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Division of Child Development Family Child Care Home Handbook
Chapter 3: HEALTH
Purpose of these Requirements
The requirements in this chapter provide the organized structure needed to promote healthy
environments for children in child care. Healthy environments not only promote basic health in
the areas of physical activity, nutrition and sleep, but also prevent sickness and injury by
excluding children who have common symptoms of illness, providing the steps needed to
administer medication correctly and providing the sanitary procedures needed in daily routines.
Implementing these requirements helps children to develop trust in their environment and
promotes learning and development in all areas.
Resources for health issues in child care:
The document, Health and Safety Resources for Child Care, with health and safety
contact information and websites, is in the Resource Section at the end of Chapter 1.
For health and safety information and for a listing of child care health consultants, visit the
North Carolina Child Care Health and Safety Resource Center website at
www.healthychildcarenc.org or call 1-800-367-2229.
SECTION 1: HEALTH RECORDS
Requirement for Child’s Health Assessment
NC General Statute 110-91(1) & Child Care Rule .1721(a)(1)
Each child must have a health assessment before being admitted, or within 30 days
following admission to a child care facility.
The assessment must be completed and signed by one of the following:
a licensed physician
the physician’s authorized agent who is currently approved by the North Carolina
Medical Board, or comparable certifying board in any state contiguous to North
Carolina
a certified nurse practitioner
a public health nurse meeting the Department’s Standards for Early Periodic
Screening, Diagnosis, and Treatment Program
Each child must have on file a Children’s Medical Report
form or a form with the same information provided by the
physician.
The health assessment must be completed before being
admitted or within 30 days of the child’s start date in the
program.
The top portion of the sample form should be completed by
the child’s parent or guardian. A health care professional
should complete the bottom portion.
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Division of Child Development Family Child Care Home Handbook
A health assessment is not required for a child who is and has
been in normal health if the child’s parent, guardian, or full-
time custodian objects in writing to a health assessment on
religious grounds which conform to the teachings and practice
of any recognized church or religious denomination. The
written statement must be maintained in the child’s records.
An objection based upon a "scientific" belief (i.e. a foreign
substance or chemical may be harmful) or non-religious
personal belief or philosophy (i.e. clean living, fresh air, pure
water) is not considered to be a religious exemption and is not
allowed under North Carolina law.
A health assessment is not required for school age children.
However, the operator must have a copy of the school-age
child’s immunization record on file.
Review health assessment information carefully to see if
there is health care information such as allergies, special diets,
prior medical history, asthma, etc. that you need to be aware
of to be able to provide proper care.
Additional forms are available in the resource section to assist
parents and the operator with outlining an action plan for a
child that has a specific chronic condition that may require
emergency medical care. Refer to the following resource
sheets:
• Food Allergy Action Plan
• Asthma Action Plan
• Diabetes Action Plan
• Seizure Action Plan
HH Although not required, request parents to update their child’s
health assessment information annually, after each annual well
check visit to a physician, or when a child’s medical condition
changes, such as being diagnosed with an allergy to ensure
you have the most up-to-date health information on file.
A sample Children’s Medical Report form (health
assessment) is located in the resource section of Chapter 4-
Records and Activities. If you choose to develop your own
health assessment form, it must include every item of
information found on the sample form.
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3.2
Division of Child Development Family Child Care Home Handbook
Requirement for Immunization Records
NC General Statute 110-91(1) & Child Care Rule .1721(a)(2)
Each child must have an up to date record of immunization on file at the
FCCH within 30 days of enrollment.
A current immunization record showing child is age-appropriately immunized must
remain on file for each child while in care.
Every center must file an immunization report annually with the State Health
Department as required by General Statute 130A-155(c).
Child care operators must request documentation of
immunizations for every child on the first day of attendance.
If is the immunization record is not presented on the first day,
the operator must notify the parent they have 30 calendar days
from the first day of attendance to obtain the required
immunizations for the child.
Child care operators must request parents to provide a copy of
each child’s immunization (shot card) record whenever new
immunizations are given.
Child care operators must complete an Annual Child Care
Immunization Report. Each FCCH should receive the forms
with instructions in the mail each year. If the operator has
questions about immunizations or needs information about
completing the report, contact the NC Immunization Branch at
919-707-5550 or
http://www.immunizenc.com/ChildCares.htm
.
When a child transfers to another child care program, the
FCCH where the child previously attended, must, upon
request, send a copy of the child’s immunization record, at no
charge, to the child care facility to which the child has
transferred.
Even though a school age child does not need a medical report
on file at the FCCH, the operator must have a current copy of
the immunization record.
A sample Immunization History form is located in the
resource section of Chapter 4- Records and Activities.
For a list of vaccine names, abbreviations and brand names
as well as a list of combination vaccines and their brand
names refer to the resource section of this chapter.
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3.3
Division of Child Development Family Child Care Home Handbook
Children in Child Care: What Shots Do They Need? is a
document in the resource section that will define and explain
each abbreviated vaccine name used on children’s
immunization records.
Additional resources are available from Immunize North
Carolina. Visit www.immunizenc.com for the recommended
immunization schedule for children and adults.
The completed Child’s Health and Emergency Information
form must be on file in the program on the child’s first day of
attendance.
Health and Emergency Information
NC General Statute 110-91(1) & Child Care Rule .1721(a)(3)
The operator must maintain the Health and Emergency Information form for each child who
attends on a regular basis, including his or her own preschool children.
If you choose to create your own form, it must include the
following information:
o the child’s name, address and date of birth
o the names of individuals to whom the child may be
released
o the general status of the child’s health
o any allergies or restrictions on the child’s
participation in activities with specific instructions
from the child’s parent or physician
o the names and phone number of the child’s physician
and preferred hospital
o authorization for the operator to seek emergency
medical care in the parent’s absence
o parent’s signature
Make sure each line on the Child’s Health and Emergency
Information form is completed.
The authorization for emergency medical care is on the
Child’s Health and Emergency Information form. It must
be signed by the child’s parent or legal guardian.
Update the information on the Child Health and
Emergency Information form regularly to assure that
current emergency information is always on file for each
child.
If a child needs to be taken to a medical facility, make sure
the Child’s Health and Emergency Information form is
taken with the injured or ill child.
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Division of Child Development Family Child Care Home Handbook
HH A copy of the Child’s Health and Emergency Information
for FCCH’s form can be used in a vehicle to document
children’s emergency and identification information. You
would need to add to the form the child’s identifying
information on an appropriate line, including eye and hair
color, height and weight.
You can find a copy of the Child’s Health and Emergency
Information form in the resource section of Chapter 4 –
Records and Activities.
Medication Administration Permission
General Statute 110-102.1A & Child Care Rule .1721(4)
Written authorization is required any time prescription or over-the-counter
medication is administered by the operator to children receiving care, including
anytime medication is administered in the event of an emergency medical condition.
The child’s name, date, time, amount and type of medication given, and the name and
signature of the person administering the medication must be recorded.
An authorization to administer medication form must be
completed prior to when medication is administered.
The Medication Administration Permission and Record
form can be used to document medication authorization or it
can be documented on a separate form developed by the
provider which includes the following information:
child’s name
date
time
amount and type of medication given
printed name and signature of the person administering the
medication
The completed Medication Administration Permission and
Record must be kept on file during the time the medication
is being administered and for at least six months after the
medication is administered.
More information about the authorization to administer
medication form is provided in SECTION 3: Medication of
this chapter.
Samples of the Medication Administration Permission and
Record, Permission to Administer Topical
Ointment/Lotion/Powder and Permission to Administer
Medication for Chronic Medical Conditions and Allergic
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Division of Child Development Family Child Care Home Handbook
Reactions are located in the resource section of Chapter 4-
Records and Activities.
In the event medication is given in error, if medical care is
sought as a result, the incident must be reported to the
consultant within seven days.
A form is provided in the resource section of this chapter for
you to use to document when medication is given in error and
actions you took to ensure the health of the child who
received the medication.
Incident Reports
Child Care Rule .1721 (b)(3)
An incident report must be completed each time a child receives medical treatment by a
physician, nurse, physician’s assistant, nurse practitioner, dentist, community clinic, or local
health department, as a result of an incident occurring while the child is in the family child
care home.
The incident must be reported on a form provided by the Division. The report must be signed
by the operator and the parent, and maintained in the child’s file.
A copy of the incident report must be mailed to a representative of the Division within seven
calendar days after the incident occurs.
This requirement applies when the parent or provider takes
the child to the doctor after the incident just to be evaluated,
even when the child receives no medical treatment.
Some operators choose to complete an incident report any
time a child is injured. However, the operator only needs to
submit the report to the Division when the child is taken to
the doctor to be evaluated.
Remember to record incidents on the incident report log.
Copies of the Incident Report form are in the resource
section of Chapter 4 – Records and Activities.
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3.6
Division of Child Development Family Child Care Home Handbook
Incident Logs
Child Care Rule . 1721(b)(4)
An incident log must be filled out any time an incident report is completed.
The log is to be cumulative, kept in a separate file and must be available for review by a
representative of the Division.
The log must be completed on the form provided by the Division.
A copy of the Incident Log is located in the resource Section
of Chapter 4- Records and Activities.
SECTION 2: INFECTIOUS AND CONTAGIOUS DISEAS
ES
In FCCHs, children and the caregiver work and play together in close areas, sharing germs.
Germs spread quickly and children can infect others before developing symptoms. During the
winter months, there is a higher concentration of germs inside because less fresh air circulates
the air. Also, children and adults spend more time indoors during the winter months, which
increases their exposure to germs. Refer to SECTION 8 - OUTDOOR PLAY to learn more about
the benefits of outdoor play. Following sanitation procedures such as handwashing and
sanitizing, helps reduce the spread of disease causing germs.
Check out this resource:
Handwashing is the single most effective way to cut down on the spread of infectious diseases.
Proper and consistent handwashing reduces the risk of spreading germs. To access handwashing
posters, visit the NC Child Care Health and Safety Resource Center at
www.healthychildcarenc.org.
Infectious and Contagious Disease Control
Child Care Rules .1718a(6), .1720(b)
You must provide a quiet, separate area for children too sick to remain with other children.
You must notify parents immediately if their child becomes too sick to remain in care.
You may care for mildly ill children, but children who are too sick must be excluded from
your program.
Children with any of the following symptoms may not
remain in care:
Fahrenheit temperature of 100 degrees when taken under
the arm or 101 degrees when taken orally.
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Division of Child Development Family Child Care Home Handbook
Sudden onset of diarrhea characterized by an increased
number of bowel movements compared to the child’s
normal pattern and with increased stool water.
Two or more episodes of vomiting within a 12 hour
period.
Red or pink eye(s) with white or yellow eye discharge.
Child may return to care 24 hours after treatment has
begun.
Scabies or lice.
Chicken pox or a rash suggestive of chicken pox.
Tuberculosis. Child may return to care after a health
professional states the child is not infectious.
Strep throat. A child may return to care 24 hours after
treatment has begun.
Pertussis or whooping cough. Child may return to care
five days after appropriate antibiotic treatment.
Hepatitis A virus infection. Child may return to care one
week after onset of illness or jaundice.
Impetigo. Child may return to care 24 hours after
treatment has begun.
If a child is not able to participate in regular activities,
regardless of symptoms, the child may not remain in care.
When a physician or other health professional issues a
written order to separate a child from other children, the child
may not remain in care.
The quiet, separate area for sick children must be in a place
that is easy for you to supervise. For example, appropriate
areas could be a cot or a mat on the other side of the room or
near the doorway of the next room. The area must be where
you can see and hear the child and respond to them quickly.
HH Sometimes children will not have a fever, but they are too sick
to remain in child care. For example, a child that is not able
to go outside due to an ear infection, or is not able to take
part in the activities of the whole group because they have a
cold, must be excluded from care.
HH Prevent the spread of germs in your FCCH by putting
mouthed toys in a bin until the toys have been cleaned and
sanitized.
HH For advice on the exclusion of children from child care due to
health issues, please call your local health department,
contact the NC Child Care Health and Safety Resource
Center at 1-800-367-2229, or use the Communicable
Diseases and Exclusion from Child Care chart.
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Division of Child Development Family Child Care Home Handbook
For a list of illnesses and diseases and how to handle the
exclusion of children, see the document, Communicable
Diseases and Exclusion from Child Care, in the resource
section of this chapter.
Conducting daily health checks is an effective way to reduce
the spread of infectious diseases. A daily health check
includes observing the child for signs of illness and talking
with the parent about how the child is feeling. A sample
Daily Child Care Health Check form is located in the
resource section of this chapter.
Six tips for germ control can be found in the article,
Maintaining a Sanitary Child Care Environment, in the
resource section of this chapter.
A document providing guidance on how to prevent the spread
of diseases that are transmitted by body fluids, Cleaning Up
Body Fluids, is in the resource section of this chapter.
During flu season, there are occasions when concerns rise
about flu outbreaks. To prepare for the potential effects of a
wide spread flu use the guide, Child Care and Preschool
Pandemic Influenza Planning Checklist, that can be found
at www.pandemicflu.gov/plan/preschool.html. Taking steps
now to prepare could prevent potential disruption of your
service. A copy of this checklist is also in Appendix D of
theFCCH Handbook.
Recognizing Common Symptoms of Illnesses
Child Care Rul
e .1720(a)(10)
You must be able to recognize common symptoms of illnesses.
Check with your local CCR&R, Smart Start partnership,
community college or local child care association for
workshops or classes you might attend on recognizing
symptoms of childhood illnesses.
A local child care health consultant, medical advisor, or
physician is someone you can call to discuss questions
regarding unfamiliar medical symptoms a child may be
exhibiting.
Turn to the local resource section of this handbook and list the
contact information for your local child care health
consultant, medical advisor, or physician.
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Division of Child Development Family Child Care Home Handbook
Emergency Medical Situations
Child Care Rule .1720(a)(8)
You must have a working telephone within the FCCH. Telephone numbers for
the fire department, law enforcement office, emergency medical service and
poison control center shall be posted near the telephone.
See the resource section of this chapter for a chart that will
help you determine whether or not certain situations require
immediate medical attention.
See Chapter 4-Records and Activities for a sample
Emergency Telephone Numbers chart.
See Appendix D of this handbook for Emergency
Preparedness Resources.
SECTION 3: MEDICATION
Though the child care rules do not require you to administer medication to children,
the Americans with Disabilities Act (ADA) requires that programs make reasonable
accommodations for children with special needs, including special health care needs. Children
with chronic health conditions like asthma, diabetes, allergies, sickle cell anemia, or seizure
disorders may only be able to attend child care if medication can be given on site. For more
information on the ADA refer to the handout in the resource section titled, “Commonly Asked
Questions Related to Giving Medicine in Child Care.” If your program chooses to administer
medication or must administer medication due to the American with Disabilities Act, it is
imperative that staff receive training in medication administration procedures and that policies
are established to reassure parents and staff that the program strives to administer medications
safely. In all cases, you must follow the guidelines in the child care requirements.
Check out these resources:
Contact a local child care health consultant to assist you in training and policy
development. To locate a child care health consultant in your area, visit the NC Child Care
Health and Safety Resource Center’s website at www.healthychildcare.org for a listing of
child care health consultants by county or call the Resource Center at 1-800-367-2229.
Complete training on Medication Administration. This is a comprehensive course
developed by the UNC-Chapel Hill and the Division of Child Development that covers the
roles of child care providers, health care providers, and parents in giving medication in
child care. The child care requirements and best practice for administering medication
safely in child care is discussed. Participants learn how to identify, store, measure, and
dispose of medication properly in child care. Time is allotted to introduce how to develop a
medication administration policy reflective of best practice and current requirements for
your facility. Contact your local child care resource and referral, local health department, or
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Division of Child Development Family Child Care Home Handbook
the NC Child Care Health and Safety Resource Center at 1-800-367-2229 to access a
trainer.
Administering Medication
NC General Statute 110.102.1A &
Child Care Rules .1720(c)(1),(A); .1721(a)(4)
No prescription or over-the-counter (OTC) medication and no topical, ointment, repellent,
lotion, cream or powder shall be administered to any child without written instructions and
authorization from the child's parent, a physician, or other authorized health professional.
A record of the authorization must be maintained at your program.
No drug or medication shall be administered for non-medical reasons, such as to induce
sleep.
Willfully administering medication without written authorization can result in a Class A1
misdemeanor charge. Willfully administering medication without written authorization
that results in serious injury to a child can result in a Class F felony charge.
It is illegal to intentionally give a child medication without
written authorization from the child’s parent.
It is the parent’s responsibility to provide all the
documentation and materials required to legally and safely
administer medication.
A sample Permission to Administer Medication form is in
the resource section of Chapter 4 – Records and Activities.
Documentation of Medication Administration
Child Care Rule .1720(c)(13)
Any time you administer prescription or OTC medication to any child in care, the child’s
name, date, time, amount and type of medication given, and the name and signature of the
person administering the medication must be documented.
You must keep documentation for administering medication for at least six months.
Written authorization to administer medication must include
the child’s name, the specific name of the medication, dosage
instructions, the beginning and end dates the medication is to
be given the child, the parent’s signature, and the date the
parent signed the authorization form.
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Division of Child Development Family Child Care Home Handbook
Parents must provide detailed instructions on the dosage of
medication and specific times the medication is to be given.
Medication can not be administered on an “as needed” basis.
A sample Permission to Administer Medication form is in
the resource section Chapter 4 – Records and Activities.
When you document the administration of medication on the
Permission to Administer Medication form or on a separate
form, you must keep the administration of medication record
on file during the time period the medication is being
administered and for at least six months after the medication
is administered.
Only one medication can be listed on each Permission to
Administer Medication form.
Check the expiration dates of the medicine you receive. No
expired medications can be given to children.
If you have questions concerning whether medication
provided by the parent should be administered, you may
decline to give the medication without signed, written dosage
instructions from a licensed physician or authorized health
professional. It is always your option to refuse to administer
any medication. This question should be discussed, however,
prior to enrollment so that children who need the medication
will get it when needed.
No documentation is required for applications of OTC topical
ointments, topical teething ointment or gel, insect repellents,
lotions, creams, and powders.
For a copy of the Steps to Administering Medication poster
go to the NC Child Care Health and Safety Resource Center
website www.healthychildcarenc.org
.
A Checklist for Administering Medication is located in the
resource section of this chapter.
HH Parents should be informed any time an error or mishap
occurs when administering medication. For example, if a
caregiver fails to give medication at the authorized time, the
parent should be notified. Missing a dose or receiving a
delayed dose of medication could affect the usefulness of the
medication or when the next dosage should be administered.
Document the error and mishap and inform the parent
immediately.
A sample Medication Error Report is available in the
resource section of this chapter.
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Division of Child Development Family Child Care Home Handbook
Prescribed Medications
Child Care Rules .1720(c)(2)(B-C), (3), (12-13)
Prescribed medication must be stored in its original container.
Prescribed medications can only be given to the person for whom they are prescribed.
Any medication remaining after the course of treatment is completed or after authorization
is withdrawn must be returned to the child's parents. Any medication the parent fails to
retrieve within 72 hours of completion of treatment must be discarded.
Prescribed medication must be in the original container that
bears the pharmacist’s label and includes the following:
Child’s name;
Date the prescription was filled;
The name of the prescribing physician or other health
professional;
The amount and frequency of dosage; and
The name of the medication or the prescription number.
If a parent brings a pharmaceutical sample, the medication
must be accompanied by dated written instructions from a
physician or other health professional specifying:
the child’s name,
the name of the medication,
the amount and frequency of dosage, and
the signature of the prescribing physician or
other health professional.
Authorization to administer prescription medication is only
valid for the course of treatment.
Only one medication should be listed on each authorization
form.
If there are no dosage directions on a label, the medicine can
be accompanied by written instructions for dosage, which
includes the child’s name and is dated and signed by the
prescribing physician or other health professional.
HH Ask parents to see if the child’s physician will prescribe
medications that only require one or two doses per day which
would reduce or eliminate the need for you to administer
medication.
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Division of Child Development Family Child Care Home Handbook
Over-The-Counter (OTC) Medications
Child Care Rules .1720(c)(4),(5),(12)
OTC medications may only be given as authorized in writing by the child’s parent, not to
exceed the amounts and frequency of dosage specified on the label.
The parent’s authorization include the child’s name, the specific name of the OTC
medicine, the amount and frequency of the dosages, the signature of the parent, physician
or other health care professional, and the date the instructions were signed by the parent,
physician or other health professional.
OTC medications may also be administered according to instructions from a physician or
other authorized health professional.
Any medication remaining after the course of treatment is completed or after authorization
is withdrawn must be returned to the child's parents. Any medication the parent fails to
retrieve within 72 hours of completion of treatment must be discarded.
Examples of OTC medications are cough syrup,
decongestants, acetaminophen, ibuprofen, topical teething
medication, topical antibiotic cream for abrasions, or
medication for intestinal disorders.
OTC medications must be in their original containers and
labeled with the child’s name.
Authorization to administer OTC medications is valid for up
to 30 days at a time.
A physician’s signature is not required for permission to
administer OTC medications. A parent’s written permission
is sufficient.
Any time OTC medications are administered you must
document the child’s name, the date, the time, amount and
type of medication given, and the name and signature of the
person administering the medication.
Medication cannot be administered “as needed.” Specific
instructions on when to administer medication must be given,
providing symptoms that indicate a need for medication.
Caregivers can only give the recommended dosage stated on
the package instructions. If a physician prescribes a larger
dosage than specified on the package, the parent must bring
in written, signed and dated instructions from the physician.
HH The Food and Drug Administration issued a public health
advisory in January 2008 stating that children younger than
two-years-old should not be given cold medications because
of serious and life-threatening side effects. The AAP has
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Division of Child Development Family Child Care Home Handbook
taken the position that over-the counter cough and cold
medicines do not work for children younger than six and in
some cases may pose a health risk. Visit www.fda.gov for
more information.
In the event cold medicine or any other over the counter
medication does not indicate on the label the dose for the age
of the child who is receiving the medication, the parents must
provide instructions on a form signed by a physician or other
health care professional. The instructions should specify:
the child’s name
the name of the medication
the amount and frequency of the dosage
the date the instructions were signed by the physician or
other health care professional
HH When children are taking these types of medication they may
have some of their symptoms eliminated but may still need to
be excluded from child care if they are not able to participate
in all daily activities.
See the Resource Section of Chapter 4 – Records and
Activities for a sample Permission to Administer
Medication form.
Blanket Permission to Administer Certain Medications
Child Care Rules .1720(c)(6-9)
A written statement from a parent may give blanket permission for up to six months to
authorize administration of OTC or prescription medication for chronic medical conditions
and allergic reactions.
A written statement from a parent may give blanket permission for up to one year to
authorize administration of OTC topical ointments, topical teething ointment or gel, insect
repellants, lotions, creams, and powders, such as sunscreen, diapering creams, baby lotion,
and baby powder.
A written statement from a parent may provide blanket permission to administer a one-
time, weight appropriate dose of acetaminophen to a child in cases where the child has a
fever and the parent cannot be contacted. This should only be used in case of emergency.
A parent can give you standing authorization to administer OTC medication as directed by
the State Health Director, when there is a public health emergency as identified by the State
Health Director.
Parents who have children with known medical conditions
with potential emergency symptoms should inform providers
and substitutes. A six month blanket statement should be
completed providing clear instructions on a provider’s
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Division of Child Development Family Child Care Home Handbook
response to an emergency and a detailed explanation of how
and when medication is administered.
Some medical conditions that would warrant a six month
blanket statement in a child care setting include, but are not
limited to: asthma, diabetes, sickle cell anemia, epilepsy and
allergies.
If you have a child in your program with allergies who
requires an Epipen, an Epipen, Jr., or a Twinject ask the
parent to provide you with a trainer Epipen or a trainer
Twinject. You are able to practice the injections without
needles.
The written twelve month statement must describe the
specific conditions under which the ointments and creams are
to be administered and detailed instructions on how, where
and when they are to be administered. Parents may not
indicate “as needed” on the authorization form.
Each time acetaminophen is administered in the event of an
emergency when the parent can not be reached, a new
blanket permission to administer medication must be
completed for the next emergency.
When a parent gives standing authorization to administer
OTC medicine as directed by the NC State Health Director,
the authorization must be in writing and is valid for as long
as the child is enrolled. Documentation must contain the
child’s name, signature of the parent, the date the
authorization was signed by the parent, and the date that the
authorization ends or a statement that the authorization is
valid until withdrawn by the parent in writing. This would
typically occur in the event of a public health emergency as
identified by the State Health Director. For example, if a
provider lives close to a nuclear power plant, they receive
potassium iodide tablets to administer if an emergency
occurs.
Each time medications are administered by a provider
whether for a chronic condition or not, a record must be kept
on either the Permission to Administer Medication form or a
form developed by the provider which includes the child’s
name, the date, time, amount and type of medication given
and the name and signature of the person administering the
medication.
The caregiver may decline to administer questionable
medication without signed written dosage instructions from a
licensed physician or authorized health professional.
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Sample blanket Permission to Administer Topical
Ointment/Lotion/Powder and Permission to Administer
Medication for Chronic Medical Conditions and Allergic
Reactions forms can be found in the resource section of
Chapter 4 – Records and Activities.
Additional forms are available in the resource section to assist
parents and staff with outlining an action plan for a child that
has a specific chronic condition that may require emergency
medical care. Refer to the following resource sheets:
Allergy Action Plan
Asthma Action Plan
Diabetes Action Plan
Seizure Action Plan
A sample blanket permission to administer medication form
for food allergies can also be found on the Food Allergy and
Anaphylaxis Network website, www.foodallergy.org.
HH To learn more about chronic medical conditions, refer to
Managing Chronic Health Needs in Child Care and Schools:
A Quick Reference Guide published by the American
Academy of Pediatrics.
For more information about chronic medical conditions go to
the American Academy of Pediatrics web page
http://www.aap.org/.
See the Resource Section of Chapter 4 – Records and
Activities for a sample Permission to Administer
Medication form.
Administering Medication In An Emergency Situation
Child Care Rule .1720(c)(10)
Medication can be administered to a child without parental authorization in the event of an
emergency medical condition when the child’s parent is unavailable, provided that the
medication is administered with the authorization and in accordance with instructions from
a medical professional.
If you administer medication in an emergency situation, you
must document the contact information from the medical
professional that you spoke with, instructions that were given
for administering the medication, child’s name, date, time
and amount and name of medication given.
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SECTION 4: NUTRITION
Research shows that there are crucial relationships between nutrition and health, and health and
learning. Mealtimes not only promote physical and mental development, they also are a time to
enhance children’s social skills. Children are beginning to hear about good manners and
participate in the conversation at the table, whether it be by smiling in response to a caregiver’s
interaction or peer to peer interaction of preschoolers. Opportunities are also given to develop
self-help skills by washing hands before and after meals, helping to set the table, serving
themselves, using child-sized utensils, and clearing their place. The purpose of these requirements
is to establish the minimum nutritional requirements for children in child care.
Meal Patterns
Child Care Rule .1718(a)(1)
All meals and snacks must comply with the Meal Patterns for Children in Child Care.
The types of food and number and size of servings must be appropriate for the ages and
developmental levels of the children in care.
The Meal Patterns for Children in Child Care is based on
the recommended nutrient intake for children. The National
Research Council bases these recommendations on what is
adequate for maintaining good nutrition for children.
If children bring food from home for their meals or snacks, or
if food is catered, you are responsible for making sure it is
nutritional and meets the Meal Patterns for Children in
Child Care. If it does not, you must have additional food
available to supplement the meals and snacks brought from
home. You should share nutritional information and meal
ideas with parents to ensure they provide a well-balanced
meal for their children.
A copy of the chart, Meal Patterns for Children in Child
Care Programs, can be found in the resource section of this
chapter.
Non-nutritional food should only be served on special
occasions.
Non-nutritional foods include such items as potato chips,
popcorn, candy, cakes, and some cookies.
Special occasions include birthdays, holidays, activities
used to enhance learning, or other similar events.
Juices that are served must be 100% fruit juice.
There are three different types of meals that can be served to
children.
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breakfast must include at least three different food
groups,
snacks must include at least two different food groups,
and
lunch/dinner must include at least four different food
groups.
It is required that milk be served when you provide breakfast,
lunch or dinner.
HH Making the menu available to parents by posting in a
prominent area helps inform parents about proper nutrition.
Get as much information as possible from the child’s parent
regarding the child’s food allergies and/or special diet.
Special diet would include dietary requirements due to
allergies or other medical issues, or could be for religious
reasons. It does not include parental preferences.
HH Children’s food allergies should be posted. Some food
allergies may cause serious, even life threatening reactions.
You should know what to look for if a child has an allergic
reaction and what measures should be taken in case of
accidental exposure.
The web site, http://www.foodallergy.org, for the Food
Allergy and Anaphylaxis Network, provides information and
resources about the management of food allergies and the use
of epinephrine (Epi Pen Jr.).
HH One way to prevent obesity in children is to serve 1% milk to
children who are 2 and older rather than whole milk.
A Menu Planning form can be found in the resource section
of this chapter.
Refer to the resource section for Issue Brief 2 – Best
Practices for Nutrition, Physical Activity & Screen
Media Time in Child Care Settings. It provides practical
nutrition, physical activity and screen media time
recommendations for the child care environment.
See the Resource Section of this chapter for strategies to
prevent obesity in the article, Why Child Care Matters for
Obesity Prevention.
You have the opportunity to start children out with good
eating habits. For useful tips and the new food pyramid by
the USDA go to the following web site:
http://www.mypyramid.gov/
Additional resources on nutrition:
USDA Center for Nutrition Policy and Promotion –
Information about healthy eating habits, dietary
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guidelines, and healthy eating activities for children and
adolescents. http://www.cnpp.usda.gov/
NC Action for Healthy Kids is a nationwide initiative
dedicated to improving the health and educational
performance of children through better nutrition and
physical activity in schools.
http://www.ncactionforhealthykids.org/AboutUs.html
Be Active Kids is an innovative, interactive physical
activity, nutrition, and food safety curriculum for NC
preschoolers ages four and five.
http://beactivekids.org/bak/Front/Default.aspx
Eat Smart, Move More North Carolina is a statewide
movement that promotes increased opportunities for
healthy eating and physical activity. Program tools have
been designed for preschool and child care programs.
www.eatsmartmovemorenc.com/Preschool.html.
Child and Adult Care Food Program
Reimburse licensed child care providers for meals and
snacks served to children. For more information about this
program call 919-707-5799 or go to
www.nutritionnc.com/snp/cacfp.htm
Nutritional Requirements
Child Care Rules .1718(a)(2-3)
No child shall go more than four hours without a meal or snack being provided.
Drinking water must be freely available to children and offered frequently.
Only pasteurized milk, milk products or fruit juices may be used.
Water should be offered to children more frequently in hot
weather and after and during vigorous play.
Remember infants, toddlers and young children may not be
able to verbalize their needs. Children who cannot drink
without help must be offered water regularly throughout the
day.
HH Create ways to make water more accessible to children.
Provide a water cooler in the indoor/outdoor area with paper
cups, have a pitcher in the refrigerator that can be used
indoors or taken outdoors, or have a child sized plastic
pitcher that could be placed on a low table in the room.
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Infant Feeding
Child Care Rules .1718(c),(d)
You must hold infants for bottle-feeding until they are able to hold their own bottles. The
bottles must never be propped.
Each child shall be held or placed in feeding chairs or other age-appropriate seating
apparatus to be fed.
Any child less than 15 months of age must have an individual written feeding schedule that
is provided by the parent or the child’s health care provider.
Any infant formula must be prepared according to the instructions on the formula package
or label, or according to written instructions from the child’s health care provider.
An infant must never be laid down with a bottle.
HH Laying infants down with bottles can cause them to choke or
aspirate the contents of the bottle. This may also contribute to
long-term health issues such as ear infections, bottle mouth
disease, orthodontic problems and speech disorders.
An infant who is able to hold his or her own bottle and older
children who can feed themselves may be placed in a high
chair, booster seat, or at a child-size table with sturdy chairs
or other age-appropriate seat while eating.
HH A child’s feet should be firmly on the floor or on a footrest to
provide support for the upper body and their elbows should
be able to rest comfortably on the table.
Children may not walk around or sit on the floor while
eating.
The Infant Feeding Schedule must include the child’s name,
the date the schedule was made, amounts of
food/breastmilk/formula, time intervals for feeding, parent or
health care provider’s signature, and the child’s date of birth.
Whenever you have questions about the type or quantity of
food that the parent listed on the Infant Feeding Schedule,
check with the parent and/or an outside professional such as a
health consultant, nutritionist or pediatrician for answers to
your questions.
The Infant Feeding Schedule should be updated in
consultation with the child’s parent and/or health care
provider, to reflect changes in the child’s needs as he or she
develops. Ask the parent to initial changes you have noted on
the schedule from verbal requests.
A sample Infant Feeding Schedule can be found in Chapter
4 – Records and Activities.
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HH Microwaves should not be used to warm baby bottles. If you
choose to warm baby bottles, warm them under warm
running tap water.
Can you suggest some examples of appropriate feeding devices?
High chair feeding table child-size table and chairs
Breastfeeding
Child Care Rule .1702(c)(9)
Accommodations for breastfeeding mothers are provided that include seating and an
electrical outlet in a place other than the bathroom, that is shielded from view by staff and
public, which may be used by mothers while they are breastfeeding or expressing milk.
Breastfeeding is the recommended feeding practice for
infants, at least birth to 12 months and older, if mutually
wanted by mother and infant. Encourage mothers to continue
breastfeeding and provide breastmilk for their infant while in
child care.
Importance of Breastfeeding:
Breastfeeding supports optimal growth and development
of infants.
It decreases the possibility that babies will get a variety of
infectious diseases, ear infections, diarrhea, and some
forms of cancer.
Breastfed infants have a lower incidence of sudden infant
death syndrome.
Breastfed infants have a lower risk of obesity in
childhood and in adolescence.
A comfortable chair and an electrical outlet must be provided
to mothers while they breastfeed or express milk. It should be
shielded from the view of additional caregivers and other
parents that may be present.
HH If space prevents you from providing a separate room for a
breastfeeding mother, you may want to purchase a screen that
can be set up in your primary space.
Two resources on breastfeeding can be found at the end of
this chapter, including How to Handle Pumped Milk and 10
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Ways Child Care Directors, Teachers, and Staff Can
Support Breastfeeding.
Contact your local Breastfeeding Coordinator or Women,
Infants, and Children (WIC) coordinator at the local health
department to get up-to-date information on breastfeeding
practices, how you can support breastfeeding, and potential
grants supporting breastfeeding in child care programs.
For information on how to support breastfeeding in your
Family Child Care Home, visit the NC Nutrition Services
Branch website for information on promoting and supporting
breastfeeding
http://nutritionnc.com/breastfeeding/breastfeeding-home.htm
Labeling Baby Bottles
Child Care Rule .1720(d)(7)
You must date and label all bottles for each individual child when storing them in the
refrigerator.
If you only have one child that is using a bottle then you are
not required to label the bottle.
Meaningful Meal Times
HH Making the transition from playing to eating can be hard for
some children. If children are over-stimulated from play,
they may not feel like eating. Try to plan an activity that will
relax the children and help them settle down before
mealtime. Washing hands will also help ease the transition.
HH Have the meal ready to serve before calling children to the
table or placing them in high chairs. When children are
required to wait they often become restless and bored. Plan
ahead to minimize wait time.
HH You can provide a positive example to children by eating the
same foods they are and by discussing the foods being eaten,
as part of nutrition education for children.
HH See mealtimes as an opportunity for interaction. Eat with the
children in your care.
HH Activities such as reading books about farming and where
different foods come from, or growing your own vegetable
gardens with the children, will encourage the children to try
foods that are new to them.
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HH Cooking/science activities are opportunities to promote good
nutrition. Choose activities that include nutritious foods, i.e.,
making a fruit salad.
HH Mealtime is important to a child’s development. The food
they eat gives them the vitamins and nutrients needed to
grow and stay healthy.
SECTION 5: FOOD SERVICE
The Division of Child Development does not require a sanitation inspection of Family Child Care
Homes by the NC Department of Environment and Natural Resources. However, Child Care
consultants monitor sanitary conditions as a part of their annual compliance visit as well as on
any other visit that may occur in the course of the year.
Sanitary Procedures
Child Care Rule .1720(d)(4)
You must follow sanitary procedures when preparing and serving food to children.
All food must be served in a sanitary manner to minimize the
possibility of spreading germs. Meals and snacks must be
served on plates, napkins/paper towels or in containers
appropriate for the age of the child. No food or snacks may
be served directly on tabletops.
You must wash your hands before and after handling food
and feeding the children.
You must be sure that children’s hands are washed before
and after each child is fed.
Children may not share bottles, plates, forks, spoons, cups,
glasses or portions of food.
Children must receive individual portions of food. For
example: Two children cannot share one drink with two
straws or one bowl of pudding with two spoons.
HH The following steps for hand washing should be followed to
ensure sanitary food preparation:
1. Wet hands with warm water, no less than 80 Farenheit
and no more than 110 Fahrenheit.
2. Apply liquid soap to hands.
3. Rub hands together vigorously for at least 15 seconds.
Rub areas between fingers, around nail beds, under
fingernails, jewelry and back of hands.
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4. Rinse hands under running water until they are free of
soap and dirt. Leave the water running while drying
your hands.
5. Dry hands with clean disposable paper towel or single
use cloth towel.
6. Turn off the faucet with a disposable paper towel or
single use cloth towel. Put disposable paper towel in
covered trash container lined with a disposable plastic
bag. Put single use cloth towel in the laundry hamper.
HH Although you are not required to sanitize the table before and
after eating, this practice is highly recommended. It reduces
the spread of communicable diseases.
Handwashing posters can be found on the NC Child Care
Health and Safety Resource Center web site,
www.healthychildcarenc.org, under the publications and
resources tab. You may want to place this poster in the hand-
washing areas.
Refrigerate All Perishable Food and Beverages
Child Care Rule .1720(d)(6)
You must refrigerate all perishable food and beverages.
The refrigerator must be in good repair and maintain a
temperature of 45 degrees Fahrenheit or below. A
refrigerator thermometer is required to monitor the
temperature.
Food left over in serving dishes or cooking containers does
not need to be discarded if it has been maintained at the
appropriate temperature and protected from contaminates.
SECTION 6: DIAPERING/TOILETING
Sanitary Toilet, Diaper Changing & Hand Washing Facilities
Child Care Rule .1720(d)(2)
You must have sanitary toilet, diaper changing and hand washing facilities.
Diaper changing areas must be separate from food
preparation areas.
Diapers should be changed on an easy to clean surface such
as diaper changing table or vinyl or plastic changing pad.
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Any areas covered with or made of cloth, such as a towel,
furniture, or carpet, may not be used as a surface for
diapering. Bacteria may grow on feces left on these mater
HH If you or the children use the same sink for both diapering
and for food preparation, it is best practice to sanitize the sink
by spraying the sink and faucets with a bleach solution after
each diapering/toileting.
Sanitary Diapering Procedures
Child Care Rule .1720(d)(3)
You must follow sanitary diapering procedures.
Diapers should be changed whenever they become soiled or wet.
You must regularly check children’s diapers to see if they
have become soiled or wet. If diapers are not regularly
changed a child can develop a rash or infection.
HH To minimize the spread of germs the following diapering
procedures are recommended when changing diapers or
helping to toilet children:
1. Get organized. Before bringing the child to the diaper
changing area, wash your hands, gather and bring the
supplies that you need to the diaper changing table (i.e.,
clean diaper, diaper cream, moistened wipes for
cleaning the child, disposable gloves, a receptacle for
the disposal of the dirty diaper, clean clothes if needed,
and sanitizing solution for the diapering surface).
2. Put on disposable gloves.
3. Bring the child to the diaper changing area. Keep
soiled clothing away from you and away from any
surfaces you cannot easily clean and sanitize after the
change.
4. Clean the child’s diaper area. Remove stool and urine
from front to back by using a fresh wipe or wet paper
towel each time.
5. Remove the soiled diaper without contaminating any
surface not already in contact with stool or urine. Fold
the soiled surface of the diaper inward. Put soiled
disposable diapers, liner, soiled towelettes, then gloves
in a covered, plastic-lined, hands-free covered
receptacle. If reusable cloth diapers are used, put the
soiled cloth diaper and its contents (without emptying
or rinsing) in a plastic bag or into a plastic-lined, hands-
free covered can to give to parents or laundry service.
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Wipe your hands with a disposable wipe. Wipe the
child’s hands with a fresh disposable wipe.
6. Put on a clean diaper and dress the child.
7. Wash the child’s hands for a minimum of 15 seconds
and return the child to a supervised area.
8. Clean and sanitize the diaper changing surface. Clean
any visible soil from the changing surface with
detergent and water; rinse with water. Wet the entire
changing surface with the sanitizing solution (spray a
sanitizing bleach solution of ¼ cup of household liquid
chlorine bleach in one gallon of tap water, mixed fresh
daily). Put away the spray bottle of sanitizer. If the
recommended bleach dilute is sprayed on the surface,
leave in contact with the surface for at least 2 minutes.
The surface can be left to air dry or can be wiped dry
after 2 minutes of contact with the bleach solution.
9. Wash your hands.
Diaper procedure posters can be found on the NC Child Care
Health and Safety Resource Center web site,
www.healthychildcarenc.org, under the publications and
resources tab. You may want to place this poster in the diaper
changing area.
HH It is best practice to use disposable gloves when changing
diapers. If you use disposable gloves:
Put them on after gathering your supplies and before
bringing the child to the changing table.
Remove gloves after disposing of soiled diaper.
Dispose of the gloves.
Clean your hands with a disposable wipe. Clean the
child’s hands with a fresh disposable wipe.
Follow steps 5, 6, 7 and 8 of the diapering procedure
above.
Always wash your hands between diapering and toileting
children.
HH To reduce the possibility of spreading germs, it is best
practice to use disposable gloves if you have a cut or open
wound on your hand.
HH A fun way to remember if you have washed your hands and
the children’s hands long enough is to wash your hands until
you have finished singing a song such as “Row, Row, Row
Your Boat” or “Happy Birthday” (or a song of similar length,
fifteen seconds long).
HH Be cautious when changing diapers on an elevated surface.
1. Never leave a child unattended.
2. Always have supplies readily accessible to you.
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3. Position yourself so the child cannot roll or wiggle off
the changing table.
4. Use a changing table or pad that has upward curved
edges.
5. If an emergency arises, you should place the child on
the floor or take the child with you.
SECTION 7: SLEEP
Daily Rest Time
NC General Statute 110-91(2)
You must provide daily rest time for each child.
Rest time should be provided according to the needs of
the child.
Children do not have to sleep during rest time. You
must provide some type of quiet activity if children are
not able to sleep.
Sleeping Space
NC General Statute 110-91(6) & Child Care Rules .1718(a)(5); .1724(a)(2),(4)
Space shall be available for proper storage of beds, cribs, mats, cots, sleeping garments and
linens.
Each child shall have their own individual sleeping space and linens.
Infants 12 months and younger must be placed in a crib, bassinet or play pen with a
firm padded surface when sleeping.
Children’s faces must not be covered while they sleep.
Examples of adequate sleeping space include bed, crib,
play pen, cot, mat or sleeping bag with individual
linens. Children must be able to rest comfortably. If
beds are used, only one child can be placed on each.
Linens must be changed weekly or whenever they become
soiled or wet and cannot be shared between children.
Infants and toddlers should be able to rest or sleep
when they are tired. Infants and toddlers often rest by
playing quietly or just lying down and gazing. Sleep
requires a safe place away from noise, movement and
stimulation.
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HH It is recommended, that children sleep at least 18
inches apart, to decrease the spread of germs.
HH It is best practice to not use a sofa/couch for a sleeping
arrangement due to sanitation and the potential of
children getting hurt should they roll off.
HH When setting up the environment, consider the ages of
the infants and other children in care. Are you going to
serve children of about the same age or children of
mixed ages. Consider how you will alter the
environment to protect younger infants from the older
infants and children who are mobile.
HH If you have children who have difficulty going to sleep, some
suggestions for helping them relax include reading books,
playing soft music, closing the blinds, or having them lie
down with their “special toy” or blanket.
There should be enough light to supervise the children.
HH Cribs and play pens used for sleeping must be easily
cleanable, and equipped with a firm, tight-fitting mattress
made of waterproof, washable material at least 2 inches thick.
HH A large vinyl-covered mat on the floor can provide a place
where infants and toddlers can move about safely. Children
who stay in a crib or a play pen for extended periods of time
will not experience the social, emotional, physical or
intellectual stimulation, so important to their development.
HH There should be ample floor space for crawling, creeping,
and toddling.
Supervision During Sleep
Child Care Rule .1718 (a)(7)(B)
For children who are sleeping or napping, the staff are not required to visually supervise
them, but must be able to hear and respond quickly to them.
Children must not sleep or nap in a room with a closed door between the children and the
supervising staff.
The staff must be on the same level of the home where children are sleeping or napping.
Electronic monitors cannot be used as the way to hear
Children cannot sleep in rooms with the door closed
if you are in another room.
Children may be placed in bedrooms that are on
ground level as long as you can hear them and respond
to them quickly. This means that your own children
must sleep on the ground level except for overnight
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care. When providing overnight care, your children
may sleep in their own rooms, even if those rooms are
not on ground level.
You may not be outdoors and leave sleeping children
indoors.
Infant Sleep Position
General Statute 110-91(15) & Child Care Rule .1724(a)(1),(4)
Infants must be placed on their backs to sleep unless there is a written waiver that specifies
another sleep position.
Nothing may be placed over the head or face of an infant aged 12 months or younger when
the infant is laid down to sleep.
You are required to place infants 12 months and younger to
sleep on their backs unless there is a written waiver from a
health care professional specifying a different position.
A health care professional is a physician licensed to practice
in North Carolina, a nurse practitioner approved to practice in
North Carolina, or a licensed physician assistant.
A waiver from a parent for a different sleep position is
allowed once the infant is at least six months old.
You must develop safe sleep policies and review the policy
with parents before the child enrolls, and parents need to sign
a statement that they reviewed the safe sleep policies.
You can find detailed information on what to include in your
safe sleep policy in Chapter 2 - Safety.
You must visually check infants at designated intervals. You
will note the intervals in your safe sleep policy. The visual
checks can be documented on the sample Visual Check forms
found in Chapter 4 – Records and Activities.
If a baby rolls over into another position after you place the
child on their back, the American Academy of Pediatrics
does not recommend that you reposition the child on his or
her back.
HH Parents are often concerned that putting a baby on their back
to sleep will cause a flat spot on the back of the head.
Changing a baby’s position throughout the day as well as
ensuring plenty of tummy play time will minimize flatness.
Tummy time also helps the child work on strengthening the
neck muscles.
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http://www.nchealthystart.org. Check this website from the
Healthy Start Foundation to learn more about Sudden Infant
Death Syndrome and the NC Back to Sleep Campaign.
ITS-SIDS information is available on the DCD website,
www.ncchildcare.net, including information on background,
related to the laws and rules, sample safe sleep policies,
sample sleep charts, sample waivers, ITS-SIDS trainer list,
trainer eligibility requirements and links to additional ITS-
SIDS resources.
Overnight Care Requirements
Child Care Rule .1701(h)
If you are licensed to provide overnight care, you may sleep during nighttime hours
provided:
The operator and the children in care, excluding the operator’s own children, are on
ground level.
All children are asleep.
You and all child care children are on the ground level of the home.
You can hear and respond to the children quickly.
A smoke detector wired into the electrical system with a battery back up, or two smoke
detectors, one wired into the electrical system with another one that is battery operated
is located in each room where children are sleeping.
If you are licensed for overnight care, it will be indicated on
your license as third shift care.
Your own children may sleep in an upstairs room during
overnight hours. During the day, your preschool children
must nap in the same area used by the children enrolled in
child care.
SECTION 8: OUTDOOR PLAY
Recent attention has been given to the increasing number of children who are overweight or
obese and the health issues that result. The American Academy of Pediatrics recommends
increasing the amount of time spent in outdoor play because children are more physically active
when they play outdoors. The Center for Disease Control and the National Association for Sports
and Physical Education recommends at least 60 minutes of physical activity daily.
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Caregivers are in a unique position to utilize the outdoor environment to promote not only
physical development but all types of development and learning. The outdoor learning
environment offers a sense of freedom for children. Children are able to play freely with peers,
expand their imagination and investigations beyond the restraints of indoor activities, release
energy and explore their sense of touch, smell, taste and sense of motion.
The purpose of these requirements is to guarantee that all children in child care are given the
opportunity to play outdoors on a daily basis.
Outdoor Play
NC General Statute 110-91(2) & Child Care Rules .1718(4), (10)(D-E)
Developmentally appropriate equipment and materials shall be provided for a variety of
outdoor activities which allow for vigorous play, large and small muscle development, and
social, emotional, and intellectual development.
The operator must provide space and time for vigorous indoor activities when children
cannot play outdoors.
The written schedule must include a minimum of one hour of outdoor play throughout the
day, if weather conditions permit.
The written schedule must include a daily gross motor activity which may occur indoors or
outdoors.
All children, including infants, toddlers, and school
age-children must be taken outdoors daily, if weather
conditions permit.
Children who are too sick to go outdoors and/or are
not able to participate in all daily activities, which
include outdoor activities, should be excluded from
care until they are well enough to participate in all
parts of the program.
HH Taking children outside provides many benefits, such
as fresh air, an environment more free of germ
containment; physical fitness; stress reduction for you
and children; and natural opportunities for active
physical play.
“Weather conditions permit” means:
Temperatures that fall within the guidelines developed by
the Iowa Department of Public Health and specified on the
Weather Watch chart. These guidelines must be used when
determining appropriate weather conditions for taking
children outside for outdoor learning activities and
playtime. This chart may be downloaded free of charge
from:
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http://www.idph.state.ia.us/hcci/common/pdf/weatherwatch
.pdf.
Healthy air quality as forecast by the Department of
Environment and Natural Resouces’ Air Quality Forecasts
and Information web page.
No active precipitation.
A copy of the chart, Child Care Weather Watch, can
be found in the Resource Section of this chapter.
HH Caregivers would be expected to shorten outside time
on days that are very cold/very hot or not go outside at
all. They should bring children inside if the children
are uncomfortable.
HH Playing in gentle rain or snow is a learning experience and
can be both educational and fun for children. Ask parents to
bring weather appropriate clothes such as rain boots, coat,
gloves, and hats.
Consult the Air Quality Index (AQI) for information
about air quality and amount of time children can play
outside. The AQI uses a color-coded system to
indicate when air quality may be a health risk.
For a color coded Air Quality Index guide and more
information on ozone levels in your area, go to the
web site for the Division of Air Quality,
http://xapps.enr.state.nc.us/aq/ForecastCenter. You can
also check your local news, listen to the radio or call 1-
888-RU4NCAIR.
See the resource section of this chapter for a color
coded Air Quality Index Guide.
HH The schedule may need to be changed to allow
children to go outdoors at the most appropriate time of
the day. For example, in the heat of the summer taking
children outside earlier when it is cooler or waiting
until the afternoon in the winter when it is warmer.
See Chapter 2 – Safety for information and rules for
outdoor play equipment.
See the resource section of this chapter for the
following articles related to the outdoor learning
environment:
Getting Started: Ten Free or Inexpensive Ideas
to Enrich Your Outdoor Learning Environment
Today
What the Research Shows: A Summary of
Research-Based Indicators of the Nature Deficit
Health
3.33
Division of Child Development Family Child Care Home Handbook
What’s In It For Me? What
Teachers/Caregivers Can Expect to Gain From
Taking on the OUTDOORS…
Many people believe children will get sick from
playing outside in cold weather. Children are actually
more likely to stay well if they play outdoors during the
winter months. Germs are not contained and
concentrated outdoors. Refer to the Winter 2005 issue
of the NC Child Care Health and Safety Bulletin on
Outdoor Health and Safety for additional information
on how the outdoors is healthy for children.
www.healthychildcarenc.org.
The North Carolina Outdoor Learning Environments
(NCOLE) Alliance is a statewide collaboration
comprised of organizations, agencies, and individuals
focused on improving the quality of outdoor
environments and experiences for all children. To
access research and other supporting information on
the benefits of outdoor play visit the Outdoor Section
of the NC Office of School Readiness website at
www.osr.nc.gov/ole.
SECTION 9: INDOOR AIR QUALITY
Smoke Free Program
Child Care Rule . 1720 (f)
The operator must not use tobacco products at any time while children are in care.
Tobacco products may not be used indoors while children are
in care or in a vehicle when transporting children.
Health
3.34
Division of Child Development Family Child Care Home Handbook
Health 3.35
SECTION 10: SCREEN TIME
Television exposure is associated with obesity, language delay, inactivity, aggression, and
decreased attention spans. Children experience these negatives effects as well as miss out on
important opportunities for socialization with peers and interactions with teachers when exposed
to television viewing. The total amount of screen time a child experiences in a day nearly
doubles if a Family Child Care Home caregiver exposes children to television. The American
Academy of Pediatrics discourages television viewing in the first 2 years of life and recommends
a daily limit of 1 to 2 hours of quality programming for older children. Rules are now in place to
limit the amount of screen time.
Screen Time
Child Care Rule .1718 (11)
When screen time, including videos, video games, and computer usage, is provided, it
shall be:
a) Offered only as a free choice activity,
b) Used to meet a developmental goal, and
c) Limited to no more than two and a half hours per week for each child two years of
age and older.
Usage time periods may be extended for special events, projects, occasions such as a current
event, homework, on-site computer classes, holiday, and birthday celebration.
Screen time is prohibited for children under the age of two years.
The operator must offer alternative activities for children under the age of two years.
When multiple ages are in a room, make sure alternative
activities are provided for children under two. Try to re-direct
the toddlers to those activities when they go towards the
television. If attempts have been made to interest the toddlers
in other activities, especially by engaging in those other
activities with them, and they still go to the television or
computer with the other children, then you would be in
compliance with the rule.
HH Refer to the resource section for Issue Brief 2 – Best
Practices for Nutrition, Physical Activity & Screen Media
Time in Child Care Settings. It provides practical nutrition,
physical activity and screen media time recommendations for
the child care environment.
Division of Child Development Family Child Care Home Handbook
Chapter 3:
HEALTH
The following pages contain resource materials related to the
content in the preceding chapter.
Some of the resources provided are forms created by the Division of Child
Development and must be used by licensed family child care homes. Other
materials are provided only as a resource for family child care homes and
may be used at your discretion.
You may also wish to use this section to store additional resource materials
that you have related to the chapter or information that is specific to your
program.
Food Allergy Action Plan
Place
Child’s
Picture
Here
Student’s
Name:__________________________________D.O.B:_____________Teacher:________________________
ALLERGY TO:______________________________________________________________
Asthmatic Yes* No *Higher risk for severe reaction
STEP 1: TREATMENT
Symptoms: Give Checked Medication**:
**(To be determined by physician authorizing
treatment)
If a food allergen has been ingested, but no symptoms:
Epinephrine Antihistamine
Mouth Itching, tingling, or swelling of lips, tongue, mouth
Epinephrine Antihistamine
Skin Hives, itchy rash, swelling of the face or extremities
Epinephrine Antihistamine
Gut Nausea, abdominal cramps, vomiting, diarrhea
Epinephrine Antihistamine
Throat† Tightening of throat, hoarseness, hacking cough
Epinephrine Antihistamine
Lung† Shortness of breath, repetitive coughing, wheezing
Epinephrine Antihistamine
Heart† Weak or thready pulse, low blood pressure, fainting, pale, blueness
Epinephrine Antihistamine
Other† ________________________________________________
Epinephrine Antihistamine
If reaction is progressing (several of the above areas affected), give:
Epinephrine Antihistamine
†Potentially life-threatening. The severity of symptoms can quickly change.
DOSAGE
Epinephrine: inject intramuscularly (circle one) EpiPen® EpiPen® Jr. Twinject® 0.3 mg Twinject® 0.15 mg
(see reverse side for instructions)
Antihistamine: give
____________________________________________________________________________________
medication/dose/route
Other: give____________________________________________________________________________________________
medication/dose/route
IMPORTANT: Asthma inhalers and/or antihistamines cannot be depended on to replace epinephrine in anaphylaxis.
STEP 2: EMERGENCY CALLS
1. Call 911 (or Rescue Squad: ____________). State that an allergic reaction has been treated, and additional epinephrine may be needed.
2. Dr. ___________________________________ Phone Number: ___________________________________________
3. Parent_________________________________ Phone Number(s) __________________________________________
4. Emergency contacts:
Name/Relationship Phone Number(s)
a. ____________________________________________ 1.)________________________ 2.) ______________________
b. ____________________________________________ 1.)________________________ 2.) ______________________
EVEN IF PARENT/GUARDIAN CANNOT BE REACHED, DO NOT HESITATE TO MEDICATE OR TAKE CHILD TO MEDICAL FACILITY!
Parent/Guardian’s Signature_________________________________________________ Date_________________________
Doctor’s Signature_________________________________________________________ Date_________________________
(Required)
TRAINED STAFF MEMBERS
1. ____________________________________________________ Room ________
2. ____________________________________________________ Room ________
3. ____________________________________________________ Room ________
Once EpiPen® or Twinject® is used, call the Rescue Squad. Take the used unit with you to the
Emergency Room. Plan to stay for observation at the Emergency Room for at least 4 hours.
EpiPen® and EpiPen® Jr. Directions
Twinject® 0.3 mg and Twinject® 0.15 mg
Directions
Pull off gray activation cap.
Hold black tip near outer thigh
(always apply to thigh).
Remove caps labeled “1” and “2.”
Place rounded tip against
outer thigh, press down hard
until needle penetrates. Hold
for 10 seconds, then remove.
Swing and jab firmly into outer thigh
until Auto-Injector mechanism
functions. Hold in place and count
to 10. Remove the EpiPen® unit and
massage the injection area for 10
seconds.
SECOND DOSE ADMINISTRATION:
If symptoms don’t improve after
10 minutes, administer second dose:
Unscrew rounded tip. Pull
syringe from barrel by holding
blue collar at needle base.
Slide yellow collar off plunger.
Put needle into thigh through
skin, push plunger down
all the way, and remove.
For children with multiple food allergies, consider providing separate
Action Plans for different foods.
**Medication checklist adapted from the Authorization of Emergency Treatment form
developed by the Mount Sinai School of Medicine. Used with permission.
June/2007
’s Asthma Action Plan DOB: _______
Child’s Name
Avoid Triggers: (Check all that apply)
Illness Cigarette/other smoke Food:
Emotions Exercise Allergies:
Weather Changes Chemical odors Other:
coughing or wheezing at night
or at child care
has early warning signs of a
flare-up:
________________________
________________________
has trouble doing usual
activities/play,
may self limit activities/
squat/hunch over
decrease in appetite/difficulty
drinking or taking a bottle.
breathing is hard and fast
coughing, short of breath,
wheezing
neck and chest “suck in” skin
between ribs, above the
breastbone and collarbone when
breathing
has trouble walking or talking
stops activities
unable to drink or take bottle
Take quick–relief medicines:
________________________
________________________
Emergency Medicine Plan:
_________________________
_________________________
_________________________
_________________________
sleeps through the night without
coughing or wheezing
has no early warning signs of an
asthma flare-up
plays actively
Take Long-Term Control
medications:
_________________________
_________________________
_________________________
_________________________
Take quick-relief
medicines 15 minutes
before active playtime.
_________________________
_________________________
Parent: ________________
Telephone:______________
Physician: ______________
Telephone:______________
Adjust Long-Term Control
medicines as follows until
back in Green Zone:
_________________________
_________________________
Activity Restrictions:
_________________________
Ozone Restrictions:
_________________________
Call child’s parent if:
child’s symptoms do not
improve or worsen 15 to 20
minutes after treatment
Call the physician if:
parent not available
Call 911 if
no improvement 15 minutes after
quick relief medication given and
nails or lips are blue
is having trouble walking or
talking
cannot stop coughing
_______________________
Physician Signature
Date:_________________
Red Zone:
Danger Zone
Emergency
Green Zone:
Child breathing at best
Well
Yellow Zone:
Child not breathing at best
Sick
Adapted by the NC Child Care
Health Consultants Association
__________________________’s Diabetes Action Plan Date: _________
Child’s Name Child’s Date of Birth:
Child Care Facility: ________________________ Teacher: ______________________________Classroom: ______________
1 Parent/Guardian: ________________________ Phone (w): _________________ (c): _______________
2 Parent/Guardian: ________________________ Phone (w): _________________ (c): _______________
Physician: _______________________________ Phone:___________________
Physician Signature: ________________________________ Date: ____________________
Diabetes Information
Hyperglycemia (High Blood Sugar)
Not enough insulin in the body to allow sugar to be used
Hypoglycemia (Low Blood Sugar)
Usually happens before lunch or after exercise
Excessive thirst Excessive hunger
Flushed dry skin Fruity odor to breath
Frequent urination Fatigue
Tired Weakness
Blurred vision Vomiting
Weakness, fatigue Excessive hunger
Feeling faint Abdominal pain
Dizziness Confusion
Shaky, trembling Anxious, Irritability
Nausea Sweaty, Pallor
Rapid pulse Slurred speech
First Aid for High Blood Sugar or Low Blood Sugar
Hyperglycemia (High Blood Sugar)
1 Check the blood sugar with a glucose meter if signs & symptoms
occur.
2 Stay with the child.
3 Call parent if blood sugar is above 250
4 Check urine for ketones. If positive call parent immediately.
5 Qualified person to administer insulin per physician’s order.
Can be given by parent.
6 Call 911 immediately, if the child is in a coma or symptoms
do not subside.
7 Provide adult supervision for the other children.
8 Stay with the child continuously.
Hypoglycemia (Low Blood Sugar)
1 Check the blood sugar with a glucose meter if signs & symptoms
occur.
2 Stay with the child.
3 Give the carbohydrate supplement ordered by the physician if
blood sugar is greater than 70 but less than 80 and child is
conscious, cooperative, and able to swallow.
Give 15 grams of carbohydrates such as 4oz of fruit juice, 6oz of
regular soda, 3 glucose tablets, I box of raisins OR____________
followed by a meal or snack of_________________________
(peanut better crackers)
4 Check child’s blood sugar level again after 15 minutes.
If normal and symptoms are gone, child may resume normal
activities
If blood sugar is still low, repeat supplement and call parent.
If still no improvement within 15–20 minutes, call physician.
5 Call 911, the parents, and the child’s physician, if
the child’s symptoms do not subside
the child loses consciousness
the child has a seizure
6 Give Glucagon ____ mg IM or sq for symptom of low blood sugar
and child is unconscious, experiencing a seizure, or unable to
swallow:
7 If child improves, you may give 4oz of juice until EMS arrives.
Diabetes Management
Blood Glucose
Monitoring
Normal Blood Sugar Range: ________mg/dl to ________mg/dl
Usual times to check blood sugar at childcare: _______ ________ _________
Other times to do extra checks: Before Active Play___ After Active Play___ Other _________
Can the child check his/her own blood sugar? ______ Yes ______ No _____ With Assistance
Insulin
Types of insulin taken:
Usual times of insulin injections: Basil Rate if on pump: __________
Amount of insulin to give (if a sliding scale is used, physician must order below):
Can child give his/her own injections? ____Yes _____No ______ With Assistance
Insulin
Administration
*Carbohydrate intake units
are to be used only for the
lunch hour blood sugar check.
For all other checks, use only
the sliding scale units to
determine how much insulin to
administer.
1Using the glucose meter, check the blood sugar. Be sure to follow the checklist for “Procedure for Recording
and Reporting.”
2 Document the observed blood sugar in the log book and NOTIFY PARENT/GUARDIAN!
3 Administer the insulin using the following calculations:
Units of Insulin to Give PLUS* Carbohydrate Intake to Give
Based on Based On
Sliding Scale of Blood Sugar Reading Units of Insulin Given
Blood Sugar < 200 = ___ Units 8-15mg Carb = ___Units 8-55mg Carbs= ___Units
Blood Sugar 200-300 = ___Units 16-23mg Carbs = ___Units 56-63mg Carbs= ___Units
Blood Sugar 300-400 = ___Units 24-31mg Carbs = ___ Units 64-71mg Carbs= ___nits
Blood Sugar > 400 = ___ Units 32-39mg Carb = ___Units 72-79mg Carbs= ___Units
40-47mg Carbs = ___Units
Qualified Staff
Staff qualified to use glucose meter:
Staff qualified to give insulin injections:
Supplies Location
Diabetes care supplies are kept:
Supplies of snack foods kept :
Nutrition and Exercise
Meals & Snacks
Times of meals and snacks and indications for additional snacks for exercise:
Breakfast time __________________am Dinnertime __________________pm
Midmorning snack __________________am Bedtime snack __________________pm
Lunch time __________________am Snack before exercise _________________am/pm
Mid-afternoon snack ________________am Snack after exercise __________________am/pm
Other times to give snacks: ________________________________________________________________
Preferred snack foods: ____________________________________________________________________
Suggested treats for in-school parties: _______________________________________________________
Foods to avoid, if any: ___________________________________________________________________
Exercise and
Sports or Activity
Restrictions
Physician’s order required
Physical activity restrictions / limitations: ______________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
Special activity accommodations that must be made? ____________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
Child should not participate in active play if blood sugar is below ______mg/dl or above _____mg/dl.
Adapted by the NC Child Care
Health Consultants Association
’s Seizure Action Plan
Child’s Name
Date of Birth: _____________
Parent: ________________________ Phone:___________________
Physician: _____________________ Phone:___________________
Physician Signature: _______________________________ Date: _______________________
Seizure Information
Seizure Type Length Frequency Description
Seizure triggers or warning signs: Response after seizure:
Special Considerations and Precautions:
(activities, trips, diet)
Treatment
Absence
Atonic
Complex Partial
Infantile Spasms
1. Stay with the child during and after the seizure. Although the child may appear
conscious, he/she may lose awareness of surroundings.
2. Be prepared to assist child to the floor if he loses consciousness.
3. Document seizure in log.
4. Notify parent.
Special Instructions:
General
Tonic/Clonic
1. Do not restrain movement. Let the seizure run its course.
2. Turn child on side. Loosen the child’s collar.
3. Do not place anything in the mouth. Remove hard, sharp objects from the area.
4. If possible turn head to the side in the event he/she vomits. (Use “Universal
Precautions” if child vomits.)
5. Observe, note time & be prepared to describe the pattern of the seizure.
6. Record details as they occur, or as soon as possible thereafter.
7. Notify parent.
8. When seizure is over, allow the child to rest.
9. Stay with the child until fully recovered or parent arrives.
Administer
Emergency
Medication:
Emergency
Response
Call 911!
Diastat order: __________________________________________________
Vagus Nerve Stimulator? Yes No
If Yes, describe magnet use: ___________________________________________
Call 911 if:
the seizure lasts more than ______ minutes, or
the child has a continuous seizure, or
the child remains unconscious after the seizure, or
he or she is having difficulty breathing, or
any injury resulted from the seizure.
Adapted by the NC Child Care
Health Consultants Association
Information based on information provided by Immunize North Carolina
Please use the following list of vaccines and brand names to assist you
in assessing a child’s immunization status. Vaccines may be listed on a
child’s immunization care by vaccine name, abbreviation, or brand
name. Please note that some brand names contain more than one
vaccine.
Disease and Vaccine Brand Names for Required Vaccines
Disease
Vaccine/Abbreviations Brand Name
Diphtheria, Tetanus, Pertussis DTaP, DTP Tripedia
Infanrix
Daptacel
Hepatitis B Hep B, HBV Engerix B
Recombivax HB
Haemophilus influenzae type b Hib PedvaxHIB* (PRP-OMP)
HibTITER (HbOC)
ActHIB (PRP – T)
Polio IPV, OPV IPOL
Measles, Mumps, Rubella MMR MMR II
Chickenpox Varicella, VZ Varivax
* 3 Pedvax doses are equivalent to 4 Hib doses
Combination Immunization Brand Names
Some health care providers give a child a single combination shot that includes more
than one vaccine. On the child's shot card they can record the brand name of the
shot next to one of the vaccines included in the combination shot, or next to each of
the vaccines in the combination shot.
Vaccine Brand Name
DTaP & Hepatitis B & IPV Pediarix
DTaP & Hib TriHIBit
Tetramune
DTaP & IPV & Hib Pentacel
DTaP & IPV Kinrix
Hepatitis B & Hib Comvax
MMRV ProQuad
Recommended (but not Required) Vaccines
Vaccine Brand Name
Influenza Fluzone, Fluvirin, Fluarix or
FluMist
Hepatitis A Havrix or Vaqta
Pneumococcal 7-valent§ Prevnar
Pneumococcal (PPV-23) Pneumovax
Rotavirus RotaTeq
§ Childhood Pnuemonia Vaccine, PCV-7
© 2006 UNC-CH/MCH and NC DHHS/DCD
MEDICATION ERROR REPORT
FacilityName StateLicenseNumber FacilityTelephoneNumber
Child’sName
Child’sDateofBirth
PRESCRIBEDorAUTHORIZEDMedicationInformation
Medication Time Date Dosage Route
DateofMedicationError TimeofMedicationError
Reason for Report (circle all that apply and
write how you gave the medicine/i.e., dene
the error.)
Incorrect Child
Incorrect Medication _____________________
Incorrect Time __________________________
Incorrect Date __________________________
Incorrect Route _________________________
Forgot to give medication
No written permission from parent/guardian
Expired permission from parent/guardian
Medicine expired
Other (be specic): ____________________
Describe /circle what you have observed:
No change observed
Change in child’s behavior (describe)
________________________________________
Temperature Seizures
Moaning Diarrhea
Itching Vomiting
Rash/hives Trouble breathing
Headache Crying
Stomachache Sweating
Trouble urinating
Change in skin color of lips or face
Other (be specic): _______________________
Action Taken
Who have you notied?
Date notied
(dd/mm/yyyy)
Signature of the Director or
person giving medicine
Regional Poison Control Center:
Yes No
Parent/Guardian (required immediately):
Yes No
Encourage parent/guardian to notify
health care provider:
Yes No
Child Care Health Consultant:
Yes No
Other: __________________________:
Yes No
261
© 2006 UNC-CH/MCH and NC DHHS/DCD
Describe corrective action taken. (Indicate that an investigation will be done.)
Describe how the error or mishap could be avoided in the future.
Nameandsignatureofallindividualsinvolvedintheerror:
1.
Date
2.
Date
ChildCareFacilityDirector/AdministratorSignature
Date
Parent/GuardianSignature
Date
Anytime an error occurs at the child care facility and the child’s condition requires medical
attention, call 911 and/or Poison Control immediately. Fill out an Incident Report.
Original to Child’s File
LicensingConsultant’sName(Print)
ChildCareHealthConsultant’sName(Print)
262
Communicable Diseases and Exclusion from Child Care
The following are guidelines developed for reference.
For more specific information:
Call your Local Health Department
Contact the NC Child Care Health & Safety Resource Center (1-800-367-2229)
Visit the Center for Disease Control and Prevention website Diseases and Conditions: www.cdc.gov/DiseasesConditions/
Reference: Managing Infectious Diseases in Child Care and Schools, 2
nd
ed., AAP, 2009 1
Disease Overview Symptoms Prevention Exclusion
CMV
(Cytomegalo-
virus)
Viral infection,
common in
children
-Mild to no symptoms
-Thorough handwashing
-Can be harmful to fetus
Do not exclude.
Chicken Pox
(Varicella-Zoster
infection)
Infection caused
by the varicella-
zoster virus
-Rash (small, red, blistering
bumps
-Fever, runny nose, cough
-Varicella vaccine
-Thorough handwashing
and surface sanitation
-Keep room well ventilated
Contact local
Health Dept.
Exclude until rash
has become dry
and crusted.
Diarrhea
(Campylobac-
teriosis)
Infection caused
by campylobacter
bacteria
-Bloody diarrhea
-Fever
-Vomiting
-Abdominal cramping
-Thorough handwashing
and surface sanitation,
especially after contact
with animals and raw meat
Exclude if bloody
or uncontrollable
diarrhea.
Diarrhea
(E.coli and E.
coli 0157:H7)
Infection caused
by Escherichia
coli and
Escherichia Coli
0157:H7 bacteria
-Loose stools (watery or
bloody)
-Abdominal pain
-Fever
-Cook ground beef
thoroughly
-Use only pasteurized milk
and juice products
Contact local
Health Dept.
Exclude until
diarrhea ends, and
2 consecutive
negative stool
samples 24 hours
apart at least 48
hours off
antibiotics.
Diarrhea
(Giardiasis)
Infection caused
by Giardia
lamblia parasite
-Watery diarrhea
-Excessive gas
-Abdominal pains
-Decreased appetite
-Weight loss
-Thorough handwashing
-Caregivers who change
diapers should not prepare
food
Exclude until
diarrhea ends.
Diarrhea
(Norovirus)
Viral infection
-Acute onset of watery
diarrhea and abdominal
cramps
-nausea
- vomiting
-Thorough handwashing
-Surface sanitation
Exclude until
diarrhea ends.
Diarrhea
(Rotovirus)
Viral infection,
most common
cause of diarrhea
and vomiting
-Non-bloody diarrhea
-Nausea and vomiting
-Thorough handwashing
and surface sanitation
Exclude until
diarrhea ends.
Communicable Diseases and Exclusion from Child Care
The following are guidelines developed for reference.
For more specific information:
Call your Local Health Department
Contact the NC Child Care Health & Safety Resource Center (1-800-367-2229)
Visit the Center for Disease Control and Prevention website Diseases and Conditions: www.cdc.gov/DiseasesConditions/
Reference: Managing Infectious Diseases in Child Care and Schools, 2
nd
ed., AAP, 2009 2
Disease Overview Symptoms Prevention Exclusion
Diarrhea
(Salmonellosis)
Infection caused
by Salmonella
bacteria
-Diarrhea
-Fever
-Abdominal cramps
-Nausea or Vomiting
-Thorough handwashing
-No reptiles
-Avoid contact with raw
eggs and poultry
-Cook eggs and poultry
thoroughly
Contact local
Health Dept.
Exclude until
diarrhea ends,
and 2 consecutive
negative stool
samples at least
24 hours apart and
at least 48 hours
after taking
antibiotics.
Diarrhea
(Shigellosis)
Infection caused
by the Shigella
bacteria
-Loose, watery stools with
blood or mucus
-Fever, headache
-Abdominal pains
-Convulsions
-Thorough handwashing
-No shared water play
-Sanitary diaper changing
techniques
-Sanitary food handling
Contact local
Health Dept.
Exclude until
treatment is
complete, and 2
consecutive
negative stool
samples at least
24 hours apart and
at least 48 hours
after taking
antibiotics.
Fifth Disease
(Erythema
Infectiosum)
Infection caused
by Human
Parvovirus B19
-Fever, headache
-Muscle and joint aches
-Red, lace-like rash on torso,
arms, and thighs that lasts
1-3 weeks
-Thorough handwashing
and surface sanitation
-Disposal of tissues
contaminated with blood or
mucus
-Can be harmful to fetus
Do not exclude
unless person has
sickle cell
syndrome, immune
deficiency, or
ordered by a
health care
professional.
German
Measles
(Rubella)
Uncommon, mild
infection caused
by Rubella virus
-Red or pink rash on the face
and body
-Swollen glands behind ears
-Slight fever
-MMR vaccine. Required.
-Can be very harmful to
fetus
Contact local
Health Dept.
Exclude for 6
days after the
beginning of the
rash.
Hand-Foot-and-
Mouth Disease
(Coxsackievirus)
Infection caused
by Coxsackie-
virus, more
common in
summer and fall
-Tiny blisters in the mouth,
on the fingers, palms or
hands, buttocks, and soles
of feet
-Common cold-like
symptoms (i.e. sore throat,
runny nose, cough, and
fever)
-When coughing or
sneezing cover mouths
and noses with a
disposable tissue
-Thorough handwashing
after handling
contaminated tissues or
changing diapers
Do not exclude.
Communicable Diseases and Exclusion from Child Care
The following are guidelines developed for reference.
For more specific information:
Call your Local Health Department
Contact the NC Child Care Health & Safety Resource Center (1-800-367-2229)
Visit the Center for Disease Control and Prevention website Diseases and Conditions: www.cdc.gov/DiseasesConditions/
Reference: Managing Infectious Diseases in Child Care and Schools, 2
nd
ed., AAP, 2009 3
Disease Overview Symptoms Prevention Exclusion
Head Lice
(Pediculosis
Capitis)
Small insects that
draw blood from
the scalp and lay
tiny eggs (Nits)
on hair shafts
-Itchy skin on scalp or neck
-Scratching around ears and
at the nape of the neck
-White nits glued to hair
-Do not share brushes,
hats, blankets, or pillows
-Launder contaminated
fabric with hot water and
high-heat drying
Exclude until after
treatment
recommended by
health care
professional.
Hepatitis A
(HAV)
Viral infection,
causes liver
inflammation
-Fever, fatigue
-Jaundice (yellowing of skin
or eyes)
-Decreased appetite,
abdominal pain
-HAV vaccine. Not required.
-Regular and thorough
handwashing
Contact local
Health Dept.
Exclusion is
dependent upon
local and state
Health Department
guidelines.
Hepatitis B
(HBV)
Viral infection,
causes liver
inflammation
-Flu-like symptoms, fatigue,
decreased appetite
-Jaundice
-Joint pain
-HBV vaccine. Required.
-Cover open wounds or
sores
-Sanitize surfaces that have
been contaminated with
blood
Exclude if
weeping sores,
biting or scratching
behavior, or a
bleeding problem.
Hepatitis C
(HCV)
Viral infection,
causes liver
inflammation
-Nausea, decreased
appetite, fatigue
-Jaundice
-Muscle and joint pain
-Cover open wounds or
sores
-Sanitize surfaces
contaminated with blood
Exclude if
weeping sores,
biting or scratching
behavior, or a
bleeding problem.
HIV/AIDS
Viral infection,
progressively
destroys the
body’s immune
system
-Slow or delayed growth
-Enlarged lymph nodes
-Swelling of salivary glands
-Frequent infections
-Wear gloves when
handling blood or blood-
containing fluids
-Sanitize surfaces that have
been contaminated with
blood
Do not exclude,
unless ordered by
a health care
professional.
Impetigo
Infection caused
by streptococcal
or staphylococcal
bacteria
-Small, red pimples or fluid-
filled blisters with crusted,
yellow scabs on the skin
-Thorough handwashing
-Disinfect and cover any
open sores or wounds
Exclude as soon
as infection is
suspected and
return after 24
hours of
medication.
Influenza
Infection caused
by a number of
respiratory
viruses
-Fever, chills, headache
-Cough and sore throat
-Muscle aches
-Decreased energy
-Flu vaccine. Not required
but advised.
-Thorough handwashing
Do not exclude,
unless ordered by
a health care
professional.
Communicable Diseases and Exclusion from Child Care
The following are guidelines developed for reference.
For more specific information:
Call your Local Health Department
Contact the NC Child Care Health & Safety Resource Center (1-800-367-2229)
Visit the Center for Disease Control and Prevention website Diseases and Conditions: www.cdc.gov/DiseasesConditions/
Reference: Managing Infectious Diseases in Child Care and Schools, 2
nd
ed., AAP, 2009 4
Disease Overview Symptoms Prevention Exclusion
MRSA
(Methicillin
Resistant
Staphylococcus
aureus)
Infection caused
by Staph bacteria
resistant to
broad-spectrum
antibiotic
treatment
-Small, red, pimple-like
bumps
-Abscesses (collection of pus
under the skin)
-Thorough handwashing
and surface sanitation
-Do not share towels,
clothing, or bedding
-Keep wounds covered
Exclude if open,
draining sores can
not be covered and
the dressing kept
dry. Complex
cases should be
cleared by a health
care professional.
Measles
(Rubeola)
Infection caused
by the measles
virus, highly
contagious
-Fever, cough, runny nose,
red and watery eyes
-Small, red spots in mouth
-Rash spreading from the
hairline downward
-MMR vaccine. Required.
-Thorough handwashing
and surface sanitation
Contact local
Health Dept.
Exclude for at
least 4 days after
the beginning of
the rash.
Meningitis
(Pneumococcus,
Meningococcus)
Bacterial or viral
infection, causes
swelling or
inflammation of
brain and spinal
cord tissue
-Fever, headache
-Nausea, loss of appetite
-Stiff neck
-Confusion, drowsiness,
irritability
-Hib vaccine. Required.
-Thorough handwashing
Contact local
Health Dept.
Exclude as soon
as infection is
suspected until
cleared by a health
care professional.
Molluscum
Contagiosum
Skin infection
caused by a
virus, similar to
warts
-Small, flesh-colored bumps
on the skin
-Thorough handwashing
after touching bumps
-Do not share towels, wash
cloths, or blankets used by
an infected child.
Do not exclude.
Mononucleosis
(Mono)
Infection caused
by the Epstein-
Barr virus
Mild to no symptoms in
young children.
-Thorough handwashing
-Do not share objects
contaminated with mucus
Do not exclude,
unless ordered by
a health care
professional.
Mumps
(Rubulavirus)
Viral infection
with swelling of
one or more
salivary glands
-Swollen glands
-Fever, headache, earache
-MMR vaccine. Required.
Contact local
Health Dept.
Exclude for at
least 9 days after
the beginning of
swelling.
Communicable Diseases and Exclusion from Child Care
The following are guidelines developed for reference.
For more specific information:
Call your Local Health Department
Contact the NC Child Care Health & Safety Resource Center (1-800-367-2229)
Visit the Center for Disease Control and Prevention website Diseases and Conditions: www.cdc.gov/DiseasesConditions/
Reference: Managing Infectious Diseases in Child Care and Schools, 2
nd
ed., AAP, 2009 5
Disease Overview Symptoms Prevention Exclusion
Bacterial or viral
infection, causes
inflammation of
eye tissue
Pink Eye
(Conjunctivitis)
Other causes:
allergies and
blocked tear
ducts in infants
-Red or pink, swollen, itchy
eyes
-Yellow or green discharge
and crusting in the eyes
-Thorough handwashing
before and after touching
the eyes, nose, and mouth
-Thorough sanitation of
objects commonly touched
by hands or faces
Exclude if
bacterial until
treatment has
begun with
antibiotic eye
drops, or if health
care professional
recommends
exclusion.
Pneumonia
Bacterial or viral
infection, causes
Inflammation of
lungs
-Cough, fever
-Difficulty breathing
-Loss of appetite
-Muscle aches
-Fatigue
-Thorough handwashing
and surface sanitation
-Dispose tissues
contaminated with mucus
Do not exclude
unless person has
sickle cell
syndrome, immune
deficiency, or is
ordered by a
health care
professional.
Pinworms
(Enterobias)
Infection caused
by small
threadlike round
worm
-Itching and irritation around
the anal or vaginal area
-Thorough handwashing
and sanitation of hard
surfaces and toys
-Change bedding often
Do not exclude.
RSV
(Respiratory
Syncytial Virus)
Viral infection
caused by
Respiratory
Syncytial virus,
causes common
cold, occurs
mostly in winter
and early spring
-Cold-like symptoms
-Respiratory problems
(wheezing, difficulty
breathing)
-labored breathing or blue
episodes
-Thorough handwashing
and sanitation of hard
surfaces and toys
-Dispose of tissues
contaminated with mucus
Do not exclude
unless rapid or
labored breathing
or blue, or person
has sickle cell
syndrome, immune
deficiency, or is
ordered by a
health care
professional.
Ringworm
Infection caused
by several kinds
of fungi, may
affect the body,
feet, or scalp
-Red, circular patches on the
skin
-Cracking and peeling of skin
between toes
-Redness, scaling of scalp
-Cover skin lesions
-Do not share objects that
come in contact with the
head (hats, brushes,
bedding, etc.)
Exclude until
treatment is
started.
Roseola
(Human
Herpesvirus 6)
Viral infection
causing a rash in
children ages 6-
24 months old
-High fever
-Red, raised rash
-Thorough handwashing
Do not exclude.
Communicable Diseases and Exclusion from Child Care
The following are guidelines developed for reference.
For more specific information:
Call your Local Health Department
Contact the NC Child Care Health & Safety Resource Center (1-800-367-2229)
Visit the Center for Disease Control and Prevention website Diseases and Conditions: www.cdc.gov/DiseasesConditions/
Reference: Managing Infectious Diseases in Child Care and Schools, 2
nd
ed., AAP, 2009 6
Disease Overview Symptoms Prevention Exclusion
Scabies
(Sarcoptes
scabei)
Infestation on the
skin by small
insects (mites)
-Rash, severe itching
-Itchy red bumps or blisters
in skin folds
-Contain clothing and
bedding that can not be
laundered in plastic bags
for at least 4 days
-Launder bedding and
clothing in hot water with a
hot dry cycle
Exclude until
treatment
recommended by
health care
professional is
completed.
Strep Throat
-Sore throat, fever, headache
-Decreased appetite,
stomachache
-Swollen lymph nodes
Scarlet Fever
Infections caused
by Group A
streptococcus
bacteria
-Sunburn-like rash with tiny
bumps that may itch
-Fever, sore throat, swollen
glands
-Yellow or white coating on
tongue and throat
-Thorough handwashing
-Avoid direct contact with
potentially infected
individuals
Exclude until
antibiotics have
been administered
for at least 24
hours.
TB
(Tuberculosis)
Infection caused
by a bacterium,
usually affecting
the lungs
-Chronic cough
-Weight loss
-Fever, chills, night sweats
-Positive skin test
-When coughing or
sneezing cover mouths
and noses with a
disposable tissue
Contact local
Health Dept.
Exclude until
cleared by a health
care professional.
Whooping
Cough
(Pertussis*)
Contagious
bacterial infection
that causes mild
to severe
coughing
-Cold-like symptoms
-Coughing that leads to
vomiting, loss of breath, or
blue face
-Whooping sound when
inhaling after coughing
-DTaP vaccine, for children
less than 7 years of age.
-Tdap vaccine, for persons
10 years and older.
-Thorough handwashing
Contact local
Health Dept.
Exclude until at
least 5 days of
antibiotic treatment
has been
completed.
DCD A/N
FORM 10B
SAMPLE 9/99
DAILY CHILD CARE HEALTH CHECK
INSTRUCTIONS:
Complete the daily health check when you greet each child and
parent upon arrival. It usually takes less than a minute.
Observe the child throughout the day and upon the child’s departure.
Greet the child and parent. Interact with both. Be on the child’s level.
¾ Check and observe the child’s: ¾ Talk with the parent about the child’s:
Behavior
Physical Condition
{ Breathing
{ Skin
{ Eyes, nose, ears, and mouth
Sleeping
Eating and drinking
Bowels and urinating
Mood and behavior at home
Unusual events
CHART FOR DAILY HEALTH CHECKS:
Child’s Name
___________________
Week of __________
date
BEHAVIOR
CHECK
PHYSICAL
CONDITION
CHECK
TALK
WITH
PARENT
COMMENTS
Monday
AM
NOON
PM
Tuesday
AM
NOON
PM
Wednesday
AM
NOON
PM
Thursday
AM
NOON
PM
Friday
AM
NOON
PM
Additional Comments:
Adapted from American Academy of Pediatrics, American Public Health Association, National Resource Center for Healthy and Safety
in Child Care.
Caring for Our Children: National Health and Safety Performance Standards: Guidelines for Out-of-Home Child Care
Programs.
2nd ed. Elk Grove Village, IL: American Academy of Pediatrics; 2002:419.
Cleaning Up Body Fluids
Treat urine, stool, vomit, blood and all body fluids as potentially infectious. Spills of body
fluid should be cleaned up and surfaces sanitized with a strong sanitizing or disinfecting
solution (1 tablespoon of bleach to 1 quart of water, 500-800 ppm of chlorine). Alternative
sanitizing solutions must be approved by the U.S. Environmental Protection Agency
(EPA) and their Material Safety Data Sheet (MSDS) must be kept on file.
For small amounts of urine and stool on smooth surfaces
1. Wipe off and clean away visible soil with a detergent solution.
2. Rinse the surface with clean water.
3. Apply disinfecting solution to the surface.
4. Let it air dry.
Follow the directions for EPA approved disinfectants.
For larger spills on floors, or any spills on rugs or carpets
1. Wear gloves while cleaning. Wear disposable gloves when cleaning a spill that may
contain blood. Use either disposable gloves or household gloves for other body fluids.
2. Avoid splashing any contaminated material onto the mucous membranes of the eyes, nose or
mouth, or into any open sores.
Smooth surfaces and floors Carpets, rugs, and surfaces covered with fabric
3. Wipe up as much visible material as
possible with disposable paper towels.
Place soiled paper towels and other soiled
disposable material in a leak-proof, plastic
bag.
Securely tie or seal the bag.
3. Vacuum carpets, rugs or
surfaces covered with fabric
with a wet/dry vacuum, if
available, OR
blot the area
to
remove body fluids as quickly
as possible.
4. Clean the spill area with a
detergent or a disinfectant-
detergent.
4. Spot clean the area with a detergent-
disinfectant (not bleach solution).
Shampooing or steam cleaning the area
may be necessary.
5. Rinse the area
with clean water. 5. Do not rinse the area.
6. Disinfect surface by wetting the affected
area with a strong bleach solution
(500-800 ppm)
OR
use industrial
disinfectant, following manufacturer’s
direction.
6. When cleaned with a detergent-disinfectant,
disinfecting happens by applying and
extracting the solution until there is no
visible soil. Follow the manufacture’s
directions for product use.
7. Dry the surface.
8. Clean with detergent, rinse, and disinfect reusable household gloves. Remove, dry and store
these gloves away from food or food surfaces. OR Discard disposable gloves in a plastic bag
.
Securely tie or seal the plastic bag.
9. Clean with detergent, rinse and disinfect all mops and other equipment used to clean up the
spill. Wring out excess water or solution and air dry.
10. Wash Your Hands.
11. Remove clothing soiled by body fluids (staff and children). Place in plastic bag. Securely tie
or seal the bag.
12. Wash soiled skin and hands of everyone involved.
13. Put on fresh clothes (staff and children).
3/06/01 copy edited revision of final table of situations requiring immediate medical attention - approved by the American
Academy of Pediatrics Committee on Pediatric Emergency Medicine 1/25/01
SITUATIONS THAT REQUIRE IMMEDIATE MEDICAL ATTENTION
In the two boxes below, you will find lists of common medical emergencies or urgent situations
you may encounter as a child care provider. To prepare for such situations:
1) Know how to access Emergency Medical Services (EMS) in your area.
2) Educate staff on the recognition of an emergency.
3) Know the phone number for each child’s guardian and primary health care
provider.
4) Develop plans for children with special medical needs with their family and
physician.
At anytime, if you believe the child’s life may be at risk, or you believe there is a risk of permanent
injury, seek immediate medical treatment
.
Call Emergency Medical Services (EMS) immediately if:
• You believe the child’s life is at risk or there is a risk of permanent injury.
• The child is acting strangely, much less alert or much more withdrawn than usual.
• The child has difficulty breathing or is unable to speak.
• The child’s skin or lips look blue, purple, or gray.
• The child has rhythmic jerking of arms and legs and a loss of consciousness (seizure).
• The child is unconscious.
• The child is less and less responsive.
• The child manifests any of the following after a head injury: decrease in level of alertness,
confusion, headache, vomiting, irritability, or difficulty walking.
• The child has increasing or severe pain anywhere.
• The child has a cut or burn that is large, deep, and/or won’t stop bleeding.
• The child is vomiting blood.
• The child has a severe stiff neck, headache, and fever.
• The child is significantly dehydrated: sunken eyes, lethargic, not making tears, not urinating.
After you have called EMS, remember to call the child’s legal guardian.
Some children may have urgent situations that do not necessarily require ambulance transport but
still need medical attention. The box below lists some of these more common situations. The legal
guardian should be informed of the following conditions. If you or the guardian cannot reach the
physician within one hour, the child should be brought to a hospital.
Get medical attention within one hour for:
• Fever in any age child who looks more than mildly ill.
• Fever in a child less than 2 months (8 weeks) of age.
• A quickly spreading purple or red rash.
• A large volume of blood in the stools.
• A cut that may require stitches.
• Any medical condition specifically outlined in a child’s care plan requiring parental notification.
© 2006 UNC-CH/MCH and NC DHHS/DCD
AMERICANS WITH DISABILITIES ACT
COMMONLY ASKED QUESTIONS RELATED TO GIVING MEDICINE IN CHILD CARE
The Americans with Disabilities Act (ADA), passed July 26, 1990 as Public Law 101-336 (42 U.S.C.
Sec. 12101 et seq.), became effective on January 26, 1992. The ADA requires that child care
provider/directors not discriminate against persons with disabilities on the basis of disability, that
is, that they provide children and parent/guardians with disabilities with an equal opportunity
to participate in child care programs and services. Child care facilities must make reasonable
modications to their policies and practices, such as giving medicine, to integrate children with
disabilities.
1. Q:
Does the Americans with Disabilities Act -- or “ADA” -- apply to child care centers? What about
family child care homes?
A: Yes. Almost all child care facilities, even small, home-based centers regardless of size or number
of employees, must comply with title III of the ADA. Child care services provided by government
agencies must comply with title II. The exception is child care centers that are actually run by
religious entities such as churches, mosques, or synagogues. Activities controlled by religious
organizations are not covered by title III.
2. Q: Our facility has a policy that we will not give medication to any child. Can I refuse to give
medication to a child with a disability?
A: No. In some circumstances, it may be necessary to give medication to a child with a disability
in order to make a program accessible to that child. Disabilities include any physical or mental
impairment that substantially limits one or more major life activities including asthma, diabetes,
seizure disorders, or attention decit hyperactivity disorder (ADHD).
3. Q: What about children who have severe, sometimes life-threatening allergies to bee stings or
certain foods? Do we have to take them?
A: Generally, yes. Children cannot be excluded on the sole basis that they have been identied as
having severe allergies to bee stings or certain foods. A child care facility needs to be prepared to
take appropriate steps in the event of an allergic reaction, such as administering a medicine called
“epinephrine” that will be provided in advance by the child’s parents or guardians.
4. Q: What about children with diabetes? Do we have to admit them to our program? If we do, do
we have to test their blood sugar levels?
A: Generally, yes. Children with diabetes should not be excluded from the program on the basis of
their diabetes. Providers should obtain written authorization from the child’s parents or guardians
and physician and follow their directions for simple diabetes-related care. In most instances, they will
authorize the provider to monitor the child’s blood sugar -- or “blood glucose”. The child’s parents
or guardians are responsible for providing all appropriate testing equipment, training, and special
food necessary for the child.
5. Q: What about children with asthma? Do we have to admit them to our program?
A: Generally, yes. Children with asthma should not be excluded from the program on the basis of
their medical condition. Providers should obtain written authorization from the child’s parents or
guardians and physician and follow their directions for asthma care.
6. Q: Are there any reference books or video tapes that might help me further understand the
obligations of child care providers under title III?
A: Yes, the Arc published All Kids Count: Child Care and the ADA, which addresses the ADA’s
obligations of child care providers. Copies are available by calling 1-800-433-5255. For
general information child care providers may call the Department of Justice Information Line
at 1-800-514-0301.
Source: The ADA Home Page: www.usdoj.gov/crt/ada/adahom1.htm
205
Checklist for Administering Medication
____1. Check for the permission slip signed by the
parent.
____2. Take the medication out of the locked storage area.
____3. Double check the amount of the dosage.
____4. Give the exact dosage to the child.
____5. Return any remaining medication to the locked
storage area.
____6. Write down the time and the dosage given.
____7. Sign the medication log.
All medications given to children by the facility staff must be in the
original container. No medication can be given without written permission
from the parent. The parent must indicate in writing the name of the
medication, the exact dosage, the times to be given each day, the days to be
given, the name of the child, and they must sign this request. Medication that
must be refrigerated must be kept in a locked box in the refrigerator.
NC DCD Family Child Care Home Handbook
Chapter 3 Resource Section October 2010
Child Meal Pattern
Breakfast
1-2 year olds 3-5 year olds 6-12 year olds
Milk—must be fluid milk 1/2 cup 3/4 cup 1 cup
Vegetable or fruit or 100% fruit juice
1/4 cup 1/2 cup 1/2 cup
Grains/Breads—must be enriched or whole grain
Bread
OR, Cornbread or biscuit or roll or muffin
OR, Cold dry cereal
OR, Hot cooked cereal
OR, Cooked pasta or noodles or grains
1/2 slice
1/2 serving
1/4 cup
1/4 cup
1/4 cup
1/2 slice
1/2 serving
1/3 cup
1/4 cup
1/4 cup
1 slice
1 serving
3/4 cup
1/2 cup
1/2 cup
Lunch or Supper
1-2 year olds 3-5 year olds 6-12 year olds
Milk—must be fluid milk 1/2 cup 3/4 cup 1 cup
Meat/Meat alternate
Lean meat, poultry, or fish without bone
OR, Alternate protein product
OR, Cheese
OR, Egg (large)
OR, Cooked dry beans or peas
OR, Peanut butter or other nut or seed butters
OR, Nuts and/or seeds
OR, Yogurt, plain or sweetened
1 oz
1 oz
1 oz
1/2 egg
1/4 cup
2 tbsp
1/2 oz
4 oz
1 1/2 oz
1 1/2 oz
1 1/2 oz
3/4 egg
3/8 cup
3 tbsp
3/4 oz
6 oz
2 oz
2 oz
2 oz
1 egg
1/2 cup
4 tbsp
1 oz
8 oz
Vegetable or fruit or 100% fruit juice—
serve two different vegetables and/or
fruits to equal
1/4 cup 1/2 cup 3/4 cup
Grains/Breads—
must be enriched or whole grain
Bread
OR, Cornbread or biscuit or roll or muffin
OR, Cold dry cereal
OR, Hot cooked cereal
OR, Cooked pasta or noodles or grains
1/2 slice
1/2 serving
1/4 cup
1/4 cup
1/4 cup
1/2 slice
1/2 serving
1/3 cup
1/4 cup
1/4 cup
1 slice
1 serving
3/4 cup
1/2 cup
1/2 cup
Snack—select 2 of the 4 components 1-2 year olds 3-5 year olds 6-12 year olds
Milk—must be fluid milk 1/2 cup 1/2 cup 1 cup
Vegetable or fruit or 100% fruit juice
1/2 cup 1/2 cup 3/4 cup
Grains/Breads—must be enriched or whole grain
Bread
OR, Cornbread or biscuit or roll or muffin
OR, Cold dry cereal
OR, Hot cooked cereal
OR, Pasta or noodles or grains
1/2 slice
1/2 serving
1/4 cup
1/4 cup
1/4 cup
1/2 slice
1/2 serving
1/3 cup
1/4 cup
1/4 cup
1 slice
1 serving
3/4 cup
1/2 cup
1/2 cup
Meat/Meat alternate
Lean meat, poultry, or fish
OR, Alternate protein product
OR, Cheese
OR, Egg
OR, Cooked dry beans or peas
OR, Peanut or other nut or seed butters
OR, Nuts and/or seeds
Or, Yogurt, plain or sweetened
1/2 oz
1/2 oz
1/2 oz
1/2 egg
1/8 cup
1 tbsp
1/2 oz
2 oz
1/2 oz
1/2 oz
1/2 oz
1/2 egg
1/8 cup
1 tbsp
1/2 oz
2 oz
1 oz
1 oz
1 oz
1/2 egg
1/4 cup
2 tbsp
1 oz
4 oz
Meal Patterns for Children in Child Care Programs
The Child Care Commission approved the use of the United States Department of Agriculture (USDA) meal patterns as the minimum
amount of food which can be served to comply with the licensing standards for adequate nutrition. The Recommended Dietary Al-
lowance is based on the age, sex, weight, and height of an individual.
click to sign
signature
click to edit
10A NCAC 09 .0901
G. S. 110-91(2)
REV 05/2008
Menu Planning Form
Week of
MEAL PATTERNS MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY
Breakfast
Juice or fruit
Bread and/or cereal
Milk, fluid
(three food groups)
A. M. Supplement
Milk, juice, fruit
or vegetable
bread or cereal
(two food groups)
Lunch
Meat and/or alternate
Vegetables and/or fruits
Bread
Butter/margarine
Milk, fluid whole
Other foods
(four food groups)
P. M. Supplement
Milk, juice, fruit,
vegetable,
bread or cereal
(two food groups)
Supper
Meat and/or alternate
Vegetables and/or fruits
Bread
Butter/margarine
Milk, fluid whole
Other foods
(four food groups)
Adapted from: Special Food Service Programs for Children, U. S. Dept. of Agriculture Food and Nutrition
Distributed by Division of Child Development
Issue Brief #2
2009
UNIVERSITY OF WASHINGTON
Center for Public Health Nutrition
BestPracticesforNutrition,
PhysicalActivity&ScreenMedia
inChildCareSettings
ChildrenwhoreceiveCACFPmeals eat
healthierfoodthanchildrenwhobring
mealsandsnacksfromhome.
1
Addingportableplayequipmenttoan
outdoorpreschoolplayground
significantlyincreasesphysicalactivity
in3‐5yearoldboysandgirls.
2
For3yearolds,eachonehour
incrementofTVviewingperdayis
linkedtoconsumptionofmoresugar‐
sweetenedbeverages,fastfood,and
calories;andlessfruit,vegetables,
calcium
,
andfiber.
3
Thechildcaresettin gstronglyinfluenceschild
behaviorandearlyhabits.
Successfulchildhoodobesitypreventioneffortsfocusoncreatinghealthy
environmentsthatmakehealthychoicespossible.Researchshowsthat
nutrition,physicalactivity,andscreenmediabehaviorsarelinkedtoa
child’sphysicalandsocialdevelopment.
Thisissuebriefofferspracticalstepsbasedonrecommendationsfrom
leadingresearchers,clinicians,childcareprovidersand
othersinthechild
carefield.Thesebestpracticescanserveasaguideforpolicychangein
alltypesofchildcaresettings.Whilesomeactionsareeasytodo,others
increasecostsandrequireadditionaleffort.Tofullyimplementthese
steps,childcareproviderswillrequiremoresupport,
training,technical
assistance,andfundingfrompublicandprivatesources.
1.Make everyca lorie countby offeringavarietyofhealthy foods.
Children’searlyexperienceswithfoodinfluencetheirpreferencesandconsumption—theylikewhattheyknow.Good
eatinghabitscomefromexposuretohealthyfoodandpleasantmealandsnacktimes.Belowaresomespecificmeasures
thatchildcareproviderscantake.
Developandfollowamenuthatincludesaselectionofnutritiousfoods.
Includenutritionandfeedingpoliciesandpracticesintheorientationfornew
employeesandregularlyreviewpolicieswithemployees.
Includeapolicyaboutfoodsbroughtfromhome intheparentguidebook.
FindoutifyouareeligiblefortheUSDAChildandAdultCareFoodProgram(CACFP)
tohelpwithfoodcostsandmenuplanning.
Providemeals,snacks,andbeveragesas suggestedbyanutritionconsultant,oras
requiredbylicensingorCACFP.
9 Juice:Ifyouservejuice,
makeit100%juiceandonlyprovidetochildren
olderthan12months.Serveincupsnotbottlesand
limitto4ouncesperday.
9 SweetenedBeverages:Avoidbeverageswith
addedsweeteners.Instead,offermilktoprovide
calciumandVitaminDwhichareessentialforbone
growth.
9 Water:Makewateravailableatalltimes.Encourage
waterwithsnackandmealtimes.
9 Lownutrition,highfat,highcaloriefoods:
Offersparinglyandprovidehealthysuggestionsto
parentsforspecialevents.
9 Grainproducts:Makemostofyourgrainswhole.
Lookonlabelsforthewordswholewheatorwhole
oats,etc.Theseprovidefibertohelpdigestion.
9 Vegetables:Varyyourveggies.Considernewways
toservethem.Usetointroducedifferentcolors,
shapesandtextures.
9 Fruits:Trynewcolors.Choosefresh,frozen,canned
ordried.
9 Meat&MeatAlternatives:Chooselowfatorlean
meatsandlimithighfatproducts(hotdogs,chicken
nuggets,etc.).Trydifferenttypesofbeanproducts.
9 Milkproducts:Golowfat(1%)orfatfreefor
children2yearsandolder.Limitflavoredmilks.
Recommendations
2.Create healthymealandsnacktimes.
Servefoodincommonbowlsandpitcherstopassaroundsochildren
canservethemselves.
Haveadultseatwithchildrenforsafetyandtomodelhealthyeating.
Introducenewfoodswithfamiliarfoods.
Letthechilddecidehowmuchtoeat.
Healthymealtimesarenotjustaboutthefood.
3.Move throughout the day.
Achild’shealth,development,andlearningdependongettingphysicalactivity
everyday.
Offer30‐60minutesofage‐appropriatephysicalactivityandplaydaily.
Trainteacherstoengageandleadchildreninphysicalactivities.
Incorporatemovement(stretching,dancing,marching,jumping,crawling)into
allaspectsofthecurriculum,includingtransitiontimes.
Includepoliciesintheparenthandbookaboutoutsideplayandphysical
activity.Askparentstodresschildreninclothesthatencourageactiveplay.
Keepextramittens,hats,andcoatsonhand.
Physicalactivityismorethanexercise.
4.Minimize ScreenMediaTime.
Evenyoungchildrenarewidelyexposedtoscreenmedia—television,video,videogames,computers,phones—every
day.Thelongtermeffectsareunknown.However,researchhaslinkedTVviewingbyyoungchildren toincreased
aggressiveandantisocialbehavior,loweracademicperformance,poornutrition,obesity,andsleepdisorders.
Becauseoftheseadverseeffects,the
AmericanAcademyofPediatrics
(
www.aap.org)recommends:
NoTVviewingforchildrenyoungerthan2years.
Limitchildren’stotalmediatimefornon‐educationalpurposesto
nomorethan1‐2hoursperday.
Encourageactivegames,listeningandmovingtomusic,andcreative
playtofosterinteractionandhelpbraindevelopment.
Lessscreentimemeansmoretimeforplay.
Formoreinformation
andtoolstoputthesepracticesinaction
see
www.cphn.org
References
1
Bruening KS et al. Journal of the American Dietetic Association. 1999 Dec;99(12):1529-35.
2
Hannon JC, Brown BB. Preventive Medicine. 2008 Jun;46(6):532-6.
3
Miller SA et al. International Journal of Pediatric Obesity. 2008;3(3):168-76.
PreparedbytheUniversityofWashingtonCenterforPublicHealthNutrition.
SupportforthisprojectwasprovidedbyagrantfromtheRobertWoodJohnsonFoundation.
uwcphn
Issue Brief #1
2009
UNIVERSITY OF WASHINGTON
Center for Public Health Nutrition
WhyChildCareMatters
forObesityPrevention
Over80%ofchildrenunder
age5spendsometimein
non‐parentalcare.
1
18.4%of4‐year‐oldUS
childrenareobese.
2
Overweightpreschool
childrenare5timesmore
likelytobeoverweightat
age12thanthosewhowere
neveroverweight.
3
Childcareneedstobepartofanystrategicplanfor
obesityprevention.
Healthychilddevelopment dependsoneatingnutriti ousfoodandbeingphysically
activeeveryday.Thisisespeciallyimportantduringthepreschoolyearswhen
childrenarerapidlybuildingtheirbrai nsandbodies.
MillionsofAmerica’schildrenspendhoursinout‐of‐homechildcareeachday.The
careenvironmentgreatlyinfluenceswhat
childreneatanddo,andcanplay
akeyroleinpreventingchildhoodobesity.Policiesfornutrition,physicalactivity,
screenmedia,andtrainingforchildcareprovidersareimportanttoolsfor
gettingchildrenontrackforgoodhealth.
1. Childcareimpactschildrenatacriticalstageofdevelopment.
Obesitypreventionmuststartearlyinlife.Manyyoungchildrenhavelittleopportunityforsustainedphysicalactivity
duringchildcareandarefedhighcalorie,lownutrientfoods.Childcarepracticesandpoliciescanhavewidespread
andlong‐termimpact.
2. Childcarepracticeisassociatedwithchildhoodobesity.
Alargenationalstudyfoundthatthetypeofchildcareintheyearbeforekindergarten
islinkedtoobesity.Childrencaredforbyaparentorinlicensedchildcarecentersare
lesslikelytostartkindergartenobesethanchildreninchil dcareofferedbyextended
family,friends,andneighbors.
4
IntheUS,33to53%ofchildrenunder5yrsoldwith
employedparentsarecaredforintheseunlicensedsettings.
5
Thisunderscoresthe
needforeducationandpoliciesthatsupportgoodpracticesinalltypesofchildcare.
3. Childcareoffersopportunitiesforhealthpromotion.
Obesitypreventioneffortsmusthappenbothinandoutofthehome.Guidelinesthat
encouragehealthybehaviorsforchildreninchildcar ecanalsobenefittheirfamilies.
Providinginformationtoparentscanincreasetheirunderstandingofchildren’s
nutritionalneedsandhelpimprovehomemealsandsacklunchessent
tochildcare.

4. Childcareisaninvestmentintomorrow’sstudents.
Wellfed,healthychildrenarebetterpreparedtofocusandlearnintheclassroom.Qualitychildcareacrossallsettings
wouldhelpreducedifferencesinearlylearningexperiencesthatcanleadtogapsinschoolreadiness.
References
1
US Census Bureau. 2005. http://www.census.gov
2
Anderson SE, Whitaker RC. Archives of Pediatrics & Adolescent Medicine. 2009 Apr;163(4):344-8.
3
Nader PR et al. Pediatrics. 2006 Sep;118(3):594-601.
4
Maher EJ et al. Pediatrics. 2008 Aug;122(2):322-30.
5
National Center for Children in Poverty. 2008. http://www.nccp.org/publications/pub_835.html
PreparedbytheUniversityofWashingtonCenterforPublicHealthNutrition.
SupportforthisprojectwasprovidedbyagrantfromtheRobertWoodJohnsonFoundation.
uwcphn
Formoreinformationsee
www.cphn.org
10 Ways Child Care Programs Can Support Breastfeeding
1. Educate staff and parents about the importance of breastfeeding.
2. Train staff in the skills necessary to handle, store and feed the mother’s
milk properly.
3. Review with parents how to properly store and label milk for child care
program use.
4. Provide a comfortable place for mothers to nurse their babies or pump
(express milk).
5. Develop a feeding plan with the parents that is regularly updated and
posted in the infant room.
6. Refer mothers to the Breastfeeding Coordinator or Woman, Infant, and
Children’s Coordinator at the local Health Departments. Keep a list of
community resources related to breastfeeding and infant nutrition in child
care and contact them for educational opportunities.
7. Display posters and provide brochures for new mothers and parents of
breastfeeding babies to show that your child care supports breastfeeding
and best practice.
8. Provide updates to staff on best practices and trends related to
breastfeeding.
9. Allow staff sufficient break time to breastfeed or express milk while
working.
10. Get feedback about your breastfeeding support by including a related
question on your parent surveys.
Sources:
Carolina Global Breastfeeding Institute. “Ten Steps to Breastfeeding Friendly
Child Care.” University of North Carolina at Chapel Hill: Department of Maternal
and Child Health. 2009.
Nutrition Services Branch of the North Carolina Division of Public Health. “10
Ways Child Care Directors, Teachers, & Staff Can Support Breastfeeding” in
How to Support Breastfeeding In a Child Care Center. Train the Trainer. June
2003.
Mason, Gladys and Sarah Roholt, eds. Promoting, Protecting and Supporting
Breastfeeding: A North Carolina Blueprint for Action. Raleigh, NC: Nutrition
Services Branch of the North Carolina Division of Public Health. 2006.
NC DCD Family Child Care Home Handbook
Chapter 3 Resource Section October 2010
2010
Understand the
Weather
Wind-Chill
• 30°is chilly and generally
uncomfortable
• 15°to 30° is cold
• 0° to 15° is very cold
• -20° to 0° is bitter cold
with significant risk of
frostbite
• -20° to -60° is extreme
cold and frostbite is likely
• -60° is frigid and exposed
skin will freeze in 1
minute
Heat Index
• 80° or below is considered
comfortable
• 90° beginning to feel
uncomfortable
• 100° uncomfortable and
may be hazardous
• 110° considered
dangerous
All temperatures are in degrees
Fahrenheit
Child Care Weather Watch
Wind-Chill Factor Chart (in Fahrenheit)
Wind Speed in mph
Air Temperature
Calm 5 10 15 20 25 30 35 40
40 40 36 34 32 30 29 28 28 27
30 30 25 21 19 17 16 15 14 13
20 20 13 9 6 4 3 1 0 -1
10 10 1 -4 -7 -9 -11 -12 -14 -15
0 0 -11 -16 -19 -22 -24 -26 -27 -29
-10 -10 -22 -28 -32 -35 -37 -39 -41 -43
Comfortable for out door
play
Caution
Danger
Heat Index Chart (in Fahrenheit %)
Relative Humidity (Percent)
Air Temperature (F)
40 45 50 55 60 65 70 75 80 85 90 95 100
80 80 80 81 81 82 82 83 84 84 85 86 86 87
84 83 84 85 86 88 89 90 92 94 96 98 100 103
90 91 93 95 97 100 103 105 109 113 117 122 127 132
94 97 100 103 106 110 114 119 124 129 135
100 109 114 118 124 129 130
104 119 124 131 137
Child Care Weather Watch, Iowa Department Public Health, Healthy Child Care Iowa, Produced through federal grant (MCJ19T029 & MCJ19KCC7) funds from the US Department of Health & Human
Services, Health Resources & Services Administration, Maternal & Child Health Bureau. Wind-Chill and Heat Index information is from the National Weather Service.
Child Care Weather Watch
Watching the weather is part of a child care provider’s job. Planning for playtime, field trips, or weather safe-
ty is part of the daily routine. The changes in weather require the child care provider to monitor the health
and safety of children. What clothing, beverages, and protections are appropriate? Clothe children to main-
tain a comfortable body temperature (warmer months - lightweight cotton, colder months - wear layers of
clothing). Beverages help the body maintain a comfortable temperature. Water or fruit juices are best. Avoid
high-sugar content beverages and soda pop. Sunscreen may be used year around. Use a sunscreen la-
beled as SPF-15 or higher. Read and follow all label instructions for the sunscreen product. Look for sun-
screen with UVB and UVA ray protection. Shaded play areas protect children from the sun.
Condition GREEN - Children may play outdoors and be comfortable. Watch for signs of children be-
coming uncomfortable while playing. Use precautions regarding clothing, sunscreen, and beverages
for all child age groups.
INFANTS AND TODDLERS are unable to tell the child care provider if they are too hot or cold.
Children become fussy when uncomfortable. Infants/toddlers will tolerate shorter periods of outdoor
play. Dress infants/toddlers in lightweight cotton or cotton-like fabrics during the warmer months. In
cooler or cold months dress infants in layers to keep them warm. Protect infants from the sun by li-
miting the amount of time outdoors and playing in shaded areas. Give beverages when playing out-
doors.
YOUNG CHILDREN remind children to stop playing, drink a beverage, and apply more sunscreen.
OLDER CHILDREN need a firm approach to wearing proper clothing for the weather (they may want
to play without coats, hats or mittens). They may resist applying sunscreen and drinking beverages
while outdoors.
Condition YELLOW - use caution and closely observe the children for signs of being too hot or cold
while outdoors. Clothing, sunscreen, and beverages are important. Shorten the length of outdoor
time.
INFANTS AND TODDLERS use precautions outlined in Condition Green. Clothing, sunscreen, and
beverages are important. Shorten the length of time for outdoor play.
YOUNG CHILDREN may insist they are not too hot or cold because they are enjoying playtime.
Child care providers need to structure the length of time for outdoor play for the young child.
OLDER CHILDREN need a firm approach to wearing proper clothing for the weather (they may want
to play without coats, hats or mittens), applying sunscreen and drinking liquids while playing out-
doors.
Condition RED - most children should not play outdoors due to the health risk.
INFANTS/TODDLERS should play indoors and have ample space for large motor play.
YOUNG CHILDREN may ask to play outside and do not understand the potential danger of weather
conditions.
OLDER CHILDREN may play outdoors for very short periods of time if they are properly dressed,
have plenty of fluids. Child care providers must be vigilant about maximum protection of children.
Understand the Weather
The weather forecast may be confusing
unless you know the meaning of the
words.
Blizzard Warning: There will be snow and
strong winds that produce a blinding snow,
deep drifts, and life threatening wind chills.
Seek shelter immediately.
Heat Index Warning: How hot it feels to the
body when the air temperature (in Fahren-
heit) and relative humidity are combined.
Relative Humidity: The percent of moisture
in the air.
Temperature: The temperature of the air in
degrees Fahrenheit.
Wind: The speed of the wind in miles per
hour.
Wind Chill Warning: There will be sub-zero
temperatures with moderate to strong winds
expected which may cause hypothermia and
great danger to people, pets and livestock.
Winter Weather Advisory: Weather condi-
tions may cause significant inconveniences
and may be hazardous. If caution is exer-
cised, these situations should not become
life threatening.
Winter Storm Warning: Severe winter con-
ditions have begun in your area.
Winter Storm Watch: Severe winter condi-
tions, like heavy snow and ice are possible
within the next day or two.
Air Quality Index
Guidelines to protect your health
Care for the air
Good
0-50
Code Green
No health effects expected.
Moderate
51-100
Code Yellow
Unusually sensitive people: consider
limiting prolonged or heavy exertion.
Unhealthy for
Sensitive Groups
101-150
Code Orange
Children, active people, older adults, and
those with heart or lung disease (like
asthma): limit prolonged or heavy
exertion.
Everyone: avoid all exertion.
Unhealthy
151-200
Code Red
Very Unhealthy
201-300
Code Purple
30,000 copies of this public document were printed on recycled paper at a cost of $2,287.30 or $ 0.076 per copy. June 2009.
The daily air quality forecast covers two common air pollutants:
Ground-level ozone forms when pollutants from cars, power plants and other sources combine in hot sunlight. Ozone is
a lung irritant that causes shortness of breath, irritates throats and eyes, and aggravates asthma. Ozone levels are
highest outdoors from early afternoon to early evening on hot, sunny days.
Particle pollution is a mixture of very small solids and liquids suspended in air. These tiny particles can reach deep into
the lungs, where they can aggravate asthma and other lung conditions, and even cause heart problems. Particle pollution
can be high at any time of day or night, and any time of year. High particle levels often are caused by forest fires or
residential wood burning, especially when weather conditions causes pollution to stay close to the ground.
The daily forecast always tells you which pollutant is of greatest concern.
Air Quality Forecasts and Information: www.ncair.org / 1-888-RU4NCAIR (1-888-784-6224)
Children, active people, older adults, and
those with heart or lung disease
(like asthma): avoid prolonged or heavy
exertion. Everyone else: limit prolonged or
heavy exertion.
Conserve energy: drive less and use
less electricity.
Carpool, use public transportation, bike
or walk whenever possible.
Keep your car, boat, lawnmower and
other engines tuned and maintained.
Keep tires properly inflated and wheels
aligned.
Never burn your trash. This is illegal
and releases toxic chemicals.
Avoid burning leaves and brush, which
is sometimes legal but always pollutes
the air.
Air Quality Color Guide
Division of Air Quality
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
www.ncair.org
How can air quality affect your health?
Air pollution irritates the lungs and respiratory system,
and can even affect the heart. Air pollution can make
asthma worse, trigger asthma attacks, or cause the
onset of asthma. Even healthy people can have trouble
taking deep breaths on “bad air” days, and can
experience damage to lung tissues. Repeated damage,
especially during childhood, can reduce lung function
permanently. Particle pollution, a type of air pollution,
has been linked to serious cardiac problems including
arrhythmias and heart attacks.
Who’s at risk?
Anyone can experience health effects – whether noticed
or unnoticed – at air pollution levels of code red or
above. But these sensitive groups can be affected at
lower levels:
All children. Children breathe at a higher respiratory
rate, their lungs are still developing, and they are likely
to be active outdoors. Children also have a higher rate
of asthma.
Older adults, because they are more likely to have
undiagnosed heart or lung disease.
Anyone with respiratory disease such as asthma or
emphysema, and anyone with a heart condition such
as coronary artery disease or congestive heart failure.
Anyone who is frequently active outdoors. In addition,
certain “unusually sensitive” individuals can
experience breathing problems even at code yellow
levels.
How can you protect your health?
Know the Code. Pay attention to the daily air quality
forecast.
Know your body. Be aware of any health conditions
that may increase your risk. Notice if you experience
breathing difficulties or other problems on bad air days.
Limit your outdoor physical activity on code orange or
worse days, especially if you’re a member of a
sensitive group. Pollution exposure depends on the
length of time and level of exertion. Any activity that
raises your breathing rate increases your risk. You
don’t need to stay indoors, but “take it easy” outdoors
to reduce your risk.
If you have a heart condition, use special caution on
forecasted high particle pollution days. Particle
pollution can be high at any time of day or night, unlike
ozone pollution, which is highest in the afternoons.
Particles also can penetrate indoors, unlike ozone, so
indoor particle levels may be higher than normal on
high particle pollution days. Limit indoor exertion, as
well as outdoor exertion, on forecasted high particle
days.
Do your share to care for the air. Driving less, keeping
your car tuned, and using less electricity reduces
emissions from cars and coal-fired power plants, so
that everyone can breathe easier.
How can I get the daily air quality forecast?
Subscribe to e-mail or text forecast notifications at
www.enviroflash.info
Check the NC Division of Air Quality website at
www.ncair.org
Check your newspaper’s weather page, or watch your
local TV weather report. Some TV news broadcasts
report orange, red, or purple forecasts only.
Call the Air Awareness hotline at 1-888-RU4NCAIR
(1-888-784-6224)
What Color Is Your Air?
Facts you should know about air quality
Division of Air Quality
www.ncair.org
Getting Started:
Ten Free or Inexpensive Ideas
to Enrich Your Outdoor
Learning Environment Today*
1. Plant a tree . . . or shrub or bush. Your
Cooperative Extension Agency or the US Forest
Service may be able to help you locate free, native
trees such as dogwood, longleaf pine, redbud,
sassafras or native red cedar. Blueberries and oakleaf hydrangea are good choices for versatile
bushes. A three foot tall fig tree ($12) will double in size in one year and will provide a shady retreat
where children can play while still in your sight. Fig leaves are very interesting. When the fruit
matures, the children can harvest figs for cooking activities. Yummy!
2. Hang a bird feeder . . . or two or three. Use the area just outside the classroom window so children
can watch the birds when they are playing inside, too. Birds are attracted to different kinds of seeds
and food. Experiment and help the children discover various birds’ preferences.
3. Create a special place for digging. Use existing dirt or buy soil from a nursery. Provide shovels,
spoons, buckets and whatever accessories complement the play themes that children initiate. What
might happen if you filled the dirt digging area with sand? A tarp will protect the digging area when
it’s not in use.
4. Place a log outside the heavily trafficked area. Children can use the log as a bench. Little
scientists will discover captivating beetles under the bark. They can roll the log to find all sorts of
interesting things underneath. They can observe changes as the log disintegrates over time.
5. Designate a table or shelf as an outside discovery center. This is an area where items collected
during nature walks can be placed and studied. Collections of rocks, seeds, pine cones and leaves can
be counted, sorted, sequenced and drawn. Encourage children to bring natural items to the center that
have been collected from their homes and neighborhoods.
6. Plant a cornfield. (Think on a three-year-old scale.) Chart the growth of the stalks. Pumpkins
planted under the shelter of the corn will thrive if the soil is good and rich. Imagine all the science
and math the children will learn beginning with planting season through harvest. What fun to stand in
the middle of the ‘field’ shaded by lush plants!
7. Create a whiskey barrel herb garden. Plant chives, rosemary, parsley, marjoram, lavender, bronze
fennel and basil for a fragrant and edible garden that will attract beautiful butterflies. Cost? Whiskey
barrel ($20), soil ($20), plants ($15). Alternative enclosures could be cinder blocks, logs, a tire . . .
Don’t forget to water!
8. Construct a rose arbor. Okay, this one may take longer than a day to pull off but you may have a
talented parent who would love to help. Imagine a shady, sweetly fragrant outdoor space with seating
where children and adults can gather to play, read, dance, stage plays, or simply experience natural
beauty . . . aahh. A thornless climbing vine such as the Banksiae Rose will cover a wooden arbor in
no time. The fragrance is incredible. Eventually, children will notice birds building nests in the arbor
and imaginations will light up with possible uses for such an appealing outdoor space.
9. Plant a North Carolina heritage garden. Okra and black-eyed peas do well together. Cabbage and
turnips or a three sisters garden of beans, corn and squash would be fun to grow. Harvest and cook
the vegetables. If you grow okra, harvest and cook the okra, but leave some to dry on the stalk.
Watch them develop into beautiful striped seed pods that make wonderful rhythm instruments for
small hands. When you are ready, take the dried pods apart to find the seeds. Plant them in the
spring. Pods can also be used to create animal figures.
10. Inventory natural elements. Take a walk with the children around your outdoor environment to
document what you find. Use photographs, charts, tape recorders and dictation to record observations.
Even toddlers can make bark rubbings. How many trees are on the playground? How many animals
and what kinds of animals live there? What colors do you notice? Expand on the documentation by
creating a list of what the children would like to see/do/smell/hear in their outdoor environment. This
activity may lead to amazing transformations . . .
_____________________________________________________________________________________
*We’ve heard from administrators and teachers who value high quality outdoor environments and
understand the importance of nature and exploration for the physical, emotional/social, and
cognitive well-being of children. This document is intended to inspire those who are ready to make
the leap and want a place to start.
Mary Bradford, Nancy Easterling, Trish Mengel and Virginia Sullivan
Professional Development Work Group of the NC Outdoor Learning Environment (OLE) Alliance
What the Research Shows: A Summary
RESEARCH-BASED INDICATORS OF THE NATURE DEFICIT
Children today spend less time playing outdoors than any previous
generation. 82 percent of mothers with children between the ages of 3 and
12 cited crime and safety concerns as one of the primary reasons they do
not allow their children to play outdoors. (Clements, 2004)
Today’s children have a more restricted range in which they can play
freely, have fewer playmates who are less diverse, and are more home-
centered than any previous generation. (Karsten, 2005)
Children’s free play and discretionary time declined more than seven
hours a week from 1981 to 1997 and an additional two hours from 1997 to
2003, totaling nine hours less a week of time over a 25-year period in
which children can choose to participate in unstructured activities.
(Hofferth and Sandberg, 2001; Hofferth and Curtin, 2006)
Children between the ages of six months and six years spend an average
of 1.5 hours a day with electronic media, and youth between the ages of 8
and 18 spend an average of 6.5 hours a day with electronic media—that’s
more than 45 hours a week! (Kaiser Family Foundation, 2005 and 2006)
Obesity in children has increased from about 4 percent in the 1960s to
close to 20 percent in 2004. (Centers for Disease Control and Prevention,
2006)
62 percent of children do not participate in any organized physical activity
and 23 percent do not participate in any free-time physical activity.
(Centers for Disease Control and Prevention, 2003)
The percent of children who live within a mile of school and who walk or
bike to school has declined nearly 25 percent in the past 30 years. Barely
21 percent of children today live within one mile of their school. (Centers
for Disease Control and Prevention, 2006)
While 71 percent of adults report that they walked or rode a bike to school
when they were young, only 22 percent of children do so today. (Beldon
Russonello and Stewart Research and Communications, 2003)
Children & Nature Network 1
94 percent of parents say that safety is their biggest concern when making
decisions about whether to allow their children to engage in free play in
the out- of- doors. (Bagley, Ball and Salmon, 2006)
Children predominantly play at home, with their activities monitored and
controlled by adults, compared to children a generation ago. Only 3
percent of today’s children have a high degree of mobility and freedom in
how and where they play. (Tandy, 1999)
Children can identify 25 percent more Pokemon characters than wildlife
species at eight years old. (Balmfold, Clegg, Coulson and Taylor, 2002)
RESEARCH-BASED INDICATORS OF NATURE’S BENEFITS TO CHILDREN
Contact with the natural world can significantly reduce symptoms of
attention deficit disorder in children as young as five years old. (Kuo and
Taylor, 2004)
The greener a child’s everyday environment, the more manageable are
their symptoms of attention-deficit disorder. (Taylor, Kuo and Sullivan,
2001)
Access to green spaces for play, and even a view of green settings,
enhances peace, self-control and self-discipline within inner city youth,
and particularly in girls. (Taylor, Kuo and Sullivan, 2001)
Green plants and vistas reduce stress among highly-stressed children in
rural areas, with the results the most significant where there are the
greatest number of plants, green views and access to natural play areas.
(Wells and Evans, 2003)
Proximity to, views of, and daily exposure to natural settings increases
children’s ability to focus and enhances cognitive abilities. (Wells, 2000)
Nature is important to children’s development in every major way—
intellectually, emotionally, socially, spiritually and physically. Play in nature
is especially important for developing capacities for creativity, problem-
solving, and intellectual development. Therefore changes in our modern
built environments should be made to optimize children’s positive contact
with nature. (Kellert, 2005)
Children will be smarter, better able to get along with others, healthier and
happier when they have regular opportunities for free and unstructured
play in the out-of-doors. (Burdette and Whitaker, 2005)
Positive direct experience in the out-of-doors and being taken outdoors by
someone close to the child—a parent, grandparent, or other trusted
guardian—are the two factors that most contribute to individuals choosing
to take action to benefit the environment as adults. (Chawla, 2006)
Children & Nature Network 2
Children & Nature Network 3
Children who experience school grounds with diverse natural settings are
more physically active, more aware of nutrition, more civil to one another
and more creative. (Bell and Dyment, 2006)
Outdoor experiences for teens result in enhanced self-esteem, self-
confidence, independence, autonomy and initiative. These positive results
persist through many years. (Kellert with Derr, 1998)
Factoring out other variables, studies of students in California and
nationwide show that schools that use outdoor classrooms and other
forms of nature-based experiential education produce significant student
gains in social studies, science, language arts, and math. One recent
study found that students in outdoor science programs improved their
science testing scores by 27 percent. (American Institutes for Research,
2005)
Studies of children in schoolyards with both green areas and
manufactured play areas found that children engaged in more creative
forms of play in the green areas, and they also played more cooperatively.
(Bell and Dyment, 2006)
Visit the Children & Nature Network, www.cnaturenet.org, for C&NN’s
Annotated Bibliographies of Research and Studies, Volumes 1 and 2 (2007).
What’s In It For Me?
What Teachers/Caregivers can expect to gain from “taking on” the
OUTDOORS . . .
By Virginia Sullivan, Principal, Learning by the Yard, Consultants to School Grounds,
and Janet McGinnis, Program Consultant, NC Office of School Readiness
It’s good for you, too!
The April 2007 issue of the NC Child Care Health and Safety
Bulletin is filled with information about how the outdoors is
healthy for children and important for their growth and
development (www.healthychildcarenc.org). Well guess what?
It’s healthy for adults too! When you think about your typical day
in your early care and education setting, how much time are YOU
spending in the fresh air, in full spectrum sunlight, in an
environment that has lots of “green” – plants, trees? The health
benefits of being outdoors continues throughout life. There is
even evidence that exposure to green spaces is healing. Research
tells us that in hospital settings, patients that have window views
onto green space (plants, trees.) heal faster than those who don’t.
We are just beginning to understand the health value of the
outdoors for all of us.
Pleasure and relief from stress:
Many teachers who develop rich outdoor environments report
that they can’t wait to get to school to see what is happening
outside. They say that being outside makes them feel calm, happy
and peaceful. And the pleasure is guilt-free. Research shows that
when adults share this interest and pleasure with children, it
contributes to children’s learning and well being.
Sense of freedom:
When you open the door for the children to go outside, babies will
kick with joy, toddlers attempt to run, and older children “charge”
across the play yard with delight and enthusiasm, expressing their joy
in the freedom found outside the classroom. Have you ever noticed
that you feel the same way?
Many teachers have had little chance themselves to explore nature
outside. You may therefore think you don’t know enough about
nature. But you don’t have to have all the answers. Children will
notice and ask about the most incredible things (as you know) It is fun, freeing and
appropriate for teachers to respond to questions by saying, “Let’s find out together! This
is how we learn…”.
A rose is a rose
is a rose . . . (but
so much more!).
Did you know
that floral scents
contribute to
cognitive
functioning –
making teachers
as well as
children smarter,
more alert and
ready
to learn?
Need exercise?
No time to go to
the gym? Try
playing “follow the
leader” with a
child. Let them
lead you and see
how much exercise
you get!
This is a chance for you to enjoy the details in nature, notice the shape of a leaf, the color
of a flower, the sound of the wind. By talking about what you see, hear, and feel, you are
modeling language and showing children that you care about the environment.
Think of it as free educational materials: acorns for counting, leaves for sorting and
counting, shadows to notice, branches to build with, shrubs to hide in, flowers to smell,
birds to observe…
The environment as teacher:
Many teachers say a well-equipped outdoor environment is
like having another teacher. Why is that? . . . Because
children are naturally curious and attracted to things in their
environment. They want to explore hills, trees, plants,
butterflies, worms, grass, sand, water… sunshine and shadow.
A rich outdoor environment suggests things to do.’ Try
chasing your shadow!’ ‘ Climb up the hill.’ You will find that
children talk more and ask more questions in the outdoor
environment. All of this is great for their development and
exciting for you as well!
So . . . have fun . . . play outside . . . knowing you are doing the right thing for children
…and for yourself!
References:
Chawla, Louise 2006. Learning to Love the Natural World Enough to Protect It.
Barn nr. 2 2006:57-78
Louv, Richard (2005). Last Child in the Woods, Algonquin Books, Chapel Hill, NC.
Marcus, Clare Cooper, and Barnes, Marnie (1999). Learning Gardens, John Wiley and
Sons, NY.
The Hundred Languages of Children (1987) City of Reggio Emilia Department of
Education, Reggio Emilia, Italy.
Reprinted with permission from the NC Child Care Health and Safety Resource Center
(www.healthychildcarenc.org
).
Photo by Wendy Banning
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