Script
“Health and Safety: The First Line of Defense”
Jahnette Wilson, Ed.D.
Slide # 1. Introduction
Welcome to the Collaborative for Children’s Online Child Care Provider Training Program, hosted by the
Texas AgriLife Extension Service. “Health and Safety: The First Line of Defense” is a course designed to
provide you with the necessary tools to implement safe and healthy practices in child care settings, both inside
and outside. You will learn about disease risks, hand washing procedures, sanitation, and supervision measures
that must be maintained for children’s safety.
Slide #2: Learning Objectives
Let’s take a few minutes to go over the learning objectives for the course. By the time you complete this course,
you should be able to:

demonstrate appropriate practices to implement and monitor infection control and manage infectious
disease, and

use preventative measures to protect children from injury or potential harm.
Slide # 3. Why Health Practices Are Important in Early Childhood Program Settings
Federal law requires that states have policies to protect young children’s health and safety. The number of
children younger than 6 in child care has steadily increased in the past 30 years. According to the National
Association for the Education of Young Children, or NAEYC, 70 percent of the children in the United States
are in a child-care setting. A reported 11.3 million children need child care, with approximately 60 percent of
these children in some type of non-parental care arrangement (Feeney, Moravcik, Nolte, & Christensen, 2010).
Incidence of illnesses decreases with age, suggesting that early childhood is a sensitive period for contracting
infectious illnesses (National Health and Safety Performance Standards, 2002). Therefore, early childhood
programs must ensure that they are doing all they can to provide for the health and safety of young children.
When children are cared for by non-family members, there is an increase in the transmission of infectious
agents, causing among others, upper respiratory tract infections and diarrhea. Respiratory tract infections are
spread when fluids from the mouth, nose, eyes, and lungs are passed from person to person. Diarrhea may be
caused by inadequate handwashing and unsanitary diapering practices (National Health and Safety Performance
Standards, 2002).
Teachers of young children must be aware of and practice routines for safety and wellness (Feeney, Moravcik,
Nolte, & Christensen, 2010). For example, rates of illnesses in early-care settings can be reduced by
implementing a simple hygiene measure: proper handwashing. This course will discuss in detail the specific
practices and routines teachers of young children should use to prevent and control the spread of illness.
Slide # 4. Health and Nutrition Education in the Curriculum
The health and safety core knowledge areas recommended by the Texas Early Care and Education Career
Development System include knowledge and skills regarding both health and nutrition education in the
curriculum.
Health education curriculum includes personal hygiene routines, medical procedures, and substance abuse.
Teachers of young children must establish and model personal hygiene routines, such as tooth brushing and
handwashing. Children will learn from repeated practice and discussion (Feeney, Moravcik, Nolte, &
Christensen, 2010). Additionally, medical procedures, such as what happens when you go to the doctor or
dentist, should be discussed with children. This will give children a more complete understanding of what to
expect when they go to these places, and it will help them to be less fearful.
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Health and nutrition education also includes safety measures such as fire, traffic, water, poison, and personal
safety. This course will address several of these areas – specifically, water, poison, and personal safety.
A critical factor in childhood obesity is children’s food choices. You must help children learn to make food
choices that will help them to grow and be healthy (Feeney, Moravcik, Nolte, & Christensen, 2010). Nutrition
education includes healthy foods to eat during snack and meal times, as well the inclusion of cooking
experiences. Specifically, the nutritional needs of children – giving attention to special dietary or cultural
requirements – are essential.
Slide # 5. Physical Education in the Curriculum
Fewer opportunities for active play and a sedentary lifestyle are factors that contribute to the growing problem
of childhood obesity in our society. As a teacher of young children, it is important that you make physical
education a part of your curriculum (Feeney, Moravcik, Nolte, & Christensen, 2010). Including physical
education in the curriculum encourages motor development and growth in the following areas: agility, balance,
coordination, power, reaction time, speed, and physical fitness.
Slide # 6. What Is a Pathogen?
We will now look at infection control in early childhood programs. To begin our discussion of this subject, we
need to define the word “pathogen,” as many of the preventative measures we will be discussing are aimed at
limiting the spread of pathogens. A pathogen is a microorganism of substance that causes a disease. Pathogens
may be bacteria, viruses, fungi, or parasites. This is what we call “germs.” Infectious diseases are those caused
by a living organism, such as bacteria or a virus. Communicable or contagious diseases are infectious illnesses
that can be spread from one person to another (Feeney, Moravcik, Nolte, & Christensen, 2010).
Slide # 7. Disease Risk in Child Care
Disease risks occur whenever blood or body fluids are involved. For example, special care must be taken when:

administering first aid while a child is bleeding or being diapered,

assisting in medical procedures,

assisting with a loose tooth,

changing bandages or dressings,

handling breast milk,

performing CPR, or

handling contaminated waste.
Slide # 8. Benefits of Infection Control
Early childhood programs must make sure that they are doing everything they can to prevent and control the
spread of disease. Illness can be controlled by limiting the ways that pathogens or germs can be transmitted or
passed from person to person. The benefits of infection control are numerous. They include, but are not limited
to, reducing:

child care illnesses,

number of physician visits,

antibiotic use,

absences from school,

expenses incurred by parents of sick children,
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
cost to parents as employees, and

cost of loss of productivity in the workplace.
Slide # 9. Hygienic Environments
To limit the spread of pathogens and provide for optimal health and safety for young children, teachers must
maintain a clean and hygienic environment. Tips for providing clean, pathogen-free environments include:

keeping all surfaces clean,

avoiding long and artificial nails,

following handwashing procedures,

following guidelines for cleaning and sanitizing toys, and

removing germ-trapping jewelry.
Slide # 10. Daily Health Checks
To further limit the spread of pathogens, conduct daily health checks of your students. The first daily health
check should be carried out at the door before the child ever enters the classroom. This will help to make sure
sick children are not coming into the classrooms. Other health checks can be done throughout the day.
Specifically, you should routinely look for changes in the child’s behavior or demeanor, as well as take note of
any noticeable changes in the child after naptime. Recognizing early signs of illness by doing health checks will
help to prevent the spread of illness.
Slide # 11. Keeping Healthy
As a precaution, teachers of young children should strive to maintain their own health. Tips for ensuring your
own health and safety include:

avoid injury;

clean all cuts, scrapes, and broken skin properly with soap and water;

stay hydrated;

eat a balanced menu of healthy foods;

get rest; and

ensure that all employees and children are immunized.
Slide # 12. Children and Fevers
A discussion of germs and infectious illness requires a conversation about children and fever. Fever is the result
of pathogens in the body. Children with fever are to be excluded from early childhood program settings under
certain conditions. The National Health and Safety Performance Standards list three conditions that require
exclusion from childcare settings, one of which directly involves fever:

The child cannot participate comfortably in the daily activities.

The illness demands greater care than teachers or caregivers can provide.

The child has fever, diarrhea, or any symptoms and signs of possible severe illness (for example,
extreme tiredness, uncontrolled coughing, difficulty breathing, wheezing, or unexplained irritability).
The Texas Minimum Standards for Childcare Centers (2006) requires certain procedures be followed if a child
becomes ill in care:
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
Contact the parent to pick up the child.

Care for the child apart from other children.

Give the child appropriate attention and supervision until the parent picks the child up.

Give extra attention to handwashing and sanitation if the child has diarrhea or vomiting.
Parents must keep the sick child at home for at least 24 hours after they no longer have fever and have stopped
taking medication for fever or flu symptoms (Texas Minimum Standards for Child-Care Centers, 2006).
Slide # 13. Importance of Handwashing
The single most effective way to prevent the spread of disease is through handwashing. Proper handwashing
decreases the level of contamination on children’s and teachers’ hands, removing the organisms from the skin
while reducing the chance of spreading disease. Studies have shown that unwashed hands are the main carriers
of disease and illness. Diarrhea-related illness has been shown to decrease by 50 percent in centers that have
implemented routine handwashing. Experts found a reduction of colds as a result of frequent and proper
handwashing practices in a center’s curriculum (National Health and Safety Performance Standards, 2002).
Many programs have not been provided extensive training or re-training in the correct methods of dealing with
potential pathogens. The next few slides will focus on appropriate and sanitary handwashing procedures.
Slide # 14. When Must Employees and Children Wash Hands?
As has already been mentioned, the single most effective way to prevent the spread of disease is through
handwashing. Teachers of young children should work to make sure that their own hands are clean by washing
their hands many times throughout the day. By doing so, it limits the spread of disease and also protects your
health (Feeney, Moravcik, Nolte, & Christensen, 2010). The National Health and Safety Performance Standards
(2002) recommend that you wash your hands:

before and after eating or handling food or medication;

before and after feeding a child;

after arriving at the center;

after diapering a child;

after assisting a child with toileting;

after personal toileting;

after handling or cleaning body fluids, such as after wiping noses, mouths, or bottoms, and tending to
sores;

after handling or feeding animals;

after outdoor activities;

after handling raw food products, especially raw meat and poultry;

after using any cleaners or toxic chemicals; and

after using sand, water, or play dough.
Slide # 15. How Must Children and Adults Wash Their Hands?
According to the National Health and Safety Performance Standards (2002), children and adults should adhere
to specific handwashing procedures:

Check to be sure a clean, disposable paper towel (or single-use cloth) is available.
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
Turn on warm water, no less than 60 degrees Fahrenheit and no more than 120 degrees Fahrenheit, to a
comfortable temperature.

Moisten hands with water, and apply liquid soap to hands.

Rub hands together vigorously until a soapy lather appears, and continue for at least 10 seconds. Rub
areas between fingers, around nail beds, under fingernails and jewelry, and back of hands.

Rinse hands under running water, no less than 60 degrees Fahrenheit and no more than 120 degrees
Fahrenheit, until they are free of soap and dirt. Leave the water running while drying hands.

Dry hands with the clean, disposable paper or single-use cloth towel.

If taps do not shut off automatically, turn the tap off with the disposable paper or single-use cloth towel.

Throw the disposable paper towel into a lined trash container; or place single-use cloth towels in the
laundry hamper; or hang individually labeled cloth towels to dry. Use hand lotion to prevent chapping of
hands, if desired.
Slide # 16. How Must I Wash Infant Hands?
You must provide assistance for infants who are unable to stand and may be too heavy for you to hold safely
while you wash their hands (National Health and Safety Performance Standards, 2002). The proper procedure
for washing an infant’s hands is as follows:

Wash the infant’s hands using soap and an individual cloth or disposable towel.

Then, rinse the soap off using clear water and an individual cloth or disposable towel.

Finally, dry the infant’s hands with a clean paper towel.

Use soap and running water when infants are old enough to be raised to the faucet and reach for the
water, as well as any other time that the caregiver has reason to believe the child has come in contact
with substances that could be harmful to the child.
Slide # 17. Other State Requirements
Children 18 months of age and older and employees must wash their hands with soap and running water. Premoistened towelettes, wipes, or waterless hand cleaners are not a substitute for soap and running water.
Additionally, the running water used should not exceed 120 degrees Fahrenheit and must be controlled by a
thermostat. It is critical that the water be comfortable for handwashing so that procedures will be followed
properly.
Slide # 18. The Facts about Hand Sanitizers
We cannot discuss handwashing without addressing hand sanitizers. Today, hand sanitizers are used frequently.
However, hand sanitizers carry safety hazards of which many caregivers are unaware. You, as a teacher of
young children, must know and be aware of the following critical facts about hand sanitizers:

Hand sanitizers contain either ethyl alcohol or isopropyl alcohol. Ethyl alcohol is the same alcohol that
is in beer, wine, and other liquors, as well as perfumes, after-shave lotions, and mouthwash.

The concentration of alcohol in hand sanitizers varies from 45-95 percent.

Pumps dispense about ½ teaspoonful, or 2.5 ml, of hand sanitizer. If this pea-size amount is swallowed
before it can be rubbed into the hands, it would not pose a problem, even for a small child. However
four mouthfuls, or eight pumps, can be dangerous for children.

A child who overdoses on hand sanitizer has symptoms of a drunken person.
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
Hand sanitizers should be properly stored out of reach of children.

Hand sanitizers can be safe if used properly.
Childcare licensing does not recognize the use of hand sanitizers as washing hands; only the use of soap and
running water is considered actual handwashing.
Slide # 19. Are Teachers Required to Wear Gloves? YES!
So, are teachers required to wear gloves? The answer to that question is a resounding YES! Handling body
fluids is one of the most common ways that diseases are spread. Care must be taken to prevent their occurrence.
In the following video, “Safety Precautions Relating to Blood,” you will see in action the specific infectioncontrol measures that should be taken whenever you come in contact with infectious materials (PDP Video
Library, 2010). As you watch the video, consider your own practices. What changes do you need to make for
your classroom to be a safer environment?
Teachers must use disposable, nonporous gloves when handling blood, vomit, or other bodily fluids that may
contain blood. Gloves should be discarded immediately after use. In removing the gloves, carefully take one
glove off at a time, grabbing the glove at the palm and stripping it off. Ball the first dirty glove in the palm of
the second dirty glove. With the clean hand, strip the second glove off, while simultaneously turning the glove
inside out. After using and disposing of the gloves, you should then wash your hands (National Health and
Safety Performance Standards, 2002).
Slide # 20. Diapering and Toy Sanitization
In addition to handwashing, proper diapering and toy sanitization are two more important preventative measures
that must be taken to limit the spread of germs resulting in illnesses.
Diapering is one of the most common ways to spread illness, and great care must be used when changing young
children’s diapers. Disposable gloves should be worn to protect you from contact with possible pathogens.
Additionally, proper diapering procedures should be followed to make sure to prevent the spread of disease. It is
important that the proper diapering procedures be posted and followed. The National Health and Safety
Performance Standards (2002) have clear minimum standards for diapering. You can look at Standard 3.014 in
Chapter 3 of Caring for Our Children for specific details regarding diaper-changing procedures. Chapter 3 is
available in the Additional Resources section of this course. The Texas Department of Family and Protective
Services (2006) also outline the following Minimum Standards for Childcare Centers regarding diaper
changing:

The changing area should be well set up and should include a changing table with a washable mat.

Promptly change soiled or wet diapers or clothing.

Children should be thoroughly cleansed with individual cloths or disposable towels.

Children must be dry before placing on a new diaper.

You must obtain parent permission before applying powders, creams, ointments, or lotions.

Powders, creams, ointments, or lotions should be labeled with the individual child’s name.

Keep all diaper-changing supplies out of children’s reach.

Supplies such as paper to cover the changing area, plastic bags for soiled diapers, lidded wastebasket,
cleaning supplies, diapers, etc. should be within reach.
Toys can be given to the child to calm them on the changing table. However, the toy must be sanitized before
being played with again. Your hands must be washed even if gloves are worn. Be sure to sanitize the changing
table after each diaper change.
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Another way to make sure that germs are not being spread is to have cloth toys and linens washed at least
weekly. This applies to toys that are not contaminated with body fluids, dress-up clothes not worn on the head,
sheets, pillowcases, used individual cloth towels, combs, hairbrushes, and machine-washable cloth toys
(National Health and Safety Performance Standards, 2002). If a toy is mouthed by a child, it should be removed
from the play area after the child is finished playing with it and sanitized before being played with again.
Let’s take a moment to talk about the sanitizing process for toys and equipment. Plastic toys should be washed
in soap and water, rinsed, and dipped in a disinfectant solution for a minimum of 1 minute. They should then be
allowed to air dry. The process for sanitizing equipment is a little different. Tables and chairs should be washed
and disinfected before and after each meal or activity. High chairs, cribs, swings, playpens, and infant seats
should be washed and disinfected daily, or after use by each child (National Health and Safety Performance
Standards, 2002).
Slide # 21. Areas of Concern in Child Care
Let’s now consider the following specific areas of concern in early childhood programs: indoor and outdoor
environments, supervision of young children, poisons, choking, and finally, child abuse and neglect, including
documenting and reporting child abuse.
Slide # 22. Creating a Safe and Secure Environment for Children in Our Care
The first area of concern involves creating a safe and secure environment for the children in our care. The Texas
Minimum Standards for Childcare Centers (2006) sets the following safety precautions for their protection.

Electrical outlets that are accessible to a child younger than five years must have childproof covers.

220-volt electrical connections within a child’s reach must be covered with a screen or a guard.

Air conditioners, electric fans, and heaters must be mounted out of children’s reach or have safeguards
that keep any child from being injured.

Glass in sliding doors must be clearly marked with decals or other materials placed at children’s eye
level.

Play materials and equipment must be safe and free from sharp or rough edges, and free of all toxic
paints.

Poisonous or potentially harmful plants must not be available to children.

All storage chests, boxes, trunks, or similar items with hinged lids must be equipped with a lid support
designed to hold the lid open in any position, be equipped with ventilation holes, and must not have a
latch that might close and trap a child inside.

All bodies of water such as pools, ponds, creeks, birdbaths, fountains, buckets, and rain barrels must be
not be available to unsupervised children.
Slide # 23. Indoor Safety Concerns
Safety concerns for both indoor and outdoor environments must be taken into consideration. Let’s first discuss
indoor safety concerns. Child-friendly indoor environments must not only be attractive and appealing, but also
safe. You should do everything possible to create a safe inside space by eliminating hazards and safety concerns
and problems. Teachers of young children should be aware of potential risks in the classroom environment, for
example:

Insufficient fall zones on indoor climbing equipment
o There must be a cushioning area under indoor climbing equipment.

Crib or playpen slats or mesh sides that permit entrapment
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o There is a risk of entrapment when slats are more than 2-3/8 inches apart.

Rocking chairs used in areas where mobile infants play

Umbrellas with sharp points left to dry within reach of children

Inappropriate materials used in a sensory table
o Some inappropriate sensory materials include kidney beans (toxic), packing materials that might
cause choking, flour, sawdust, finely milled corn meal, and corn starch.

Dangerous toxic material within reach of children
o Very young children should not use glitter or shaving cream, nor should they be able to reach bleach
water or sanitizers used in the classroom.

Objects and toys small enough to cause choking
o Teachers should be careful when selecting classroom toys. Things like small pegs and bottle tops
should not be allowed in the classroom. You must also be careful to watch what children bring from
home.

Medications that should be stored in locked cabinets
o All medication should be kept out of reach of children. No medications, creams, or ointments should
be kept in children’s bags.
Slide # 24. More Indoor Safety Concerns
Other risks within the classroom environment include the following:

Doors of classrooms left open so a child might leave unnoticed and unsupervised
o All classroom doors should be closed, or safety gates should be used.

Microwave ovens used to heat bottles and baby foods
o Bottles should be warmed with hot water, a bottle warmer, or a crockpot.

Electric fan blades within reach of children
o Fans should be kept out of reach of children.

High chairs, infant seats, or strollers that do not have safety straps and/or the straps are not used with
children
o Safety belts should always be used.

Children playing near doors that open inward into infant/toddler play spaces

Space so crowded that evacuation of children in an emergency would be difficult
Keep these indoor safety concerns in mind as you watch the following video, “Child Proofing Your Child Care
Program” (PDP Video Library, 2010). You will see how to assess your program for safety hazards by looking at
the room from a child’s perspective. As you watch the video, think about your own classroom. What changes do
you need to make in your program or classroom to make sure the children in your room are safe?
Slide # 25. Outdoor Safety
Outdoor safety concerns often focus on the arrangement of outdoor activity space. Outdoor activity space must
be arranged so that caregivers can adequately supervise children at all times. Playground equipment should
provide for engaging play and learning opportunities for children. Therefore, it is critical that current safety
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guidelines set by the United States Consumer Product Safety Commission are met. More than 200,000 children
are injured on playground equipment each year (Feeney, Moravcik, Nolte, & Christensen, 2010). Risk of injury
is reduced when playground equipment follows the appropriate guidelines and is maintained appropriately.
There are several considerations in ensuring that outdoor equipment is safe for young children:

The outdoor equipment must be age appropriate.
o Children under five cannot use chain or cable walks, free standing arch climbers, see-saws, log rolls,
spiral slides with more than one turn, parallel or monkey bars, or vertical sliding poles.

Equipment must not have openings or angles that can entrap a child’s body or body parts.

Equipment must be securely anchored according to manufacturer’s specifications to prevent collapsing,
tipping, sliding, moving, or overturning.

All anchor devices must be placed below the level of the playing surface to prevent tripping or injury
resulting from a fall.

Outdoor porches or platforms more than 20 inches in height for pre-kindergarten and young children
must have protective barriers, such as railings.
Slide # 26. Sun Safety
Sun safety is another outdoor environment safety concern of which teachers of young children must be aware.
Unless local health authorities determine that the air quality has risks, children should be brought outside for
outdoor play. During extremely warm weather, it is safest to play outside before 10:00 a.m. and after 2:00 p.m.
For safest play during warm weather:

Provide appropriate shade.

Provide plenty of fluids.

Make sure children have protective clothing.
Teachers should check equipment to make sure that it will not burn children’s skin, as outdoor equipment can
retain hot temperatures in the sun (Feeney, Moravcik, Nolte, & Christensen, 2010). It is important to note that it
is not appropriate for programs to apply sunscreen without parental permission.
Slide # 27. Supervision of Children
The second area of concern in early childhood programs is the supervision of children. Constant, attentive
supervision is essential to ensure children’s optimal safety. To properly supervise young children, a teacher
must have all children within sight, earshot, and easy reach. To facilitate constant, attentive supervision of
children, you must:

be prepared with supplies and materials,

not allow children to leave the classroom unattended,

position yourself so that you can see and hear your students, and

maintain appropriate group size.
Slide # 28. Caregiving Responsibilities Are Top Priority
Caregiving responsibilities must be your top priority. While supervising children, you should avoid lengthy
conversations with co-workers and parents. Talking with one another rather than supervising children puts
children at risk and limits your ability to provide appropriate supervision. You should absolutely never turn
your back on children, especially infants and toddlers. Your eyes must be on the children at all times. Because
activities have various supervision requirements, your caregiving techniques and practices should be modified
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to meet the necessary requirements for different types of activities. For example, art activities and materials,
sand and water play including wading pools, diaper changing, as well as transitions, arrivals, and departures
require varied supervision practices. Therefore, the supervision techniques you use must match the specific
activity.
Slide # 29. Consistent Supervision
So, what is consistent supervision? Consistent supervision involves two important areas: whole group
supervision and individual supervision.
Teachers must first be aware of the whole group. A watchful eye is necessary in providing consistent
supervision. Additionally, equipment should be arranged to prevent blind spots in the room. Pathways should
remain clear and uncluttered to prevent injury and in case of emergency evacuations.
Teachers must also be prepared to give individualized supervision. One reason for doing this would be to
provide closer supervision for children with challenging behaviors. Closer supervision for children with
challenging behaviors allows both proximity to the child and a watchful eye. For example, if you know that a
child is a “biter,” then closer proximity and a watchful eye would be appropriate to provide individual
supervision. Infants benefit from individual supervision as well, as they should be positioned so that they are in
clear view and reach of you, the caregiver.
Slide # 30. Consistent, Careful Supervision Helps Prevent Problems before They Occur
Consistent, careful supervision helps to prevent problems before they occur. Tips for providing supervision that
prevent potential problems include:

bringing out duplicate toys so children do not argue over single toys,

moving active play to a safe area,

keeping children close in proximity to you so you can always intervene if needed, and

watching children closely.
Your eyes should be on the children at all times. Constant and attentive care is critical in providing appropriate
supervision of children. Specific supervision practices during naptime include watching the children closely.
Slide # 31. Staff Vary Supervision to Meet Various Requirements of Activities
In addition to consistent, careful supervision, you must also vary supervision practices to meet the mandatory
requirements of various activities, such as art activities and materials, sand and water play, wading pools, and
diaper changing.
The standards provided by the National Health and Safety Performance Standards (2002) stipulate that only arts
and crafts materials that are labeled nontoxic may be used in programs so as to prevent contamination and
injury. Labels are required on art supplies so as to identify ingredients that are hazardous, risks that are
associated with their use, specific precautions, first aid procedures, and other sources where further information
might be found.
Contamination of hands, toys, and equipment used with water and sand play tables appear to increase the
transmission of diseases in early childhood programs. Sticking to proper handwashing and sanitizing of the
water and sand tables will help to prevent the transmission of diseases. The National Health and Safety
Performance Standards (2002) state that unsupervised water play tables are not allowed. Children must always
be supervised when using water play tables. Additionally, the following conditions must be applied:

The water tables must be filled with fresh water for each group of children.

The basin and toys must be washed and sanitized before the next group uses the water table.
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
Only children who do not have cuts, scratches, and sores on their hands and do not have colds or runny
noses should be allowed to play at the water play table.

Children must wash their hands before and after they use the water play table.

Caregivers must ensure that no child drinks the water from the water table.
Young children can drown within 30 seconds in as little as 2 inches of water. The United States Consumer
Product Safety Commission (1994) found that children under 5 years of age: drown in familiar surroundings,
drown quickly (5 minutes or less), and drown silently with no alert of trouble. Therefore, the National Health
and Safety Performance Standards (2002) state that children should not be allowed to play without constant
supervision near any type of water (swimming pools, built-in wading pools, tubs, pails, sinks, toilets, ponds, or
irrigation ditches). The Texas Minimum Standards for Childcare Centers (2006) requires wading or splashing
pools holding 2 feet of water or less must be:

stored out of children’s reach when not in use,

drained daily and sanitized, and

stored so they do not hold water.
As we have previously discussed, diaper changing is one of the most common ways to spread illness among
infants and toddlers. Teachers must follow proper diapering routines and procedures to ensure optimal health
and safety of the children in their care per both the National Health and Safety Performance Standards (2002)
and the Texas Minimum Standards for Childcare Centers (2006). As has already been mentioned, to allow for
sanitary diapering, procedures should be posted and followed.
Slide # 32. Poisons Come in Many Different Forms
A third area of concern is the presence of poisons, which come in many different forms. They may be solids,
liquids, sprays, or even invisible to the eye. Medicines, plants, powders, granules, pesticides, and fertilizers are
all examples of solid forms of poisons. Examples of liquid poisons include lotion, liquid laundry soap, furniture
polish, lighter fluid, and syrup medicines. Spray poisons may be in the form of insecticides, spray paint, and
some cleaning products. Finally, invisible to the eye are the gaseous forms of poisons, which may be either
gases or vapors.
Slide # 33. Poison
Here are some important facts for you to know regarding poisons:

Many cleaning products, medicines, plants, paints, and fuels can cause injury or death if ingested,
breathed, or splashed in the eyes or on the skin.

The American Academy of Pediatrics no longer recommends syrup of ipecac as an emergency treatment
for poisoning.

Art and craft supplies must be non-toxic and safe for children. The item label should state “non-toxic
and safe,” or it should have the approved seal of the Art and Creative Materials Institute.

Finally, if you are ever faced with a questionable substance or product, call Poison Control. The
National Poison Control number is 1-800-222-1222.
Slide # 34. Medications
Medications are one of the leading causes of childhood poisoning. Almost one third of oral prescription drugs
involved in poisonings belong to someone other than the child’s immediate family. It is important to note that
child-resistant caps are not child proof.
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Slide # 35. Choking Hazards
A fourth area of concern is the potential for choking incidences. Ninety percent of all fatal choking episodes
occur in children younger than four. Sixteen percent of first aid episodes happening in early childhood program
settings involve choking. Small objects less than 1-¼ inches diameter and shorter than 2-¼ inches long present
serious choking hazards to young children. Specifically, objects and pieces such as Lego pieces, beads, coins,
small wads of paper, paper clips, safety pins, and loose buttons should be kept away from children as they are
small enough to put in their mouths (National Health and Safety Performance Standards, 2002). A choke tube
can be used to test items. A choke tube acts as a model of the child’s airway to test small parts. Ideally, if a toy
part fits inside the child safety choke tube, then the piece is too small for the child to play with.
Slide # 36. Important Recommendations
Evidence of injury and even death from aspiration on small pieces is well-documented. Eliminating small
objects from the classroom environment will significantly reduce the risk. Let’s discuss some important
recommendations for eliminate choking hazards:

Check toys regularly for small objects or pieces that could present choking risks.

Ninety percent of fatalities caused by choking occur in children younger than four years of age. Do not
offer foods that are known choking dangers such as foods that are round, hard, small, thick, sticky,
smooth, or slippery as these foods are often implicated in choking incidents. Examples include hot dogs
(whole or sliced into rounds), raw carrot rounds, whole grapes, hard candy, nuts, seeds, raw peas, hard
pretzels, chips, peanuts, popcorn, marshmallows, spoonfuls of peanut butter, and chunks of meat larger
than can be swallowed whole.

Children should be supervised once they begin to feed themselves as supervised eating discourages
activity that may potentially lead to choking. For example, many young children love to place several
pieces of food in their mouth at one time, which increases the likelihood of choking.

Bedding must be free of crib toys or small objects that could cause choking.

Balloons are potential aspiration hazards. Infants, toddlers, and preschool children must not be permitted
to inflate balloons, suck on balloons, put balloons in their mouths nor have access to uninflated or
underinflated balloons.

Additionally, styrofoam is a potential choking hazard and must not be within reach of young children
(National Health and Safety Performance Standards, 2002).
Slide # 37. Child Abuse and Neglect
A final area of concern for teachers that we will discuss in this course is child abuse and neglect. To set the
stage for this section, let’s watch a video in which Pat Tooman and Charles Carson discuss the definition of
child abuse (PDP Video Library, 2010). As you watch the video, answer the following question: How does this
definition match your own ideas about child abuse?
Child abuse and neglect is the second-leading cause of death for children 6 months to 13 years. Almost 1
million confirmed cases of child abuse occur in the U.S. yearly. Many more cases go unreported. It is important
to note that no one child is completely immune to potential child abuse and neglect as abuse crosses all socioeconomic lines, regardless of status, race, culture, geographic area, or age.
Slide # 38. Child Abuse and Neglect (continued)
Teachers, physicians, and nurses are required by law to report suspected maltreatment. Persons who observe the
suspected maltreatment must make a report to authorities. Further, they must have reasonable cause to believe,
or to suspect, that abuse has occurred. Finally, persons reporting are not required to provide evidence or
documentation of the suspected abuse.
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So, what do we mean by the term “maltreatment”? In the following video, Charles Carson describes what is
meant by “maltreatment” (PDP Video Library, 2010). After watching the video, what are some things you
would describe as specific examples of maltreatment?
Slide # 39. SIDS
What is sudden infant death syndrome? It is a medical diagnosis regarding the death of an infant in which there
are no findings or medical evidence of the cause of death. SIDS occurs most frequently when infants sleep on
their tummies. According to an article from Exchange (2003), more SIDS-related deaths occur in childcare
settings than in homes. Data collected throughout the past decade show that SIDS is less likely to occur when
infants sleep on their backs.
In the following video, Dr. Ray Walsh discusses the prevention of SIDS, as it is a topic of critical importance to
teachers in early childhood programs (PDP Video Library, 2010). What are the key ideas to keep in mind in the
prevention of SIDS?
For more information about sudden infant death syndrome, visit: www.sidsalliance.org.
Slide # 40. Facts
Here are some important facts about SIDS that you’ll want to know:

African-American infants are twice as likely to die from SIDS, while Native-American infants are three
times as likely to die from SIDS.

Males are at more risk than females.

Infants that sleep on their stomachs are more susceptible.

Soft bedding can increase risk.

Babies of young mothers are at increased risk.

Babies that are born with low birth weight are also at increased risk.

Smoking around babies increases their risk of dying from SIDS.

Breast-feeding is a protective factor.
Slide # 41. Shaken Baby Syndrome
Shaken baby syndrome is also a topic of critical importance. Shaken baby syndrome is the shaking of an infant
or child by their arms or legs, or shaken with or without impact of the head. This trauma can result in bleeding
and brain injury, with no outward signs of abuse. However, let there be no mistake … shaking a child is child
abuse.
Let’s listen to Dr. Ray Walsh for a more thorough explanation and discussion of shaken baby syndrome (PDP
Video Library, 2010). Take a moment to think about some of the key ideas that Dr. Walsh explains about
shaken baby syndrome.
For more information about shaken baby syndrome, visit www.shakenbaby.com.
Slide # 42. Additional Resources
For additional resources and information regarding the health and safety of children, please refer to the
“Additional Resources” section accompanying the course. This slide lists the additional resources found there.
This concludes the informational portion of this course. Please click on the “Next Section” button at the bottom
of this page to proceed to the post-learning assessment. If you would like to review any of the previous sections,
click on the desired title in the left menu bar.
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REFERENCES
American Academy Of Pediatrics, American Public Health Association, & National Resource
Center for Health and Safety in Child Care and Early Education (2002). Caring for Our
Children: National Health and Safety Performance Standards: Guidelines for Out-of Home
Child Care Program. (2nd ed.). Elk Grove Village, IL: American Academy of Pediatrics
and Washington, DC: American Public Health Association. Also available at
http://nrckids.org.
Aronson, Susan S., M.D. (September/October 2003). Sudden infant death syndrome. Exchange.
Retrieved July 25, 2010 from
http://www.ccie.com/resources/view_article.php?article_id=5015367.
Feeney, S., Maravcik, E., Nolte, S., & Christensen, D. (2010). Who am I in the lives of children.
(8th Ed.) Ohio: Merrill.
Rockefeller College, University of Albany, & State University of New York. Professional
Development Program Video Library. Retrieved July 27, 2010 from
http://www.tsg.suny.edu/videolibrary.shtm#discpvids.
Texas Department of Family and Protective Services. Texas administrative code: Texas
minimum standards for child-care centers. Retrieved July 24, 2010 from
http://www.dfps.state.tx.us/Child_Care/Child_Care_Standards_and_Regulations/rules.asp
US Consumer Product Safety Commission (1994). Infants and toddlers can drown in 5-gallon
buckets. Washington, DC: 5006.
Photographs in this presentation were obtained from Microsoft Office Images http://office.microsoft.com/enus/images/?CTT=97, EyeWire Images www.eyewire.com and from IStock Images
http://www.istockphoto.com/index.php
Videos in this presentation were used with permission from the Professional Development Program of
Rockerfeller College University of Albany, State University of New York
http://www.tsg.suny.edu/videolibrary.shtm#discpvids
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