Keynote Speakers:

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Update on Infant and Toddler Policy Issues

• Keynote Speakers
• Joan Lombardi, Ph.D.
• Founder, Better Baby Care Campaign
• Susan Aronson, MD, FAAP
• Clinical Professor of Pediatrics
• The Childrens Hospital of Philadelphia
• November 8th, 2005

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• Towards
• Better Care
• for Babies..
• Joan Lombardi, Ph.D.
• Founder, Better Baby Care Campaign

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Babies and toddlers today

• 4 million babies born each year
• 12 million infants and toddlers in the
• United States
• More than 2 million infants and toddlers live in
  poverty
• Almost 40 percent of the babies and toddlers in
  the U.S live in or near poverty
• Infants are the fastest growing group in foster
  care

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Increasing number of infants and toddlers are in
non parental care on a regular basis
SourceNIEER based on National Center for
Education Statistics, (2001)National Household
Education Survey of 1999 Data Files.
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Health and Safety in EarlyEducation and Child
Care  What You Need to Know and Do

• Susan S. Aronson, MD, FAAP
• Clinical Professor of Pediatrics
• The Childrens Hospital of Philadelphia
• Audio conference - November 8, 2005

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Objectives

• List/Describe/Use
• Health Safety Issues for Infant/Toddler Early
  Education Child Care
• Three-way Communication of Families, Educators
  and Health Professionals
• Role of Health Consultants
• Helpful References and Tools

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All Children are in Child Care

• All children are in some form of child care,
  including those who remain at home with a parent.
  Even at home, there may be questions about safe
  environments, developmental instruction, and
  desires and interest of the at home parent to
  care for a young child
• Peter Michael Miller, MD, MPH, and Ed Schor, MD
• US News and World Report (12/3/00)

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Vocabulary The Facilities

• Center-based (full day/part day)
• Head Start
• Nursery Schools
• Child Care, Child Development Centers
• Family Child Care Homes
• Large (also called Group Homes)
• Small single provider business
• Relatives home with family only
• Childs Own Home

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Goals Shared by Educators and Health
Professionals

• Promote well-being
• Prevent harm
• Collaborate with
• Families
• Other sources of support for the child and family
  
• Policy makers and advocates

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Ensure Preventive Health Care

• Early education programs as a safety net to
  ensure immunizations and screenings
• Check documentation, give families reminders
• Tools Secure Internet link to use software

http//www.wellcaretracker.org
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Prevent Injury

• Rates for infants and toddlers Centers lt FCCH
  lt Own Home
• Peak Hours 10 am and 4 PM
• Most common/most severe (all ages) falls to
  surface
• SIDS in child care

Briss Sacks, 1990 (U.S. centers) Kopjar
Wickizer, 1992 (Norwegian town) Cummings
Rivara, 1996 (King County WA) Kotch, 1997 (3 NC
counties) Gershon Moon, 1997 (DC area BTS
positioning)
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Safe Child Care Project

• 33 of observed centers did not practice
  back-to-sleep positioning
• No special care plan for children with special
  health needs
• 59 - seizures
• 61 - asthma
• 68 - allergy
• 76 - development

134 volunteering PA-licensed centers ECELS
pretest data 2001-02
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Illness Frequency Early Education Child Care

• Sick more often in first 2 years of life
• More ear infections, tympanostomy tubes
• More antibiotic-resistant bacterial infections
• Increased illness rates bears little relation to
  other aspects of development

Wald, J Pediatr, 1991 Holmes, Epi Rev, 1996
NICHHD Early Child Care Research Network, 2001
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URI By Type of Care
Odds of illness in each type of care compared
with odds of illness if only in own home
NICHD. Arch Pedatr Adolesc Med.2001155481-488
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Ear Infection By Type of Care
Odds of illness in each type of care compared
with odds of illness if only in own home
NICHD. Arch Pedatr Adolesc Med.2001155481-488
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GI Illness By Type of Care
Odds of illness in each type of care compared
with odds of illness if only in own home
NICHD. Arch Pedatr Adolesc Med.2001155481-488
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Health Consultant Activities

• Give Technical Advice (phone/email, on-site,
  written policies/procedures)
• Educate Staff Parents
• Plan Care (child with special health needs)
• Ensure Preventive Care Referrals
• Address Staff Health
• Do Research

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Requirements for CCHC

• 29 states require some use of health consultants
• 22 states require CCHC visits for infant/toddler
  care
• NAEYC Accreditation criterion 4 visits/year for
  infant/toddler programs

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Efficacy of Health Consultants

• Reduction of hazards and risky practices safe
  active play, emergency preparedness, sanitation,
  nutrition food safety, SIDS (PA, NC, CA)
• Improved access to care and more complete
  preventive health services (PA, NC, CA)
• Reduction of outbreaks, absence from care,
  acute/emergency medical care, medical care costs,
  work time lost by parents (NC)

Aronson Fiene 1992 Crowley 1990 1997 Alkon
2002 Kotch 2004
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Efficacy of Health Consultants

• Improved written health policies (PA, NC, CA)
• CT providers perceive CCHC as valuable
• 85 of CT directors
• 73 CT directors prefer at least weekly visits
• NJ directors FCCH providers rated
• Satisfaction with CCHC, mean score 2.85/4
• Changes due to CCHC, mean score 2.33/4

Aronson Fiene 1992 Crowley 1990 1997 Alkon
2002 Kotch 2004 Dellert 2004
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Resources

• Caring for Our Children National Performance
  Standards, 2002 AAP/APHA/NRC
• Stepping Stones (to CFOC) - NRC
• Health in Child Care Manual for Health
  Professionals AAP
• Healthy Young Children NAEYC

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Resources

• Model Child Care Health Policies hard copy from
  NAEYC electronic copy at www.ecels-healthychildca
  repa.org
• Managing Infectious Diseases in Child Care and
  Schools - AAP
• Posters www.global-healthychildcare.org

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Resources

• Resource and Referral
• National Association of Child Care Resource and
  Referral Agencies www.naccrra.org
• National Child Care Information Center
  www.nccic.org
• Accreditation
• National Association for the Education of Young
  Children www.naeyc.org
• National Association For Family Child Care
  www.nafcc.org
• Environmental Rating Scales
• Frank Porter Graham Child Development Institute
  (ITERS-R, ECERS-R, FDCRS, SACERS)
  www.fpg.unc.edu/

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Support and Professional Development

• National Resource Center for Health and Safety in
  Child Care http//nrc.uchsc.edu
• (University of Colorado Health Sciences
  Center)
• National Training Institute for Child Care Health
  Consultants www.sph.unc.edu/courses/childcare/
• (School of Public Health, University of North
  Carolina)
• Health and Child Care Partnership Program
  Healthy Child Care America www.healthychildcare.o
  rg
• (American Academy of Pediatrics)

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Summary

• Focus on shared goals of educators and health
  professionals
• Promote health care in a medical home
• Use effective communication to foster on-going
  relationships among educators, health
  professionals and families
• Use resources to foster healthful care