Caring for Our Children Guidelines for Early Care and ...

1 Caring for Our ChildrenFOURTH EDITIONN ational Health and Safety Performance Standards Guidelines for Early care and Education ProgramsCaring for Our ChildrenNational Health and Safety Performance StandardsGuidelines for Early care and Education Programs, 4th EditionA Joint Collaborative Project of American Academy of Pediatrics American Public Health AssociationNational Resource Center for Health and Safety in Child care and Early EducationEvery day millions of Children attend Early care and education programs. It is critical that they have the opportunity to grow and learn in healthy and safe environments with Caring and professional caregivers/teachers. The American Academy of Pediatrics, the American Public Health Association, and the National Resource Center for Health and Safety in Child care and Early Education are pleased to release the fourth edition of Caring for Our Children : National Health and Safety Performance Standards; Guidelines for Early care and Education Programs.

2 These national standards represent the best evidence, expertise, and experience in the country on quality health and safety practices and policies that should be followed in today s Early care and education revised and updated, the fourth edition features 10 chapters of more than 650 standards and dozens of appendixes with valuable supplemental information, forms, and Include Staffing Program Activities for Healthy Development Health Promotion and Protection nutrition and Food Service Facilities, Supplies, Equipment, and Environmental Health Play Areas/Playgrounds and Transportation Infectious Diseases Children with Special Health care Needs and Disabilities Administration Licensing and Community ActionAnd Features More than 100 updated standards Updated appendixes, including Signs and Symptoms Chart, recommended immunization schedules, and Recommendations for Preventive Pediatric Health care Many revisions and updates in environmental health, infectious diseases, and nutritionCaring for Our ChildrenNational Health and Safety Performance Standards Guidelines for Early care and Education Programs, 4th EditionAAPCFOC COVER SPREAD - All Pages11/29/18 4:10 PMA Joint Collaborative Project ofAmerican Academy of Pediatrics345 Park BoulevardItasca, IL 60143 American Public Health Association800 I Street NWWashington, DC 20001-3710 National Resource Center for Health and Safety in Child care and Early EducationUniversity of Colorado, College of Nursing13120 19th AvenueAurora, CO 80045 Support for this project was provided by the Maternal and Child Health Bureau, Health Resources and Services Administration, Department of Health and Human Services (Cooperative Agreement #U44MC30806).

3 Caring for Our ChildrenFOURTH EDITIONN ational Health and Safety Performance Standards Guidelines for Early care and Education ProgramsThe National Standards are for reference purposes only and shall not be used as a substitute for medical or legal consultation, nor be used to authorize actions beyond a person s licensing, training, or of resources does not imply an endorsement by the copyright holders. The copyright holders are not responsible for the content of external resources. Information was current at the time of names are furnished for identification purposes only. No endorsement of the manufacturers or products mentioned is implied. The publishers have made every effort to trace the copyright holders for borrowed material. If they have inadvertently overlooked any, they will be pleased to make the necessary arrangements at the first discounts are available for bulk purchases of this publication.

4 E-mail Special Sales at for more information. 2019 American Academy of Pediatrics, American Public Health Association, and National Resource Center for Health and Safety in Child care and Early EducationAll rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means electronic, mechanical, photocopying, recording, or otherwise without prior written permission from the publisher (locate title at and click on Get permissions; you may also fax the permissions editor at 847/434-8780 or e-mail photographs in this publication were taken using funds from cooperative agreement #U44MC30806 for the US Department of Health and Human Services, Administration for Children and Families, Office of Head Start, Office of Child care , and Health Resources and Services Administration, Maternal and Child Health Bureau, by the National Center on Early Childhood Health and Wellness.)

5 The photographs may be duplicated for noncommercial uses without permission. The photographs are in the public domain, and no copyright can be claimed by persons or Citation:American Academy of Pediatrics, American Public Health Association, National Resource Center for Health and Safety in Child care and Early Education. Caring for Our Children : National Health and Safety Performance Standards; Guidelines for Early care and Education Programs. 4th ed. Itasca, IL: American Academy of Pediatrics; 2019 Printed in the United States of America1 2 3 4 5 6 7 8 9 10MA0908 ISBN: 978-1-61002-297-2eBook: 978-1-61002-298-9 Cover and publication design by Linda DiamondLibrary of Congress Control Number: 2018947984iiiAcknowledgments ..ixIntroduction ..xviiGuiding Principles ..xixAdvice to the User ..xxHistory of Caring for Our Children Standard Language Changes Since the 3rd Edition (Through July 2018).

6 Xxiii Chapter Staffing ..1 Child:Staff Ratio, Group Size, and Minimum Age .. Child:Staff Ratio and Group Size .. Minimum Age .. Recruitment and Background Screening .. Pre-service Qualifications ..11 Director s Qualifications .. Caregiver s/Teacher s and Other Staff Qualifications .. Family Child care Home Caregiver/Teacher Qualifications .. Professional Development/Training .. Pre-service Training .. Orientation Training .. First Aid and CPR Training .. Continuing Education/Professional Development .. Specialized Training/Education .. Educational Leave/Compensation .. Substitutes ..34 Consultants ..36 Staff Health .. Human Resource Management .. Benefits .. Evaluation ..47 Chapter Program Activities for Healthy Development ..49 Program of Developmental Activities .. General Program Activities .. Program Activities for Infants and Toddlers from Three Months to Less Than Thirty-Six Months.

7 59 Program Activities for Three- to Five-Year-Olds .. Program Activities for School-Age Children .. Supervision and Discipline .. Parent/Guardian Relationships .. General .. Regular Communication .. Health Information Sharing .. Health Education .. Health Education for Children .. Health Education for Staff .. Health Education for Parents/Guardians ..90 ContentsivContentsChapter Health Promotion and Protection ..93 Health Promotion in Child care .. Daily Health Check .. Routine Health Supervision .. Physical Activity and Limiting Screen Time .. Safe Sleep .. Oral Health .. Hygiene .. Diapering and Changing Soiled Clothing .. Hand Hygiene .. Exposure to Body Fluids .. Cleaning, Sanitizing, and Disinfecting .. Health Protection in Child care .. Tobacco and Drug Use .. Animals .. Emergency Procedures .. Child Abuse and Neglect.

8 Sun Safety and Insect Repellent ..135 Strangulation .. care Plans and Adaptations .. Management of Illness .. Inclusion/Exclusion Due to Illness .. Caring for Children Who Are Ill .. Medications .. Reporting Illness and Death ..155 Chapter nutrition and Food Service ..159 Introduction .. General Requirements .. Requirements for Special Groups or Ages of Children .. nutrition for Infants .. nutrition for Toddlers and Preschoolers .. nutrition for School-Age Children .. Staffing .. Meal Service, Seating, and Supervision .. Food Brought From Home .. nutrition Learning Experiences for Children and nutrition Education for Parents/Guardians .. Kitchen and Equipment .. Food Safety .. Meals from Outside Vendors or Central Kitchens ..206 Chapter Facilities, Supplies, Equipment, and Environmental Health ..209 Overall Requirements.

9 General Location, Layout, and Construction of the Facility .. Space per Child .. Openings .. Exits .. Steps and Stairs ..221 Exterior Areas .. Quality of the Outdoor and Indoor Environment .. Ventilation, Heating, Cooling, and Hot Water .. Lighting .. Noise .. Electrical Fixtures and Outlets ..233 Fire Warning Systems ..234 Water Supply and Plumbing .. Sewage and Garbage .. Integrated Pest Management ..241 Prevention and Management of Toxic Substances .. General Furnishings and Equipment .. General Furnishings and Equipment Requirements ..253 Additional Equipment Requirements for Facilities Serving Children with Special Health care Needs ..260 Space and Equipment in Designated Areas .. Toilet and Handwashing Areas .. Diaper Changing Areas .. Bathtubs and Showers .. Laundry Area .. Sleep and Rest Areas.

10 Space for Children Who Are Ill, Injured, or Need Special Therapies ..272 Storage Areas .. Maintenance ..277 Chapter Play Areas/Playgrounds and Transportation ..281 Play Area/Playground Size and Location ..283 Play Area/Playground Equipment .. General Requirements ..287 Use Zones and Clearance Requirements ..291 Play Area and Playground Surfacing .. Specific Play Equipment ..293 Inspection of Play Areas/Playgrounds and Water Play Areas (Pools, Etc.) .. Access to and Safety Around Bodies of Water ..297 Pool Equipment .. Pool Maintenance .. Water Quality of Pools .. Other Water Play Areas .. Toys .. Selected Toys .. Riding Toys and Helmets ..305 Transportation .. Transportation Staff ..307 Transportation Safety ..309 Vehicles ..313 viContentsChapter Infectious Diseases ..315 How Infections Spread.