at:
Washington State Family Home Child Care Licensing Guide (2nd ed., DEL, 2013) Section 3 “Care and Education of Young Children”;
Section 4 “Environments”;
Section 5 “Health, Safety and Nutrition”.  

6. How can you make healthy habits fun?
Option 2: How can you make healthy habits fun?
Ask participants to turn to someone sitting nearby and pair up in twos (or threes), introduce themselves, and share any ideas they have for making healthy habits fun for kids, such as using funny songs, colored soap, or puppets to encourage hand washing. In a small group, debrief by asking participants to introduce their partner(s) and share the idea. In a larger class just ask for a few examples. Record ideas on a whiteboard (or paper) and leave posted to refer to later in the module. Encourage participants to add ideas during and after the module.
everydayhealthplan.blogspot.com

7. While children are in your care, what do you do to keep them healthy
While children are in your care, what do you do to keep them healthy? Which of the food handling and preparation regulations do you have the most trouble implementing? Is the way you are required to diaper a child in licensed care different from the way parents diapers their children? Why?
Outcome A
The student will demonstrate healthy practices: hand washing, diapering, food-handling and meal/snack procedures.
 Discussion Question
While children are in your care, what do you do to keep them healthy?
Which of the food handling and preparation regulations do you have the most trouble implementing?
Is the way you are required to diaper a child in licensed care different from the way parents diapers their children? Why?
 Presentation
Hand washing
We all agree that keeping children and staff healthy is a number one goal of any early learning program. Frequent hand washing is the single best protection we have against the spread of germs and therefore staying healthy. Did you notice the long list of times staff members are required to wash their hands with soap and warm water?
When arriving at work
After toileting and diapering
After attending to an ill child
Before and after preparing, serving, or eating food
Before and after giving medication
After being outdoors engaged in play
As needed.
Can you think of examples of “As needed?” How about after wiping a child’s drippy nose? When do children need to wash their hands? What is proper hand washing technique? (See Activity 1, Handout 1).

8. Diaper Changing
Diaper changing is a task requiring special attention because germs love warm, damp, dark places, and there is no place warmer, damper and darker than a soiled diaper. Close your eyes and imagine yourself going through these steps when changing a diaper:
Wash hands.
Gather necessary material.
Put disposable gloves on hands.
Place child gently on table and remove diaper.
Dispose of diaper in a hands-free garbage can with a lid.
Clean the child’s diaper area from front to back, using a clean, damp wipe for each wipe.
Apply topical cream / ointment / lotion when written consent is on file.
Remove gloves.
Wash hands or use wet wipe (if no fecal matter on hands).
Put on clean diaper and dress the child.
Wash child’s hands with soap and running water or with wet wipe and dry hands with paper towel.
Place child in safe place.
Clean and disinfect diapering area and any equipment touched.
You can understand why each diaper changing area is required to have posted instructions on this procedure.
turningithome.com

9. Food handling and Snack / Meal Preparation
Best Practice:
All staff preparing, handling, and serving food should maintain a current Food Handler’s Card. This includes all teachers and caregivers who serve children food and snacks.
Food handling and snack / meal preparation
Children are especially vulnerable to foodborne illnesses due to their smaller body size and underdeveloped immune systems. It is critical that food safety be maintained in all areas of food storage and preparation. In programs where food is prepared, at least one staff member must have a Washington State Department of Health Food Handler’s Permit to:
Monitor and oversee food handling and service, and
Provide orientation and on-going training for all staff involved in food handling.
Best Practice: All staff preparing, handling, and serving food should maintain a current Food Handler’s Card. This includes all teachers and caregivers who serve children food and snacks.
You have an important role to play in preventing the spread of food-borne illnesses by simply following a few steps to be sure food is handled appropriately The Washington State law outlines approved food sources. Following is a list of foods you may not serve:
Leftover food previously served outside your center.
Home canned, frozen or prepared food unless it is for the person’s own children.
Donated food from restaurants or caterers that was previously served.
Game meat that has not been inspected by the USDA.
Donated meat, fish, poultry or milk that is not from a source inspected for sale.
How about families bringing food into the program? Is this approved? What does your Guidebook or Guide advise on this subject?
Cooking and storing foods at incorrect temperatures are major contributing factors to foodborne illnesses. Thorough cooking, consistent hot holding, proper cooling, cold storage, and complete reheating of foods are all critical steps in preventing the growth of pathogenic bacteria in foods. Important numbers to remember for safe holding temperatures are:
41°F or cooler and 135°F or hotter
Danger zone: bacteria will grow very rapidly in foods between 41°F and 135°F
Foods that are moist and high in protein (such as meats, rice, beans, dairy foods and eggs) are most susceptible to bacterial growth. The warmer and moister the food, the faster bacteria can grow. That is why there is such a concern about foods sitting at room temperature or warmer. Raw produce can also be a source of food borne illness. Fresh produce should be cleaned appropriately and cut leafy greens, tomatoes and melons should be refrigerated.

10. Invisible germs! Option 2: Invisible germs!
Materials and Resources Needed
Book “Mean Nasty Dirty Downright Disgusting but… Invisible Germs” by Judith Anne Rice
Read the children’s book listed above. Model a circle time discussion. Ask the class members to take on the role of the children and instructor, and model questions.
How do we kill those bad germs?
When do we wash our hands? Why? How?
How do you feel when you are sick? How do you make sure your friends do not get sick too?
Why do we use tissue to wipe our noses?
Option 3: Diapering babies
Three baby dolls
Diaper changing supplies
Using the dolls and supplies, demonstrate the steps in properly and improperly changing diapers. Ask the group to tell you what’s wrong in Demos #1 and #2.
Demo #1: Don’t use wipes, change wet pants, or wash hands while saying how “yucky” the baby is.
Demo #2: Diaper normally but treat baby as an object--never looking at or talking to her/him, and instead telling the group about a favorite novel or movie.
Demo #3: Model the conversation the care provider might have with a baby during a change of diapers while following proper changing procedures (such as discussing what you are doing, and asking the baby to help as much as possible).
Finish by discussing the concept of partnering with a baby or toddler during routine tasks, and identify barriers to healthy practice and ideas that can help.
 Option 4: Healthy practice: food preparation and serving
Handout 2, “Healthy Practices for Preparing and Serving Food to Children in Your Care”
Use Handout 2 as a tool for reflecting on food handling practices. Not all participants may see themselves as responsible for keeping food safe, but best practice recommends that everyone is knowledgeable.

11. Most children’s settings do not provide opportunities for children to participate in the recommended 60 minutes of structured and 60 minutes of unstructured physically active play. Why is this? Very few of us get enough sleep. How can you help children in your care get enough rest?

12. Safe and Healthy Environments
Young children depend upon the adults in their lives to make healthful choices for them
and to teach them to make such choices for themselves
Presentation
High quality programs promote safe and healthy environments where children can thrive and grow. Young children depend upon the adults in their lives to make healthful choices for them and to teach them to make such choices for themselves
Infant Nutrition
Infants should be fed when they are hungry and should always be held when being fed a bottle. Feeding time should be pleasant with the caregiver making eye contact with the infant in their arms. Breastfeeding is the best food for an infant and child care providers have the unique opportunity to support and encourage mothers to continue to breastfeed their infants. Some infants may be receiving infant formula. Infants under 12 months of age should receive breast milk or infant formula and not cow’s milk. Solid foods should be introduced between 5-7 months of age when the infant can sit up by themselves, hold up their head and engage in feeding by opening their mouth when they want food and closing mouth and turning away when they are full. Juice should not be offered to infants. Water can be offered in a small cup for infants over 6 months of age. Do not feed infants honey or foods made with honey because of the risk of a rare but serious condition called botulism. At 8 to 9 months begin to introduce table foods such as small pieces of cooked vegetables, meat, chicken or turkey; soft fruit such as bananas; cooked chopped noodles or rice; mashed beans, tofu or egg yolk; and bite sized pieces of toast, plain crackers or tortillas.

13. Child Nutrition: Just how much food do children need?
Just how much food do children need? According to the regulations food must be offered about every 2 to 3 1/2 hours. Snacks or breakfast must be served upon arriving at morning care, and snacks need to be served to children after school. Children in care for five hours need to be served breakfast or lunch and a snack at the minimum. Basically, if children are hungry, feed them. Children do have small stomachs so they need small amounts of food often. A general rule of thumb is one tablespoon per year of age as a serving size. A two year old’s snack might be two tablespoons of applesauce, ½ slice of whole wheat toast and a quarter cup of water.
Children need a variety of foods from each of the food groups. Children should be offered a wide variety of fresh, frozen or canned fruits (canned in 100% juice or water) and vegetables; nonfat or 1% milk for children over 2 years of age and whole milk for those 1-2 years of age; whole grains (100% whole wheat breads, brown rice); and lower fat protein foods (lean beef or chicken, beans). Limit or do not serve high fat processed meats (hot dogs, corn dogs, sausages) and pre-fried or fried and then baked meats and potatoes (chicken nuggets, fish sticks, French fries, tater tots). Also limit sweets (candy, cake, cupcake, cookies); sweet grains/breads (pop tarts, donuts, muffins, sugary cereals) and sweetened beverages. Children should have access to water throughout the day as needed. The regulations provide the following guidelines:
Breakfast must contain:
Fruit or vegetable or100% juice
A dairy product
A grain product
Lunch or dinner must contain:
Source of protein – meat, fish, legumes, tofu
Fruit and Vegetable – or two of one of these
Snack must offer a beverage and at least two of the following:
Source of protein – egg, legumes, meat, tofu
Fruit or Vegetable
WA State Meal Pattern for Licensed Child Care Programs in graphic format:
Preschool Snack Handbook:
Healthy Recipe Ideas for Child Care Programs:
journalistsresource.org

14. Snack and Mealtimes are Social times
Snack and mealtimes are social times-- make sure you sit down and eat with children. Serve family style, so that each child can serve himself to satisfy his hunger. This also gives the children opportunities to practice motor and social skills, to engage in conversation, and to have plenty of time to enjoy each other around the table.
Make sure you sit down and eat with them.

15. Mix it up — serve a variety of nutritious choices.
Opt for healthier alternatives
Childhood obesity is a growing concern around the country. One in six children is overweight or obese by age six. What is your role in helping children in your care establish healthy eating habits? Many resources are available to you. Check out the great ideas from the “Let’s Move Child Care” website, and print out resources to distribute in class from these links or

16. Dental Care Dental Care
Dental decay is the most common childhood disease, and there is much you can do to prevent it. Following is a short list of best practices:
Wean children from bottles by age one
Avoid prolonged use of sippy cup
Between meals, water only – fluoridated tap water
Limit fruit juice to no more than a half a cup a day
Brush teeth once per day while at child care
Encourage families to begin regular dental examinations when their child is one year of age and to brush their child’s teeth until they turn six or when they are capable of adequately brushing their teeth on their own.
Free dental education materials from the Washington Dental Services Foundation:
myzazoo.com

17. Physical Activity Improved energy level Better concentration
Reduced risk of child diabetes, heart disease, and high blood pressure
Opportunity to develop friendships
Improved ability to handle stress
Physical Activity
Promoting physical activity should be a part of a quality program. Too many children spend too much time in sedentary activities resulting in problems with obesity and patterns that Physical activity provides many benefits, including:
Better concentration
Improved energy level
Improved ability to handle stress
Increased self-confidence and self-esteem
Opportunity to develop friendships
Reduced risk of child diabetes, heart disease, and high blood pressure
Children are built for play and activity. Your role is to provide opportunities for developmentally appropriate, challenging, fun and safe choices for physical activities
Take a quick look at this visual, print it up as a reminder of how you might meet children’s needs for exercise. “My Activity Pyramid”:
Check out the Playworks website for a list of age-specific games to play with children. Most require minimal equipment:
Children must have daily opportunities for outside play. Fresh air and time to explore the natural world are just some of the benefits.

18. Sleep / Rest How much sleep do children need?
How much sleep do children need? How do you know when they are getting enough rest? We know that tired children cannot concentrate, are irritable, and just do not function well. Research is also linking sleep loss with obesity. For young children, the crucial factor in reducing the risk of obesity was getting more than 10 hours of sleep at night, daytime naps did not help. As a child care provider, you must provide a rest period for all young children (five or younger) if they are in your care for more than six hours OR if they show a need for rest. Babies and toddlers younger than 29 months need to follow individual sleep schedules; toddlers need about 2 hours of naptime during the day. Even if a child is not able to fall to sleep while in your care, they must be provided with alternative quiet activities.
Go to this site for an informative brochure to share with parents as you develop a partnership to insure children get enough sleep and rest:
How do you know when they are getting enough rest?

19. Sudden Death Syndrome (SIDS)
About one in five sudden death syndrome (SIDS) deaths
occur while an infant is in the care of someone
other than a parent,
often within the first few days of care
outside the home.
Back to sleep
About one in five sudden death syndrome (SIDS) deaths occur while an infant is in the care of someone other than a parent, often within the first few days of care outside the home. When babies who are used to sleeping on their backs are placed to sleep on their tummies by their child care provider, they are 18 times more likely to die from SIDS. This is called “unaccustomed tummy sleeping.” You can reduce a baby’s risk of dying from SIDS by placing babies in your care one their back during naps. For more information:

20. Sleeping equipment for children over 1 year of age
Where and how do child care providers get all of their children down for cozy naps? Floors are cold and hard – children need comfortable, warm and clean sleeping surfaces. Each child must have his own separate bedding and it needs to be stored without touching other bedding.

21. Talk about “sometime” vs. “anytime” foods.
Instead of expecting young children to understand the do’s and don’ts of nutrition, it can help to talk about “sometime” and “anytime” foods.
So “sometime” foods are snacks and meals that are OK for kids to have only occasionally:
cookies
cakes
candy
ice cream
chips
processed meats (like hot dogs, bologna, and others)
And “anytime” foods are much healthier options kids can enjoy plenty of whenever:
fruits
vegetables
whole grains
low-fat dairy products
healthy proteins (like beans, chicken, fish)
Help the kids learn all about "sometime" and "anytime" foods with the Healthy Habits for Life Resource Kit. Created by Sesame Workshop and Let's Move! Child Care partners Nemours and Nemours' KidsHealth.org, this guide (available in English and Spanish) teaches child care providers and children concepts of nutrition and physical fitness using kids' favorite Sesame Street puppet friends.

22. Physical Activity- getting the fun started!
Option 2: Fitness & exercise- getting the fun started
Materials Needed
Paper, pens or whiteboard
As a large group or in pairs, make a list of characteristics of an early learning program that encourage physical activity and healthy eating for children. Ideas to get them started:
Large playground space
Limited use of electronic media
Guidance policies where removal of outdoor play is NOT a consequence for negative behavior and food is NOT a reward
Adults take an active role in outdoor play
amrutam-nopen.blogspot.com

23. Healthy Choices: Let children participate in preparing food, if possible.
When kids have a hand in helping to make their own foods, they’re more likely to try and eat new, nutritious things. Giving them special jobs (like stirring and adding ingredients) makes them feel like helpful "big boys" and "big girls" and proud of what they created.
Try some of these kid-friendly recipes from Nemours' KidsHealth.org:
Cracker Stackers
Crazy Combos
Disappearing Zucchini Muffins
Junior Salad Bar
Mini Pizzas
Peachy Parfaits

24. Websites have great ideas for healthy snacks
Websites have great ideas for healthy snacks! Let kids create their snacks
ants on a log (celery topped with peanut butter and raisin "ants")
egg boats (hard-boiled egg wedges topped with a cheese sail)
veggie faces (like cucumber eyes, tomato nose, green bean mouth, and shredded carrot hair)
friendship fruit salad (every child brings in a whole or cut-up fruit and it all gets mixed together)
Do the veggie/fruit dip.
Toddlers and preschoolers love dipping, so try serving veggies with yogurt, hummus, low-fat dressing, or low-fat melted cheese.
Learn about how food grows.
Take a field trip to the local farmers’ market or pick-your-own-farm. Or grow a garden with the kids to talk about where food comes from and to pique their interest in trying the new produce they see.
Get ideas from Grow It, Try It, Like It! Preschool Fun With Fruits and Vegetables — a garden-themed nutrition education kit from the U.S. Department of Agriculture (USDA) Team Nutrition.
Web sites:
Kid’s Health form Nemour “Kids and Exercise”:
“BAM” (Body and Mind) for kids, from the Centers for Disease Control and Prevention:
Peak Fitness by Dr. Mercola:
Head Start’s “I am Moving, I am Learning”--a source of information, excellent videos, booklets, suggestions for environments:
Guide for children’s sleep:

25. What childhood illnesses and injuries are you most likely to see
What childhood illnesses and injuries are you most likely to see? Can you identify symptoms and recommended care? How do your practices reduce exposure to childhood illnesses?
Outcome C
The student will identify signs of and care for basic childhood illnesses and injuries.
 Discussion Questions
What childhood illnesses and injuries are you most likely to see? Can you identify symptoms and recommended care?
How do your practices reduce exposure to childhood illnesses?
Presentation
Too ill?
Your first responsibility in keeping children healthy while in your care is to check them for signs of illness when they arrive, as well as throughout the day. (See Handout 4, “Daily Health Check,” for symptoms for both children and staff).
Children with common colds do not need to stay home. Usually a child has already exposed others before presenting symptoms. Refer to your local health department to get a list of contagious and non-contagious illnesses. Excluding or isolating children with non-contagious, mild illnesses can be a hardship on the family and child.
The center must have a clear policy on excluding a child from care. Some infections such as chickenpox, hepatitis, and meningitis require the child to stay home for a lengthy recovery period. The policy should be included in the Parent Handbook, and parents should be encouraged to have a back-up plan for their child’s care when their child is too sick to be in your program. If children are uncomfortable, disoriented, or irritable, they are better off at home getting the rest and individual attention they need. Talk to your health consultant or your local health department if you have questions about a particular illness (refer to for specific information). See Handout 5 “Following Health Policy.”
Handout 4-Daily Health Check

26. When a Child becomes Ill or is Injured While in Your Care
Children who become ill while in your care must be isolated. Have them lie down in a quiet space away from the other children, but within view of the staff. Staff must supervise ill children at all times. Contact the parents to come pick up their child. Your responsibilities include the following:
Keep a confidential, individualized, written record in the child’s file that includes the date of an illness or injury, treatment provided and names of staff providing the treatment. (See your Guidebook / Guide for sample reporting forms)
If you suspect the child has a communicable disease, remember to sanitize all equipment that the ill child used.
If an injury or illness results in a visit to the child’s doctor and includes casting, stitches, or hospitalization, you are required to notify your child care licensor.
Notify parents in writing when their children have been exposed to infectious diseases or parasites. The notification may be either a letter to families or posting for all in a visible location.
todaysparent.com
What must you do?

27. Giving Medication to Children in Your Care
If a child has a condition
where the American with Disabilities Act (ADA) would apply,
you must make reasonable accommodations
and that may mean giving a child medication.
What are your responsibilities when giving medication to children in your care?
If a child has a condition where the American with Disabilities Act (ADA) would apply, you must make reasonable accommodations and that may mean giving a child medication. The family must provide written instructions to caregivers on the proper administration of the medications or treatment required for the child. Care providers are free to choose whether or not to give medications outside of those required by the ADA. Your decision must be clearly documented in your health care policy and handbook. If a medication is prescribed two times per day or daily, oftentimes the family members will be able to administer it at home. There are exceptions, such as asthma medication, so be clear on when specifically medication needs to be administered.

28. Key Points to Remember Regarding Administering Medication:
Medications cannot be given “as needed.”
There must be a start and stop date for each medication
Return any unused portion to the family
Only documented staff who have been trained and oriented to your medication policies can give medications to children.
Key points to remember regarding administering medication:
Only documented staff who have been trained and oriented to your medication policies can give medications to children.
There must be a start and stop date for each medication. You can only give the medication for the duration of the illness. Medications cannot be given “as needed.” (See WAC regarding use of EpiPens and asthma inhalers).
Return any unused portion to the family.
Read all labels carefully!  

29. Administering Medication
Parents must give written consent
before you give any child any medication.
Non-prescription medications
also require family consent
Parents must give written consent before you give any child any medication.
Non-prescription medications also require family consent, such as antihistamines, non-aspirin fever reducers / pain relievers, decongestants, ointments for dry skin or diaper area, and sunscreen.
You may not mix medications in formula or food unless you have written directions to do so from a health care provider.
Prescription medication must be in the original prescription bottle or packaging.
Prescription medication
must be in the original prescription bottle or packaging.

30. Health Policy Examples
You should not accept a child for care before the parent signs the medical emergency authorization form.
The medical emergency authorization form should be with the child at all times they are in your care. This includes field trips.
Health policy examples
Licensed programs must have a written health policy signed by a physician, physician assistant, registered nurse, or public health nurse. The policy must be reviewed and approved whenever any changes are made in your health practices or procedures, but at least every three years (usually at re-licensing time). Each program is unique, so new staff must be trained in the details of your health policy. All policies must be available for review by staff, parents, or others (licensors, health care consultants, etc.). Many centers have a three-ring binder at a central location that contains the Health Policy, Disaster Plan, Pesticide Policy, and Animals on the Premises Policy. See your Center Guidebook Appendix A (page 233, “Health Policy”) or Family Home Child Care Licensing Guide Section 5 (“Health”) and Section 6 (“Health Plan”).
Your Health Policy will inform you of what to do in the case of a medical emergency. Among the forms families must sign when they enroll their child is a Medical Emergency Authorization form (also referred to as a Medical Consent form). With this form, families authorize and give personal consent for medical personnel to begin emergency medical treatment before parents arrive. Medical personnel cannot legally provide services for a minor without the consent of his/her guardian.
For your protection and the safety of the child you should not accept a child for care before the parent signs the medical authorization form.
The medical emergency authorization form should be with the child at all times they are in your care. This includes field trips.

31. Emergency Preparedness
What will you do?
Emergency preparedness
Health Policies also include basic plans for Emergencies / Disasters / Crisis Preparation. Though each plan will be specific to the program and facility, disaster plans must include:
What you will do if families are not able to get to their children for two or three days
Who is designated to be responsible for each part of the plan
Procedures for accounting for all children and staff during and after the emergency
Plans for evacuation and meeting after the emergency
Accommodations for children with special needs
Plans for contacting parents, transporting and providing for children
Written documentation of quarterly disaster drills for children and staff
For an example of a complete emergency plan see:
Including children and families in preparing for emergencies increases the likelihood that children will be kept safe and out of harm’s way. Some examples:
Teaching preschoolers how to “Stop, Drop, and Roll”
Engaging families in collecting emergency supplies to provide for three days of care in your program
Practice evacuation drills at different times of the day using alternate exits
You take on huge responsibilities when caring for young children. Knowledge is powerful and skill development is vital. Stay current with Pediatric First Aid / CPR training and practice so you will know what to do.

32. What would you do…?
Option 2: What would you do…?
Handout 5, “Following health policy: What would you do…?”
Copies of the Child Care Center Licensing Guidebook and/or Family Home Child Care Licensing Guide
Use Handout 5 as a review of how your program’s health policy will determine how you deal with different situations involving illness, injury or illness prevention. Have students use the Licensing Guidebook or Family Home Guide as resources to help fill in the table. Discuss answers.
For instructor:
Lizzy’s case of Whooping cough needs to be reported to the local health department (WAC ). Go to for the complete list of communicable diseases professionals are mandated to report. See Appendix in the Center Guidebook (page 241) for an example of Health Policy addressing this situation.
For Jamal’s injury, follow first aid steps, fill out the Child Care Injury/ Incident Report or Incident Log, closely monitor his symptoms, and then communicate with his parents when they come to pick him up.
Explain to the visiting parent Gloria that “In order to protect all children in our care and our staff, and to meet state health requirements, we only accept children fully immunized for their age. The Certificate of Immunization Status (CIS) is kept on file to prove compliance. Children may attend child care without an immunization if the parents sign the back of the CIS form stating they have personal, religious, or philosophical reasons for not obtaining the immunizations, OR the child’s health care provider signs that the child is medically exempted from immunizations. However, children not immunized will not be accepted into care during outbreaks of diseases or illnesses which can be prevented by immunizations.” (See Appendix A of the Center Guidebook or pages 5.17 of the FHCC Guide).
Handout 5, “Following health policy: What would you do…?”

33. Module 7 Review This module is designed:
To address the concepts of wellness, nutrition and fitness in early childhood.
Introduce the basic licensing requirements for the Washington Administrative Code (WACs) for healthy practices.
Ball toss circle
Materials Needed
Small, soft ball
Ask the group to stand in a large circle and gently toss a small soft ball (like a Kush or Nerf) to a participant and ask her/him to:
Name one new thing s/he learned today or thought was particularly important (explain that they can say pass if nothing comes to mind at the time).
Next s/he tosses the ball underhand to another participant to answer the questions and so on until whole group has participated.

34. Check for Understanding
Assessment of Learning
Have students take the quiz on Handout 6, “Check for Understanding
Handout 6, Check for Understanding
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