January Ocampo

Certificate III in Early Childhood Education and Care Learner Guide A1 Ensure the Health and Safety of Children Learner Guide A1 - Ensure the Health and Safety of Children Page 1 A1 Certificate III in Early Childhood Education and Care Certificate III in Early Childhood Education and Care: Learner Guide A1 Ensure the Health and Safety of Children Version 1.0 © Education Services Australasia Limited 2015 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior written permission of the publisher. The views expressed in this work do not necessarily represent the views of Education Services Australasia Limited. In addition, Education Services Australasia Limited does not give warranty or accept any legal liability in relation to the content of this work. Published in January 2015. Learner Guide A1 - Ensure the Health and Safety of Children Page 2 A1 Certificate III in Early Childhood Education and Care Table of Contents A1A: Introduction……………………………………………………………………………………………….………………6 A1B: Supporting each child’s health needs ...............................................................................6 A1B1: Communicating with families about children’s health needs ......................................... 6 A1B2: Maintaining confidentiality in relation to children’s individual health needs .............. 7 A1B3: Assisting others to implement appropriate practices when administering medication …………………………………………………………………………………………………………………8 A1B4: Checking the written authorisation form to administer medication from the parent or guardian…………. ................................................................................................................................. 9 A1B5: Checking the medication does not exceed the use-by date, is supplied in its original packaging and displays the child's name ..................................................................................... 10 A1B6: Storing medication appropriately ................................................................................... 10 A1C: Providing opportunities to meet each child’s need for sleep, rest and relaxation ...............10 A1C1: Ensuring sleep and rest practices are consistent with approved standards and meet children’s individual needs .....................................................................................................12 A1C2: Providing appropriate quiet play activities for children who do not sleep or rest………………………………………………………………………………………………………………………………13 A1C3: Respecting children’s needs for privacy during any toileting and dressing and undressing times…………………………………………………………………………………………………………15 A1C4: Ensuring children’s and families’ individual clothing needs and preferences are met, to promote children’s comfort, safety and protection within the scope of the service requirements for children’s health and safety ................................................................................ 16 A1C4.1: Other considerations in children's clothing ......................................................... 16 A1C4.2: Respect for children's choices ............................................................................. 17 A1C4.3: Respect for family's choices ................................................................................. 17 A1C5: Sharing information about individual children’s rest and sleep with families as appropriate…………………………………………………………………………………………………………………..18 A1D: Implementing effective hygiene and health practices ..................................................... 18 A1D1: Consistently implementing hygiene practices that reflect advice from relevant health authorities….. .................................................................................................................................... 19 A1D2: Supporting children to learn personal hygiene practices ....................................... 19 A1D3: Implementing the service health and hygiene policy and procedures consistently 21 A1D4:Ensuring that service cleanliness is consistently maintained ....................................... 22 A1D4.1: Cleaning equipment ....................................................................................... 22 Learner Guide A1 - Ensure the Health and Safety of Children Page 3 A1 Certificate III in Early Childhood Education and Care A1D4.2: When to clean ........................................................................................................ 22 A1D4.3: Special considerations for cleaning..................................................................... 23 A1D5: Observing and responding to signs of illness and injury in children and systematically record and share this information with families ................................................... 26 A1D5.1: What to do if a child seems unwell.………………………………………………….……. .27 A1D5.2: Keeping records…….…………………………………………………………………………… 27 A1D6: Consistently implementing the service policies for the exclusion of ill children......... 28 A1D7: Discussing health and hygiene issues with children ..................................................... 29 A1E: Supervising children to ensure safety ........................................................................................... 30 A1E1: Supervising children by ensuring all are in sight or hearing distance at all times ...... 31 A1E2: Adjusting levels of supervision depending upon the area of the service and the skill, age mix, dynamics and size of the group of children, and the level of risk involved in activities ………………………………………………………………………………………………………………..31 A1E3:Exchanging information about supervision with colleagues to ensure adequate supervision at all times..................................................................................................................... 32 A1F: Minimising risks ...................................................................................................................... 32 A1F1: Assisting in the implementation of safety checks and the monitoring of buildings, equipment and the general environment ....................................................................................... 34 A1F2: Consistently implementing policy and procedures regarding the use and storage and labelling of dangerous products ...................................................................................................... 34 A1F3: Following service procedures for the safe collection of each child, ensuring they are released to authorised people .......................................................................................................... 35 A1F4: Assisting in the supervision of every person who enters the service premises where children are present…………………………………………………………………………………………………….. 36 A1F5: Discussing sun safety with children and implement appropriate measures to protect children from over-exposure to ultraviolet radiation ................................................................... 36 A1F6: Checking toys and equipment are safe for children and safe to use in their proposed area ................................................................................................................................................ 38 A1F7: Removing any hazards immediately or securing the area to prevent children accessing the hazard…………. ............................................................................................................................40 A1G: Contribute to the ongoing management of allergies………………………………………………….46 A1G1:Identifying and recognising signs, symptoms and key characteristics of allergies and anaphylaxis………………………………………………………………………………………………………….…..….47 A1G2:Applying organisational risk-management strategies for children with severe allergies……………………………………………………………………………………………………………………….48 A1G3: Following organisational policies and legislative requirements in relation to medication for anaphylaxis………………………………………………………………………..………………… 49 A1H: Contributing to the ongoing management of asthma .......................................................... 50 A1H1: Identifying signs, symptoms and triggers of asthma .................................................... 50 Learner Guide A1 - Ensure the Health and Safety of Children Page 4 A1 Certificate III in Early Childhood Education and Care A1H2: Identifying children who have an asthma management plan and following that plan ............................................................................................................................................. 51 A1H3: Following organisational policies and legislative requirements in relation to medication for asthma………………………….……………………………………………………………… 52 Appendix 1: Giving Medicines to Children Safely and Effectively .................................. 53 Learner Guide A1 - Ensure the Health and Safety of Children Page 5 A1 Certificate III in Early Childhood Education and Care A1A: Introduction. In this module, we will look closely at our most important consideration when caring for children – ensuring their health and safety. Everything we do must, first and foremost, ensure the safety and health of the children in our care. There is a lot we need to know and a lot we can do to achieve this. First, we need to make sure that we provide a safe environment for the children. The risk of an injury happening is directly related to the physical environment and children’s behaviours, and how these are managed. This is why early childhood educators need to be identify and remove hazards that may harm children in the education and care setting. It is important to take note that hazards may also include “triggers” of children’s allergies or asthma. Daily routines and activities should be done in such a way that maintain a high level of cleanliness and safety. However, even with the utmost care, children still get sick and accidents still happen. So early childhood educators also need to know what to do in those situations. It’s important that early childhood educators inform themselves of the service’s policies and procedures concerning health and safety of the children, particularly in maintaining hygiene and cleanliness, and administering medication to children and managing allergies or anaphylaxis and asthma. A1B: Supporting each child’s health needs. It is important that nominated supervisors, educators, and family day care educator assistants are aware of the health requirements of all children and that there are effective processes to support and Element 2.1.2 of the National monitor these. Quality Standards state that “Each child’s health needs are supported.” Children can also have specific health requirements and these often change over time and as children develop. The approved provider needs to work closely with children, families and, where relevant, schools and health care professionals to promote healthy lifestyles and ensure they understand and meet children’s specific health requirements. A1B1: Communicating with families about children’s health needs. Individualisation is key to the philosophy of every education and care setting. Each child entering a service brings a unique set of developmental and health needs and these needs should be addressed appropriately. Learner Guide A1 - Ensure the Health and Safety of Children Page 6 A1 Certificate III in Early Childhood Education and Care These health needs can either be acute or chronic. Acute health needs involve conditions that last only a short time, such as a flu or minor injuries sustained from an accident. Chronic health needs are those conditions that continue over a long period of time, often for life. A child with a chronic condition may or may not be unwell from day to day. Chronic conditions vary widely. Some examples of chronic childhood conditions include allergies, asthma, hearing loss, diabetes, seizures, cerebral palsy, cancer, spina bifida, and HIV/AIDS. A child might be diagnosed with a single chronic condition or multiple conditions. For example, children born premature and with very low birth weight may have multiple conditions such as developmental delays, cerebral palsy, and asthma. Children's symptoms of chronic conditions can range from mild to severe. They may need few or many adaptations in daily activities. For example, a child with allergies and asthma might be well on a daily basis with only seasonal episodes requiring treatment; whereas a child with diabetes might need daily medication and monitoring of diet, exercise, symptoms, and blood sugar levels. The course of chronic conditions can also vary over time. A chronic condition may stay the same or change, either getting better or worse, over time. For example, a child's visual impairment from birth might be stable over time; a child successfully treated for leukaemia might go into remission; and a child with HIV disease might progress from having no symptoms to frequent illnesses.1 It is important that early childhood educators are aware of the health needs of all children and that there are effective processes in the service to support and monitor these. So how do early childhood educators inform and update themselves about children’s health needs? They can start with each child’s enrolment records containing health information and authorisations. At time of enrolment, parents will be usually be asked to identify if their child has a medical condition, including the diagnosis of asthma, anaphylaxis or diabetes. Where the parent indicates a medical condition, the parents will be required to work with the service to develop an individual medical management plan that may include a risk minimisation plan, communication plan, and an emergency treatment plan (to be developed by a medical professional). Early childhood educators need to regularly communicate and work closely with each other, children, families and, where relevant, health care professionals to promote healthy lifestyles and ensure they understand and meet children’s specific health needs. An Office of the Administration for Children and Families Early Childhood Learning and Knowledge Center, Addressing Individual Child Health Needs and Keeping Children Healthy, http://eclkc.ohs.acf.hhs.gov/hslc/ttasystem/health/Health/Health%20Manager%20Resources/Health%20Manager%20Resources%20Program%20Staff/PartA1He althOrientationGuide.pdf 1 Learner Guide A1 - Ensure the Health and Safety of Children Page 7 A1 Certificate III in Early Childhood Education and Care A1B2: Maintaining confidentiality in relation to children’s individual health needs. The education and care service understands the importance of developing practices that respect privacy and confidentiality so that families will trust the service and openly exchange information with educators and staff, which may be important to the care of a child. Legislation requires that families provide personal information to the service so that appropriate care can be taken of their children. Authorised educators and staff at the service will use this information and may discuss a child’s personal details with another educator or staff in order to fulfil their responsibilities towards the child. For example, staff who prepare and serve food should be fully aware of which children have food allergies and what each affected child is allergic to. Educators who monitor the children in the playground should be aware if any children are allergic to bee stings, or if any children have a chronic condition which warrants especially close monitoring during play (such as poorly controlled epilepsy, or diabetes treated by insulin injection). Early childhood educators and staff need to know if any children in care have been prescribed medications, for what reasons, and what the possible side effects are, since they are likely to be administering the medications and monitoring the reaction. Program directors and educators need to know if there are any un- or under-immunized children in care, so that appropriate measures can be taken in the event of exposure to a vaccine-preventable illness. It is important therefore to ensure that educators and staff are truly aware of their responsibilities for maintaining strict confidentiality under the Privacy Act, and also that families are informed of their rights in regard to access to their own personal information, and how the service will ensure the information is protected from unauthorised access. Families need to be informed about which people have authorised access to their children’s personal information. 2 Maintaining confidentiality is also an ethical responsibility. Early Childhood Australia’s Code of Ethics states that: “In relation to families, I (the early childhood educator) will maintain confidentiality and respect the right of the family to privacy.” You may review 2C3.A1: Privacy Act 1988 and 2FA1: Maintaining confidentiality in the Learner Guide of Module 2: Work within a relevant legal and ethical framework. It is more important, however, that you consult your service’s standards, policies and procedures in maintaining confidentiality. 2 Professional Support Coordinator Alliance, Confidentiality and Privacy, http://www.pscalliance.org.au/wp-content/policies/psca-confidentiality-privacy.pdf Learner Guide A1 - Ensure the Health and Safety of Children Page 8 A1 Certificate III in Early Childhood Education and Care A1B3: Assisting others to implement appropriate practices when administering medication. When children are ill, they may require medication to help manage symptoms or stop infection. But early childhood educators should keep in mind that medication (including prescription, over-the-counter and homeopathic medications) must be administered to a child at a service only when there is written authorisation by a parent (or guardian with the authority to consent to administration of medical attention to the child). There are only two exemptions to this rule. 1. In the case of an emergency, it is acceptable to obtain verbal consent from a parent, or a registered medical practitioner or medical emergency services if the child’s parent cannot be contacted. 2. In the case of an anaphylaxis or asthma emergency, medication may be administered to a child without authorisation. In this circumstance, the child’s parent and emergency services must be contacted as soon as possible. 3 The administration of medication is considered a high risk practice. This is why giving medicines to young children may require early childhood educators and/or staff to work together. According to the Guide to the Education and Care Services National Regulations, medication must be administered: • with a second person checking the dosage of the medication and witnessing its administration; and • details of the administration must be recorded in the medication record. In relation to the second requirement, early childhood educators should record all relevant details after they have given the medicine. These details include: ● the dosage that was administered, and ● the manner in which the medication was administered, and ● the time and date the medication was administered, and ● the name and signature of the person who administered the medication, and ● the name and signature of the other person required to check the dosage and witness the administration. 3 Australian Children’s Education and Care Quality Authority, Guide to the Education and Care National Law and National Regulations, http://www.acecqa.gov.au/Article.aspx?pid=301&gcpid=2&acpid=372 Learner Guide A1 - Ensure the Health and Safety of Children Page 9 A1 Certificate III in Early Childhood Education and Care A1B4: Checking the written authorisation form to administer medication from the parent or guardian. While families place a high level of trust and responsibility on staff when administering medication to children and must feel confident that the process is carried out responsibly, educators and staff must also feel they are protected against any possibility that instructions have been misunderstood. Thus, parents are expected to properly document their requirements. Educators and staff must ensure this has been done before any medication is administered. If a child requires medication while attending an education and care service, a parent or legal guardian must provide the service with written authority to administer the medication. To do this, families will usually be required to complete and sign a medication record. A record will need to be completed each time a child needs to receive a new course of medication. Your service should have a medication record in place that parents or guardians can request for and complete. Parents or guardians will be required to write the following information in the Medication Record: • the name of the child; • the authorisation to administer medication (including, if applicable, selfadministration), signed by a parent or a person named in the child's enrolment record as authorised to consent to administration of medication; • the name of the medication to be administered; • the time and date the medication was last administered; • the time and date, or the circumstances under which, the medication should be next administered; • the dosage of the medication to be administered; and • the manner in which the medication is to be administered. It is also vital that educators and staff are also told about any other medication being administered while the child is not attending the service. Learner Guide A1 - Ensure the Health and Safety of Children Page 10 A1 Certificate III in Early Childhood Education and Care A1B5: Checking the medication does not exceed the use-by date, is supplied in its original packaging and displays the child’s name. According to Guide to the Education and Care Services National Law and National Regulations, medication administered in the service should also be: • from its original container before the expiry or use-by date; • in accordance with any instructions attached to the medication or provided by a registered medical practitioner; and • for prescribed medications, from a container that bears the original label with the name of the child to whom it is prescribed. It’s important that the use by date on the label is checked by early childhood educators. After the use by date, medications may no longer be effective and can even be harmful to young children. Medication errors may happen in education and care settings. Giving the wrong dose of medication is one example. This includes overdoses, under doses, and missed doses. Giving the medication incorrectly can also mean not carrying out the accompanying instructions, (for example, with food, etc.). Potentially, the most serious errors occur when giving the medication to the wrong child. This may happen when two or more children need to have medication administered to them on the same day or days. This is why medication brought to the centre should always be in its original container that bears the original label with the name of the child to whom the medication is to be administered. It can also help if a photo of the child is attached to the label, especially when the staff giving the medicine is quite new in the centre. The label also bears the dose and frequency by which to administer the medication, unless the child’s medical practitioner has given other instructions. You may want to read Appendix 1 for more information on how to give medicines to children safely and effectively. A1B6: Storing medication appropriately 4. Early childhood educators should keep all medications in the original containers in which they were accepted. This applies to both prescription and over-the-counter medications. Medicines should be kept in locked secure storage areas. Only designated staff should have access to the medications, and it must be out of reach of children. In an education and care 4 Healthy Childcare, Medication Safety in the Childcare Setting. by Cynthia D Sprouse, BA Western KY University, Training & Technical Assistance Services, Project Associate. http://www.healthychild.net/TheMedicineChest.php?article_id=A113 Learner Guide A1 - Ensure the Health and Safety of Children Page 11 A1 Certificate III in Early Childhood Education and Care setting, a locked cupboard or storage area close to or in the classroom will allow the staff to supervise children while retrieving medication. If the program has a nurse’s office, this is a suitable alternative. A family day care provider may use a locked hall cupboard, and place medications on a high shelf, making sure the door is securely locked (not latched). Day care providers have the additional challenge of keeping their family’s personal medications away from children. These also should be stored in a secure, locked area inaccessible to children. Store medications at the correct temperatures. Medications that require refrigeration should be stored away from food and placed inside a locked container, preferably in a separate refrigerator. Store all medications in clearly marked containers and in an orderly manner. In addition, the storage area should be well lit. When administering medications, only handle one medication at a time. Always double-check that you are administering the proper medicine at the exact dosage to the correct child. Immediately return each medication to proper storage before retrieving medication for another child. As medications are received in the service, note them on a checklist. Designated staff should update this checklist each time medicine is added or removed. Medication brought in by staff for their personal use should be kept in a separate location from the children’s medicines. It should also be kept in a locked and secure storage area, inaccessible to children. A1C: Providing opportunities to meet each child’s need for sleep, rest and relaxation. Rest and quiet times are opportunities for children to take the necessary breaks they need to get through a happy and active day. Here are some tips and ideas on how you can organise opportunities for the children’s sleep and rest time: • Pick up on children's cues such as rubbing eyes, yawning, etc. • Make a space where children can sleep quietly and safely. • Be sure each child sleeps in the same place each day, draw a diagram of the room so that relief staff can ensure consistency. • Encourage parents to bring their child's security object from home such as a blanket, soft toy, dummy, etc. • Develop a sleep/rest time ritual that you repeat each day with individual children like singing a lullaby or rocking and patting to sleep. Learner Guide A1 - Ensure the Health and Safety of Children Page 12 A1 Certificate III in Early Childhood Education and Care • Be aware of children's differences when planning sleep time, for example, it may work best if you sit first with children who settle easily and then focus on the children who require more time and attention. Children will rest more effectively if they are in a restful environment. This can be achieved in many ways. Darken the room by drawing the curtains. Just make sure there’s still a small amount of light for safety reasons. Temperature should also be comfortable. Turn on the fans or heaters, depending on the season. Playing soft relaxation music may also help children to unwind. Remember that the main purpose of rest times is for children to have the opportunity to rest and engage in quiet activities, not for staff to catch up on work. So be with the children during rest times. Sitting with the children and maybe reading a quiet story or rhythmic poem will reinforce a calm quiet environment. A1C1: Ensuring sleep and rest practices are consistent with approved standards and meet children’s individual needs. Sleep time ensures that children get the rest they need during their active day in the setting. Well-rested children have more energy and are alert and curious. Over-tired children are often emotional, prone to accidents and intolerant of the behaviour of other children. Ensuring that all children have the rest they need will contribute to their individual well-being and the harmony of the group. Sleep requirements differ from individual to individual, but in general, a younger child needs more sleep than an older one. For instance, it’s important that babies get up to 1A1 hours of sleep while pre-schoolers need around 10 – 12 hours. Most kids' sleep requirements fall within these predictable range of hours based on their age, but you have to remember that each child is also a unique individual with distinct sleep needs. For example, two-year-old Sarah might sleep from 8:00 PM to 8:00 AM, whereas 2-year-old Johnny is just as alert the next day after sleeping from 9:00 PM to 6:00 AM. It is important to recognise that children have different sleep patterns and that you have to accommodate their needs accordingly. To accommodate varying needs for rest, an important thing to remember is that a quiet area where children can go to relax should be provided throughout the day. Children may become tired at any time of the day and may need to go to a quiet area even when it is not yet time for the whole group to rest. The area could be a simple corner where mats and pillows are set up. Make sure it’s away from the active areas in your room such as the block area or music area. Safe sleep practices Most services in Australia recognise SIDS and Kids as the expert authority on safe sleeping practices for children aged 0 – 2 years and implement safe sleep practices advised by the organisation. Learner Guide A1 - Ensure the Health and Safety of Children Page 13 A1 Certificate III in Early Childhood Education and Care All education and care services should be following these guidelines: • sleeping babies on their back, not on their tummies or side. Placing babies on their backs means they have better airway protection and are less likely to choke on vomit than babies sleeping on their tummies; • ensuring babies’ faces are not covered with anything such as doonas, pillows, soft toys or lamb’s wool; • providing a safe sleeping environment which includes safe cots, mattresses and bedding; • never sleeping babies on pillows, beanbags or couches; • ensuring that cots and mattresses meet the relevant Australian Standards; and • never exposing children to cigarette smoke; Although the evidence suggests that the risk of SIDS occurs in the first two years of a child’s life, early childhood educators are encouraged to maintain these practices for children of all ages. Children should always have a safe place to sleep, regardless of their age. Safe sleep practices will be discussed more thoroughly in Module 9: Provide care for babies. A1C2: Providing appropriate quiet play activities for children who do not sleep or rest. Quiet time should provide an opportunity for children to sleep or rest. There may be children under your care who won’t need naps anymore. It’s important these children are provided with appropriate quiet play activities. Watching television or playing video games does not meet this criteria. Provide children with activities that do not over stimulate, but that keep them engaged. Keep in mind that each child is different. You may need to experiment to determine what works best for the children who do not need naps anymore. The following are several quiet play activities that you can provide for non-napping children: 1. listening to audio stories 2. threading or lacing activities 3. playing with puzzles 4. manipulating stickers on a sticker book 5. doing activity or colouring books 6. hunting for a character in look and find books 7. drawing and/or writing on paper or Aqua doodle products Learner Guide A1 - Ensure the Health and Safety of Children Page 14 A1 Certificate III in Early Childhood Education and Care 8. matching or sorting games 9. playing with paper dolls 10. cutting, pasting or doing a craft activity A1C3: Respecting children’s needs for privacy during any toileting and dressing and undressing times. A safe toileting environment includes appropriate supervision. Infants and toddlers should not have access to the toilet area without direct supervision. Toilets are potentially dangerous to very young children, who can drown in the toilet, play in it, and touch contaminated surfaces. Pre-schoolers still need supervision in the toilet area; and supervision by sight and sound should be maintained. Children at this age may begin to become more modest and want some privacy. In this case, door latches on toilet rooms allow pre-schoolers privacy and give them the experience of latching a door before they use the toilet. One important concept that children learn about in the toileting area is privacy. It is highly recommended that children six years of age and older have separate male/female toileting facilities, and that children younger than six years who are competent and capable in their use of the toilet also be granted use of separate and private toilet facilities if they request them. Cultures have various traditions and beliefs about privacy, so it is important to be aware of those differences in working with children and their families. Younger children need adult help and supervision in the toilet area. In some education and care facilities, the toilet may be located on a different floor and out of sight of an early childhood educator. In that case, children younger than five years of age should have an adult escort them to and from the toilet area. 5 The same privacy should be given to children during dressing and undressing times. Early childhood educators need to be aware of individual children’s and families’ attitudes regarding privacy and modesty when children are having their clothes changed or are dressing themselves. Older children need access to safe comfortable and private spaces for dressing and changing. Services need to work with individuals and families to ensure that individual needs and preferences are understood and catered for. 5 Healthy Child Care, Safe & Appropriate Toilet Spaces in Childcare Programs, http://www.healthychild.net/InSicknessandHealth.php?article_id=A180 Learner Guide A1 - Ensure the Health and Safety of Children Page 15 A1 Certificate III in Early Childhood Education and Care A1C4: Ensuring children’s and families’ individual clothing needs and preferences are met, to promote children’s comfort, safety and protection within the scope of the service requirements for children’s health and safety.6 Children’s clothing can have a significant impact upon their health, safety and wellbeing. This can relate not only to the types of clothes that children wear, but also to when and how these are worn. A child’s age is also an important consideration for early childhood educators when they determine how a child’s clothing may affect their comfort and safety. A1C4.1: Other considerations in children’s clothing. Temperature It is important that children are not over or under dressed, and that clothing suits the temperature. The smaller the child, the more easily they can become chilled or overheated. Natural fibres such as cotton are generally cooler than acrylic fabrics. Babies and younger toddlers should be dressed warmly for sleep, and children should be checked regularly to see that they are covered if they are not dressed warmly enough to sleep comfortably without covers. To check if a child is warm enough, touch the tummy or back rather than hands or feet, as this gives a truer indication of the child’s body temperature. Footwear. Safe, comfortable footwear that fits well is essential. Shoes must provide support as well as protection for the feet. Shoes that give little protection or support or that have raised heels or soles can cause accidents. Shoes in the dress up area, for example those with high heels, can also be a safety hazard. Sun protection. Children need protection from the sun. Tightly woven fabrics such as t-shirt material, long sleeves and long trousers offer good protection. Hats are essential and should have soft brims to allow for movement and provide for maximum protection. Clothing types and accessories. It is important that the design and fit of clothes and accessories, including those for dressing up play, are safe. For example, long hems can put children at risk of tripping, and items such as capes, scarves, necklaces, long drawstrings and ribbons also present strangulation or tripping hazards. Early childhood educators need to ensure that children engaging in dress up play are carefully supervised to monitor any clothing hazards. The younger the child, the more carefully clothing safety hazards need to be considered. 6 National Childcare Accreditation Council Inc., Children’s clothing in child care, http://ncac.acecqa.gov.au/educator-resources/factsheets/qias_factsheet_1A1_children%27s_clothing%20.pdf Learner Guide A1 - Ensure the Health and Safety of Children Page 16 A1 Certificate III in Early Childhood Education and Care Clothing fabrics. Children can be very sensitive to scratchy fabrics, and some may have an allergic reaction to some treatments on clothes, including particular detergents. All clothes that children wear, especially those for sleeping, must be low fire danger. A1C4.2: Respect for children’s choices. All practices in an education and care setting, including clothing policies and procedures, need to convey respect for children and an appreciation of their individuality. Early childhood educators can show respect for children by building in opportunities for them to make choices in relation to getting dressed, and the clothing they wear. The younger the child the more control adults usually have over their clothing. However, even very young children should have opportunities to make choices. To give children these opportunities, adults need to decide what genuinely matters. For example, issues related to health, safety and the child’s play and learning are important, whereas fashion, aesthetics, and sometimes even convention are usually not of great importance to what young children wear. Items of clothing need not match, or colours complement if a child has strong preferences about what he or she wears. If a child succeeds in putting on their shirt, it does not matter if it is back to front or inside out. What matters is that the child has accomplished the task. Toddlers in particular may have specific clothing preferences, such as insisting on wearing a particular colour or piece of clothing. It is important that early childhood educators give the child a choice whenever possible and to ensure that the choices offered are among items that are suitable. Offering a variety of acceptable options will ensure that the child’s preference can be accepted. Unless there is a health or safety issue involved, it’s best to go along with children’s fads or strong preferences, as these are not harmful, and will eventually pass. A1C4.3: Respect for family’s choices. Respect is important in addressing issues about clothing with families. Sometimes there are differences in the views of early childhood educators and families about appropriate clothing for children in care, and being respectful and understanding of families’ choices is essential. Children often come to the setting in clothes that may be considered to be “too good” for play and learning times, and these children may be reluctant to participate in experiences because of what they are wearing, or their clothes may interfere with their play. Some services may feel that the best solution is to change the child into spare clothes from the service, and to change the child into his or her own clothes before they are collected. This is a good solution if the service and families discuss it and agree on it together. However, if this is done without collaboration with the family, it is disrespectful and dishonest and may give confusing or negative messages to the child. If the child is worried that his or her clothes will be soiled or damaged, try to work out a solution that respects the precious item, respects the family’s choice of clothing and allows the child to participate in a range of experiences. Even if the child doesn’t appear to be inhibited by the special clothing, talk to families about the issue. Let them know that the reality is, even though you would like to, you cannot ensure the clothing will not be soiled or damaged. Learner Guide A1 - Ensure the Health and Safety of Children Page 17 A1 Certificate III in Early Childhood Education and Care Avoid criticising or judging families. They may dress their child in their “good” clothes to demonstrate to you or to other families that they care about their child or that they are doing well financially. They may send the child in good clothes out of respect for the service, much in the same way that people dress up for a special occasion. Alternatively, some families may not have the resources for their child to have a variety of suitable clothes, or they may not always have access to a washing machine. Children who are dressed in too many or too few clothes may come from families who are adjusting to a new climate, or from families who have particular cultural traditions regarding clothing. There may be a range of cultural and religious issues related to dress that early childhood educators need to be aware of, although it is important that they avoid making assumptions about families based on cultural background or religion. A1C5: Sharing information about individual children’s rest and sleep with families as appropriate. As stated earlier, it is important to recognise that children have different sleep patterns and that you have to accommodate their needs accordingly. How do you identify the children’s varying needs for sleep? Communication with parents is the key. Exchange information with parents about their child’s sleep routine and make resources available to parents who may be having difficulty with children sleeping at home. Work with parents to resolve differences. If, for example, the parent wants their child to sleep for only half an hour, do your best to accommodate this. A1D: Implementing effective hygiene and health practices. Infections are common in children and often lead to illness. At home, children are reasonably well protected from infectious diseases because they do not come into contact with as many people as children who attend education and care services. The adults they meet are usually immune to many childhood illnesses because they had them as children, or have been vaccinated against them. Many children first enter education and care services at a time when their immune systems are still developing. They may not have been exposed to many common germs that cause infections—bacteria, viruses, fungi, protozoa—and they may be too young to be vaccinated against some diseases. The way that children interact in education and care services means that diseases can quickly spread in a variety of ways. Children (particularly younger children) will have close physical contact with other children and carers through regular daily activities and play; they often put objects in their mouths; and they may not always cover their coughs or sneezes. Learner Guide A1 - Ensure the Health and Safety of Children Page 18 A1 Certificate III in Early Childhood Education and Care Element 2.1.3 of the National Quality Standards state that “Effective hygiene practices are promoted and implemented. Maintaining high standards of hygiene in education and care services is essential in preventing the spread of infectious diseases and ensuring good health of children. Effective hygiene practices assist significantly in reducing the likelihood of children becoming ill due to cross-infection or as a result of exposure to materials, surfaces, body fluids or other substances that may cause infection or illness. Both the Early Years Learning Framework and the Framework for School Age Care state that: “In their settings, educators and co-ordinators promote continuity of children’s personal health and hygiene by sharing ownership of routines and schedules with children, families and the community.” A1D1: Consistently implementing hygiene practices that reflect advice from relevant health authorities. Methods for encouraging children to follow simple hygiene rules should be included in any education and care setting’s policies and procedures. To make sure hygiene strategies are appropriate, early childhood educators should stay up to date with current recommendations from health authorities for children’s hygiene. Coordination unit staff should ensure these recommendations are reflected in the service’s policies and procedures, and that these are monitored and regularly reviewed. The service’s policies and procedures should also be communicated effectively to all educators and staff. A1D2: Supporting children to learn personal hygiene practices 7. While it is not possible to prevent the spread of all infections, it is possible to reduce the risk of diseases spreading in education and care settings. Along with other hygiene methods, early childhood educators can minimise the spread of infection by supporting the development of children’s personal hygiene practices. Basic hygiene practices that young children should be supported to learn include hand washing, dental care, hygienic nose blowing, coughing and sneezing, and safe food handling and eating. Hand washing and drying. Thorough hand washing and drying by both children and adults is the most effective method for reducing the risk of cross infection in services. In busy education and care environments, it can be challenging to find time to help children to wash and dry their hands properly. However, by making sure there is plenty of time throughout each day for routines and free 7 National Childcare Accreditation Council (2006), Ask a Child Care Adviser: Dental Health, http://ncac.acecqa.gov.au/educator-resources/pcf-articles/ACCA_Dental_Health_Jun06.pdf Learner Guide A1 - Ensure the Health and Safety of Children Page 19 A1 Certificate III in Early Childhood Education and Care play, early childhood educators can model and support children to develop hygienic hand washing and drying skills. Early childhood educators should talk with and regularly remind children of when to wash their hands, including before and after meals, after going to the toilet, after wiping their nose, after playing outside and in the sandpit, and after art, craft and messy activities. Dental care. The most common dental diseases in children are dental caries (dental decay) and periodontal (gum) disease. Both dental decay and gum disease can affect even very young children and are preventable through effective dental hygiene practices. Dental decay and gum disease can lead to negative outcomes for children including discomfort, other related health problems, poor nutrition, disfigurement or future dental problems. Children may also be adversely affected by experiencing major medical or dental treatment that may be required as a result of poor oral or dental health. Education and care services can promote and implement effective health practices in a number of ways, beginning with infants and moving through to school age children. There are two main factors that affect dental health. These relate to: • • Dental care activities, for example, tooth brushing, visiting the dentist The types of food and drinks consumed and the ways these are consumed. For example, the use of infants’ bottles with sweetened drinks or pacifiers (‘dummies’) dipped in sweet substances Educators and staff can endeavour to address these factors in a number of ways: through the service’s policies and practices; through children’s programs and experiences; and by providing up to date information and support for families. It is also essential that carers and staff offer support and opportunities for children to develop self-care skills in relation to their own dental health. Hygienic nose blowing, coughing and sneezing. When coughing or sneezing, the National Health and Medical Research Council recommends that children be encouraged to cover their mouth and nose with a tissue then throw the tissue in a bin, or they should cough into their upper sleeve or elbow. Children should also be encouraged to thoroughly wash and dry their hands after coughing or sneezing. Safe food handling and eating. Early childhood educators should discuss with children the importance of having clean hands while preparing food. The following rules can assist children’s hygiene when cooking with children: • Wash hands thoroughly prior to handling food. • Do not cough or sneeze into food. • Do not lick fingers while preparing food. Learner Guide A1 - Ensure the Health and Safety of Children Page 20 A1 Certificate III in Early Childhood Education and Care • Tie children’s hair back before handling food. • Prevent children from sharing food and utensils, and from eating food or using utensils that have been dropped on the floor. Other strategies. Early childhood educators can also use the following strategies to support children’s hygiene practices: • Incorporate information on hygiene and dental care into children’s everyday experiences such as during meal times and when children use the bathroom. • Have regular conversations with children about hygiene and model appropriate practice. • Make self-care fun through socio-dramatic play, books, posters, songs and rhymes. • Display visual information for children about hand washing in care and play session environments (these are also useful reminders to early childhood educators, families and visitors). • Provide children with protective clothing for messy play. • Invite children to participate in washing toys with soapy water and to clean up after messy activities. • Use pump packs for sun screen and hand cleansers. A1D3: Implementing the service health and hygiene policy and procedures consistently. There is no advantage in having the most professional and comprehensive health and hygiene policy if the practices and procedures contained within are not being implemented. A policy manual that stays on the shelf and is not referred to on a daily basis by the staff that run the service, is of no value at all. Policies must be seen to be important from top management down to the most inexperienced member of staff. Everyone within the service needs to be fully informed, and understand the importance of consistent policy implementation, especially with regards to health and hygiene. When parents are asked what the most important thing is for them when seeking child care, a healthy and safe environment is at the top of the list. After all, with their still developing immune systems, children do need to be supported in staying clean and healthy. With this in mind, early childhood educators should create healthy environments and teach healthy habits to the children in their program on a daily basis. Learner Guide A1 - Ensure the Health and Safety of Children Page 21 A1 Certificate III in Early Childhood Education and Care A1D4: Ensuring that service cleanliness is consistently maintained. 8 Keeping the children safe and well begins with providing a clean and hygienic environment for them. We have lots of little people together in a confined area, so any illnesses or infections can spread very easily if given the chance. The aim of environmental cleaning is to minimise the number of germs that survive on surfaces in the education and care service. It is advisable to use warm water when cleaning because this makes it easier to remove dirt from a surface. However, cold water and a little extra scrubbing can also be used to effectively clean a surface. Start the cleaning process in the cleanest areas and finish in the dirtier areas. This method helps to prevent cross-infection because it decreases the risk of contaminating a clean room with germs from a dirty room. A1D4.1: Cleaning equipment. Appropriate cleaning equipment includes mops with detachable heads (so they can be laundered in a washing machine using hot water), disposable cloths or cloths that can be laundered, and vacuum cleaners fitted with hePA (high-efficiency particulate air) filters to reduce dust dispersion. Ensure that cleaning equipment is well maintained, cleaned, and stored so it can dry between uses. It can be useful to have colour-coded cloths or sponges for each area (e.g. blue in the bathroom, yellow in the kitchen) so that it is easier to keep them separate. Wear utility gloves when cleaning and hang them outside to dry. Wash your hands after removing the gloves. When choosing cleaning products, it is important to consider the product’s effectiveness against germs and the length of time the product must be in contact with a surface to properly clean it. A1D4.2: When to clean. The table below shows how often different surfaces and areas should be cleaned. If the education and care service does not have control over cleaning (e.g. if a separate organisation provides or supervises cleaning services), make sure the cleaning staff are aware of the requirements in the table below. 8 National Health and Medical Research Council (2012), Staying Healthy: Preventing infectious diseases in early childhood education and care services, http://www.nhmrc.gov.au/guidelines/publications/chA1A1 Learner Guide A1 - Ensure the Health and Safety of Children Page 22 A1 Certificate III in Early Childhood Education and Care When to clean different surfaces Surface or area Wash daily plus when visibly dirty Bathrooms – wash tap handles, toilet seats, toilet handles and door knobs. Check the bathroom during the day and clean if visibly dirty.  Toys and objects put in the mouth  Surfaces that children have frequent contact with (e.g. bench tops, taps, cots and tables)  Beds, stretchers, linen and mattress covers (if children do not use the same mattress cover every day)  Door knobs  Floors  Wash weekly plus when visibly dirty Low shelves  Other surfaces not often touched by children  Disinfectants are only necessary if a surface is known to be contaminated with potentially infectious material. Remember, if the surface is not clean, the disinfectants cannot kill germs, so you should always clean first, then (if required) disinfect. A1D4.3: Special considerations for cleaning. Bathrooms and toilets Bathrooms and toilets should be cleaned at least once a day, and more often if they are visibly dirty. Ensure that the education and care service has bathrooms and toilets that are appropriate for staff and visitors as well as children; these should include appropriate disposal bins for sanitary products. Nappy change area After each nappy change, clean the nappy change area thoroughly with detergent and water, rinsing and drying with single-use paper towel. If faeces or urine spill onto the change table or mat, clean it with detergent and water, then rinse and dry with single-use paper towel. If possible, it is useful to have at least two nappy change surfaces for each day. At the end of the morning and at the end of the day, remove the nappy change surface (waterproof sheet or change mat), wash it with warm water and detergent and dry it, preferably in the sun. Learner Guide A1 - Ensure the Health and Safety of Children Page 23 A1 Certificate III in Early Childhood Education and Care Clothing Staff clothing or over-clothing should be washed daily with detergent, preferably in hot water. It is recommended that children’s dress-up clothes are washed once a week in hot water and detergent, plus when they are visibly dirty. Linen Wash linen in detergent and hot water. Do not carry used linen against your own clothing or coverall— take it to the laundry in a basket, plastic bag or alternative. Treat soiled linen as you would a soiled nappy, and wear gloves. If washed at the education and care service, soiled linen should be: • soaked to remove the bulk of the contamination; • washed separately in warm to hot water with detergent; and • dried in the sun or on a hot cycle in the clothes dryer. Cots If a child soils a crib or cot: • wash your hands and put on gloves; • clean the child; • remove your gloves; • dress the child and wash the child’s hands and your hands; • put on gloves; • clean the cot o remove the bulk of the soiling or spill with absorbent paper towels o place the soiled linen in a plastic-lined, lidded laundry bin o remove any visible soiling of the cot or mattress by cleaning thoroughly with detergent and water • remove your gloves and wash your hands; and • provide clean linen for the cot. Dummies Never let children share dummies. When not in use, dummies should be stored in individual plastic containers labelled with the child’s name. Store dummies out of children’s reach, and do not let the dummies come in contact with another dummy or toy. Learner Guide A1 - Ensure the Health and Safety of Children Page 24 A1 Certificate III in Early Childhood Education and Care Toothbrushes Never let children share toothbrushes. Each toothbrush should be labelled with the child’s name. Because bacteria can grow on wet toothbrushes, the bristles should be exposed to the air and allowed to dry after each use—do not let toothbrushes drip on one another. Store them out of the reach of children, but do not store them in individual containers, because this stops them from drying. Toys Washing toys effectively is very important to reduce spread of disease. Toys need to be washed at the end of each day, especially those in rooms with younger children. Wash toys in warm water and detergent, and rinse them well—many toys can be cleaned in a dishwasher (but not at the same time as dishes). All toys, including cloth toys and books, can be dried by sunlight. Only buy washable toys, and discard non-washable toys that are for general use. Individual non-washable toys may be assigned to a child and kept in the child’s cot for the use of that child only. Books should be inspected for visible dirt. They can be cleaned by wiping with a moist cloth with detergent on it, and allowing to dry. Keep damp or wet books out of use until they are dry. Remove toys for washing during the day. Start a “toys to wash” box and place toys in it during the day if you see a child sneeze on a toy or put a toy in their mouth, or if the toy has been used by a child who is unwell. Toys can also be split into two lots and rotated between washing one day and in use the next. In the nappy change area, have a box of clean toys and a box of toys to be washed. Give a child a clean toy if they need one while being changed. Immediately after the nappy change, place the toy in the “toys to wash” box. Cushions Make sure that all cushions, including large floor cushions, have removable cushion covers that can be changed and washed daily, as well as when they are visibly dirty. Carpets, mats and curtains Carpets and mats should be vacuumed daily and steam cleaned at least every 6 months. Curtains should be washed every 6 months and when they are visibly dirty. Spot clean carpets, mats and curtains if they are Learner Guide A1 - Ensure the Health and Safety of Children Page 25 A1 Certificate III in Early Childhood Education and Care A1D5: Observing and responding to signs of illness and injury in children and systematically record and share this information with families. 9 Because you care for the children in your group every day, you are probably used to the way each of them looks and behaves when they are healthy. It is useful for educators and other staff to have some understanding of the signs and symptoms that suggest that a young child may be quite ill and need urgent medical attention. These include the following: • High fever—a high fever in a young child can be a sign of infection, and needs to be investigated to find the cause. However, fever by itself is not necessarily an indicator of serious illness. • Drowsiness—the child is less alert than normal, making less eye contact, or less interested in their surroundings. • Lethargy and decreased activity—the child wants to lie down or be held rather than participate in any activity, even those activities that would normally be of interest. • Breathing difficulty—this is an important sign. The child may be breathing very quickly or noisily, or be pale or blue around the mouth. The child may be working hard at breathing, with the muscles between the ribs being drawn in with each breath. • Poor circulation—the child looks very pale, and their hands and feet feel cold or look blue. • Poor feeding—the child has reduced appetite and drinks much less than usual. This is especially relevant for infants. • Poor urine output—there are fewer wet nappies than usual; this is especially relevant for infants. • Red or purple rash—non-specific rashes are common in viral infections; however, red or purple spots that do not turn white if pressed with a finger require urgent medical referral because the child could have meningococcal disease. • A stiff neck or sensitivity to light—this may indicate meningitis, although it is possible for infants to have meningitis without these signs. • Pain—a child may or may not tell you they are in pain. Facial expression is a good indicator of pain in small infants or children who do not talk. General irritability or reduced physical activity may also indicate pain in young children. 9 National Health and Medical Research Council (2012), Staying Healthy: Preventing infectious diseases in early childhood education and care services, http://www.nhmrc.gov.au/guidelines/publications/chA1A1 Learner Guide A1 - Ensure the Health and Safety of Children Page 26 A1 Certificate III in Early Childhood Education and Care These clinical features cannot be relied on to say for certain that a child is seriously ill, nor does their absence rule out serious illness. The more of the above features that are seen, the more likely it is that the child may have a serious illness. Remember that illness in infants and young children can progress very quickly. if there is any doubt, seek medical advice without delay. A1D5.1: What to do if a child seems unwell. Separate the ill child from the other children. If the child is not well enough to participate in activities, contact their parent and send them home. A child who is feeling unwell needs to be with a person who cares for them—this is usually a parent or grandparent. When caring for an ill child, remember the main ways to break the chain of infection: • Remind a child who is coughing or sneezing to cough or sneeze into their elbow. If the child covers their mouth with their hands, ask them to wash their hands. • If you wipe a child’s nose, dispose of the tissue in a plastic-lined rubbish bin and then wash your hands. • If you touch a child who might be ill, avoid touching other children until after you have washed your hands. • Encourage parents to tell you when anyone in the family is ill. If someone in the family is ill, watch for signs of illness in the child. • If a child appears very unwell or has a serious injury that needs urgent medical attention, call an ambulance. While waiting for the parent to arrive, keep the child away from the main group of children, if possible. For example, they could lie on a floor cushion or mat in a corner of the room where you can still comfort and supervise them. After the child leaves, ensure that the mattress or floor cushion is cleaned before it is used again. Some infectious agents can persist on surfaces and may cause infection even if an object looks clean or is wiped clean. A1D5.2: Keeping records Keep records of any illness in children, educators or other staff at the education and care service. It may also be useful for the parents and the child’s doctor to have written information on the child’s illness. It is important to record which part of the education and care service the person was in for most of the day. Learner Guide A1 - Ensure the Health and Safety of Children Page 27 A1 Certificate III in Early Childhood Education and Care The table shows an example record of illness. Name Basil Dukakis Amy Johnson Jason Wong Aarushi Pinto Age 2 Symptoms Date Time of onset Comments Toddlers 4 May 2011 2pm 6 months Fever, Infants runny nose 4 May 2011 1.30pm Dad contacted. Paracetamol given Mum contacted. Will collect 4 Rash on head and Room or group Weeping eye Preschool 4 May 2011 4 pm Educator Weeping eye Preschool 4 May 2011 4 pm Record the symptoms you see as best you can, and record when you first noticed the illness. You can also record information such as the action taken (e.g. exclusion for A1 days, review of nappy changing practices) and the doctor’s diagnosis. Keeping records can help prevent the spread of infection—records show you when your approach to infection control is working. They are invaluable in helping you and public health workers to identify the cause of any outbreak and how to control it. A1D6: Consistently implementing the service policies for the exclusion of ill children. The spread of certain infectious diseases can be reduced by excluding a person who is known to be infectious, from contact with others who are at risk of catching the infection. Parents may find an exclusion ruling difficult and some parents may place great pressure on the director to vary from the centre’s exclusion rules. Often these parents are under great pressure themselves to fulfil work, study or other family commitments. This may lead to stress and conflict between parents and centre staff. The best way to avoid conflict is to have a written policy that clearly states the centre’s exclusion criteria. This policy should state the National Health and Medical Research Council’s, or NHMRC’s, recommended minimum exclusions periods as well as any additional conditions or exclusion periods your centre may have. Give the policy to all parents and staff when they first join the centre. Directors should not be influenced by letters from doctors which allow the child back into care, unless the child’s condition fulfils the criteria for return to care. Sometimes doctors make different diagnoses for children in the same centre with illnesses that appear similar. Your public health unit should be able to help you with these situations or when you are in doubt about exclusion. Learner Guide A1 - Ensure the Health and Safety of Children Page 28 A1 Certificate III in Early Childhood Education and Care Whenever you exclude a child, take the opportunity to review your infection control techniques with all early childhood educators. Download the National Medical Health and Research Council poster on “Recommended minimum exclusion periods” for your convenience and easy reference. You may download it from http://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/chA1A1d_ex clusion_period_poster_130701.pdf A1D7: Discussing health and hygiene issues with children. Developing the ability to manage aspects of their own care, including health and hygiene tasks, is an important aspect of each child’s journey toward independence and autonomy. This is why it’s important to discuss and teach health and hygiene issues with them. A good place to start is a short discussion about germs and their role in sickness very early on. Then early childhood educators can talk to children about things they can do to prevent germs from making them sick. Discussions with children should be creative. To keep children’s interests, you can do any of the following strategies: • A great way to teach young children about how germs are spread is by simulating them with glitter or flour. Coat the children's hands with the flour or glitter, and instruct them to go on about their usual business for a set amount of time, 1A1 minutes or two hours if you like. During this time, they may touch toys, desk, walls, each other, and each time, the glitter or flour will transfer, representing the transfer of germs. When they have completed the activity, the children will be able to see how quickly the germs have spread throughout the classroom just from their hands. • Pretend to be a “germ detective” and use a magnifying glass to examine each child’s hands and teeth. Give them a “secret mission” to wash their hands or brush their teeth. • Give each child a "buddy" to wash while he washes his hands, such as a rubber ducky, plastic figure or toy car. Ask if his buddy used soap, rather than asking your child about his own hands. • Use a “puppet helper.” Have children choose a puppet that will be a washing buddy in the bath or remind them to wash hands when he gets home. Talk in a funny voice with the puppet to differentiate the puppet from the educator. Being "helped" by a puppet and being nagged by a parent will get different results from your child. Learner Guide A1 - Ensure the Health and Safety of Children Page 29 A1 Certificate III in Early Childhood Education and Care A1E: Supervising children to ensure safety. Element A1.1.1 of the National Quality Standards states that “Educator-to-child ratios and qualification requirements are maintained at all times.” The National Quality Standard sets educator-to-child ratios to ensure the safety, welfare and wellbeing of children while attending the service. The presence of adequate numbers of qualified and experienced educators has been consistently linked with quality interactions and positive learning experiences for children. Carefully planned rosters ensure that educators are always available to respond to children and to support continuity of care and adequate supervision at all times when children are in the service and on excursions. The required educator to child ratios are listed below: Service Centrebased services Age group Birth to 24 months Educator to child ratio 1:4 Timeframe for compliance 1 January 2012 – in all states and territories (1 August 2012 in WA) Over 24 months and less than 36 months 1:5 1 January 2012 – in ACT, NT, TAS 1 August 2012 – in WA I January 2016 in NSW, QLD, SA Saving provision applies in VIC 36 months up to and including preschool age 1:11 1 January 2012 – in ACT, NT 1 January 2016 – in QLD, VIC Saving provision applies in NSW, SA, TAS, WA Family Day Care Over preschool age No national ratio has been set (state and territory ratios may apply) Birth to 13 years 1:7, with no more than four children preschool age or under 1 January 2012 – in ACT, QLD, SA, VIC 1 January 2014 – in NSW, NT, TAS, WA Learner Guide A1 - Ensure the Health and Safety of Children Page 30 A1 Certificate III in Early Childhood Education and Care A1E1: Supervising children by ensuring all are in sight or hearing distance at all times. Early childhood educators need to know, however, that educator-to-child ratios alone do not determine what is considered adequate supervision. Supervision is critical to the safety of children. At its most basic level, supervision helps to protect children from hazards or harm that may arise in their play and daily routines. Adequate supervision means that an educator can respond immediately, including when a child is distressed or in a hazardous situation. Effective supervision also requires educators to be actively involved with children. It is not the intention of this requirement that educators merely “stand back and watch”. Every child should always be monitored actively and diligently. This means knowing where children are at all times. Children of different ages and abilities will need different levels of supervision. In general, the younger children are, the more they may need an adult to be physically present and close by to support and help them. For example, in a Centre-based service for young children, adequate supervision might mean that the children remain in close proximity to the adult who is supervising them. With babies and toddlers who are sleeping, educators need to be able to see and hear the children. With preschool age children, the program may include experiences in both indoor and outdoor environments and it is important that the educators supervise the children in both these environments. For school age children, educators should know where each child is and be in a position to respond if necessary.10 A1E2: Adjusting levels of supervision depending upon the area of the service and the skill, age mix, dynamics and size of the group of children, and the level of risk involved in activities. The adequacy of supervision should be determined by a range of factors, including: • number, ages and abilities of children; • number and positioning of educators; • each child’s current activity; • areas where children are playing, in particular the visibility and accessibility of these area; • risks in the environment and experiences provided to children; 10 Australian Children’s Education and Care Quality Authority, Guide to the Education and Care National Law and National Regulations, http://www.acecqa.gov.au/ArticleCategory.aspx?pid=372&gcpid=2 Learner Guide A1 - Ensure the Health and Safety of Children Page 31 A1 Certificate III in Early Childhood Education and Care • the educators’ knowledge of each child and each group of children; and • the experience, knowledge and skill of each educator. At times, a service may need to provide additional educators to adequately supervise and support children. For example, at the beginning of the year when a number of children are transitioning to new rooms, a service may need to roster educators in excess of minimum ratios. This could assist educators to respond to children’s needs and foster children’s sense of security and belonging. 11 A1E3: Exchanging information about supervision with colleagues to ensure adequate supervision at all times. Adequate supervision requires teamwork and good communication among staff. For example, educators should let their colleagues know if they need to leave the area for any reason such as to get a resource from another area, or to use the bathroom. Educators should also develop a handover routine when changing shifts. This might include implementing strategies such as a diary or communication book. A1F: Minimising risks. All children have the right to be safe at home, at school and in their education and care setting. The provision of safe environments for children is essential to prevent injury and enable them to grow and develop. Injury is the leading cause of death for children, with approximately A1000 children in Australia each day needing medical attention as a result of accidents. Element 2.3.2 of the National Quality Standards state that: “Every reasonable precaution is taken to protect children from harm and any hazard likely to cause injury.” Children naturally interact with their environment in an exploratory way. As a result the potential for injury often arises, particularly when children are using new equipment or developing new skills. The challenge for management, staff and families of education and care services is to minimise the potential for injury and keep children safe. Emergency procedures One of the more important aspects in keeping children safe in an education and care setting is the management of emergency situations. Planning to manage incidents and emergencies assists services to: • protect adults and children; • maintain children’s wellbeing; 11 Australian Children’s Education and Care Quality Authority, Guide to the Education and Care National Law and National Regulations, http://www.acecqa.gov.au/ArticleCategory.aspx?pid=372&gcpid=2 Learner Guide A1 - Ensure the Health and Safety of Children Page 32 A1 Certificate III in Early Childhood Education and Care • maintain a safe environment; and • meet requirements of relevant work health and safety legislation. A fire, earthquake or other disaster can be a very frightening concept for a child. Many children have seen bad things happen on the news and worry about what would happen if an emergency occurred in a place away from home. Preparation and planning are key in helping children understand that, if there was a real emergency, things would be alright. Practising what to do during a disaster makes children feel informed and empowered. Having a clear plan for the management of emergency situations assists early childhood educators to handle these calmly and effectively, reducing the risk of further harm or damage. Teaching young children what to do during a disaster can help children protect themselves. Some of the self-protective behaviours that can be taught are: ● to duck, cover, and hold in case of an earthquake. ● to crawl along the ground to avoid smoke inhalation in case of fire, and ● to stay away from windows during tornadoes. Because many emergencies strike with little or no warning, life-protecting actions must be taken immediately at the first indication. There will not be time to think through what to do. Therefore, of all emergency preparedness measures, emergency drills are the most important. Their purpose is to help children (and staff) learn how to react immediately and appropriately. Emergency drills should be held every three months by staff members, volunteers, children attending the education and care service on that day and the responsible person who is present at the time. Basic home fire safety The Australasian Fire Authorities Council (AFAC) published a report indicating that the groups of people at risk from dying in house fires are: • children under the age of 5 years old, • people over the age of 65 (with vulnerability increasing with age), and • adults affected by alcohol. General findings show that more deaths occurred during sleeping hours of the cooler months, May to September. Most fires occurred in owner-occupied houses and were mainly caused by electrical faults, smoking materials, heaters, open fires and lamps. Learner Guide A1 - Ensure the Health and Safety of Children Page 33 A1 Certificate III in Early Childhood Education and Care Smoke alarms were not fitted in most of the homes where deaths occurred and in those that did have them, 31% of them were not working. 12 A1F1: Assisting in the implementation of safety checks and the monitoring of buildings, equipment and the general environment. The service’s buildings and grounds should be designed, set up and regularly checked to minimise risk to children. However, this should be balanced with providing an environment that is stimulating and allows children to take reasonable risks. All areas and objects including play areas, fences, doors, windows, sand pits, storage areas, electrical cords and child resistant catches should be regularly checked to ensure they are in good repair and free of hazards. To ensure safe buildings and grounds, early childhood educators can assist in the following practices: • Carrying out daily safety checks to identify and remove hazards; • Selecting appropriate play equipment for children; • Conducting and recording regular audits of buildings and equipment to monitor and remove hazards; • Developing an action process for reporting and removing hazards; • Keeping records of the maintenance and repair of equipment and buildings; • Keeping electrical cords, double adaptors and power boards out of children’s reach; • Covering unused power points with protective caps; and • Regulating hot water to ensure it does not scald or burn children. 13 A1F2: Consistently implementing policy and procedures regarding the use and storage and labelling of dangerous products. Children naturally want to explore the environment through their senses by touching and tasting things within their reach, including hazardous and toxic products. Poisonous and dangerous products such as cleaning products, garden and pest control chemicals, medications and sharp objects must be kept out of children’s reach at all times. Poisonous substances should also be labelled clearly, but in a way that does not attract children’s curiosity or attention. 12 South Australian Country Fire Service, Home Fire Safety, http://www.cfs.sa.gov.au/site/fire_safety/house_fire_safety.jsp National Council Accreditation Council Inc., Safety in Children’s Services, http://ncac.acecqa.gov.au/educator-resources/factsheets/qias_factsheet_%202.pdf 13 Learner Guide A1 - Ensure the Health and Safety of Children Page 34 A1 Certificate III in Early Childhood Education and Care Your service will have procedures concerning the use, storage and labelling of dangerous products. Among the procedures your service will require of you may include: • minimising the use of toxic products without compromising hygiene; • being made aware of which products may pose a danger to children in the centre; • helping maintain a register of all hazardous substances kept on the education and care premises; • making sure that all potential dangerous products are clearly labelled and stored in their original labelled containers with the relevant Material Safety Data Sheet (M S D S) for that product, out of reach of all children, or unauthorised adults. Storage areas will be clearly labelled to assist relief educators/ staff. • making sure that all hazardous products are used in accordance with the manufacturer’s written instructions and specific workplace procedures, and dangerous chemicals are only used when children are not present at the service. • suggesting that First Aid Action Plans be developed for each hazardous product kept on the education and care premises; • storing flammable materials separately from anything that constitutes or is likely to constitute a fire hazard; and • discussing the dangers of certain products with the children. A1F3: Following service procedures for the safe collection of each child, ensuring they are released to authorised people. According to the Education and Care Services National Law and National Regulations, a child may only leave the education and care service premises under any of the following circumstances: • a parent or authorised nominee collects the child; • a parent or authorised nominee provides written authorisation for the child to leave the premises; • a parent or authorised nominee provides written authorisation for the child to attend an excursion; and • the child requires medical, hospital or ambulance treatment, or there is another emergency. Learner Guide A1 - Ensure the Health and Safety of Children Page 35 A1 Certificate III in Early Childhood Education and Care It is important to note that in this regulation, the term “parent” does not include a parent who is prohibited by a court order from having contact with the child. Your service will have the necessary policy and procedures in place to comply with these requirements. Make sure to follow these for the safe collection of each child. A1F4: Assisting in the supervision of every person who enters the service premises where children are present. The National Law and National Regulations require the approved provider of a family day care service to ensure that the service has developed and implements policy and procedures in relation to visitors to family day care residences and approved family day care venues while education and care is being provided to children as part of a family day care service. Although this requirement applies specifically to family day care services, long day care centres and preschools will greatly benefit from such policies and procedures. Such procedures will ensure that the security, health, safety and welfare of the children in the centre are protected, especially when visitors are in attendance. Procedures for the supervision of people who enter the service premises may include: • having the visitor report to the supervisor/educator/staff member on arrival; • having the visitor sign an attendance record; • being aware of where visitors are at all times; and • restricting visitors from certain areas in the service. A1F5: Discussing sun safety with children and implement appropriate measures to protect children from over-exposure to ultraviolet radiation. According to Cancer Council Australia, incidence of skin cancer in the country is one of the highest in the world, two to three times the rates in Canada, the U S and the U K. The major cause of skin cancer is too much exposure to ultraviolet (U V) radiation from the sun. Skin can burn in as little as 15 minutes in the summer sun so it is important to protect your skin from U V radiation. Young children are especially vulnerable to skin damage from the sun because they have very little melanin in their skin to protect them from sunburn. Sun safety for babies. Evidence suggests that childhood sun exposure contributes significantly to a lifetime risk of skin cancer. Cancer Council Australia recommends keeping babies out of the sun as much as possible for the first 12 months. Learner Guide A1 - Ensure the Health and Safety of Children Page 36 A1 Certificate III in Early Childhood Education and Care Where this is not possible, parents and/or early childhood educators should minimise exposure by: 1. Planning the day’s activities outside the peak UV times of 10am – 3pm. 2. Covering as much skin as possible with loose fitting clothes and wraps made from closely woven fabrics. 3. Choosing a hat that protects the baby’s face, neck and ears. 4. Making use of available shade or creating shade for the pram, stroller or play area. The material should cast a dark shadow. The baby will still need to be protected from scattered and reflected UV radiation. 5. Keeping an eye on the baby’s clothing, hat and shade to ensure they continue to be well-protected. 6. Applying a broad spectrum, water resistant sunscreen to small areas of the skin that cannot be protected by clothing, such as the face, ears, neck and hands, remembering to reapply the sunscreen every two hours or more often if it is wiped or washed off. There is no evidence that using sunscreen on babies is harmful, although some babies may develop minor skin irritation. Try sunscreen milks or creams for sensitive skin which are less likely to irritate the skin. As with all products, use of any sunscreen should cease if any unusual reaction occurs. Sun safety for young children in the service. The Cancer Council Australia recommends implementing sun safety procedures when the UV alert is 3 and above. Ultraviolet (U V) radiation is the invisible killer that you can't see or feel. U V radiation can be high even on cool and overcast days. This means you can't rely on clear skies or high temperatures to determine when you need to protect yourself from the sun. According to Cancer Council Australia, the SunSmart U V Alert is a tool you can use to protect yourself from U V radiation. It tells you the time during the day that you need to be SunSmart. The Alert is issued by the Bureau of Meteorology when the U V index is forecast to reach 3 or above. At that level, it can damage your skin and lead to skin cancer. The Alert is reported in the weather page of all Australian daily newspapers, on the Bureau of Meteorology website, and on some radio and mobile weather forecasts. Because the climate varies across Australia, the U V alert will also vary between each state and territory and at different times of the year. Therefore every service will implement their policies on sun safety differently, but there are some basic practices that should be a regular part of everyday sun safety for children and adults. Learner Guide A1 - Ensure the Health and Safety of Children Page 37 A1 Certificate III in Early Childhood Education and Care Some of these basic sun safety practices include: • During outdoor times, wearing sun safe hats and clothing that offers protection from the sun, such as sleeved shirts and longer shorts and skirts. • Applying sunscreen (The most effective sunscreen is labelled SPF30+, broad spectrum and water-resistant.). • Making use of shaded areas when outdoors. • Avoiding the outdoors during peak UV times. • Encouraging older children to wear sunglasses that meet Australian Standards. • Early childhood educators adopting sun safe behaviours and setting positive examples for children, and • Teaching children about sun safety and assisting them to become independent in protecting themselves from the sun. 14 A1F6: Checking toys and equipment are safe for children and safe to use in their proposed area. When choosing equipment and furniture, adults need to consider the age and developmental stage of their child. A toy or equipment that is not age appropriate can lead to frustration or boredom and can also be a potential safety hazard. According to Product Safety Australia, when buying products for children, always ensure that they: • • • • meet safety standards; come with instructions for safe assembly and safe use; are complete with no worn or missing parts; and have not been previous recalled by checking www.recalls.gov.au Children’s equipment and furniture should also be carefully selected, installed and maintained to ensure it complies with the requirements of recognised authorities. A huge variety of equipment is used every day in the different areas of an education and care setting. This includes things like furniture, appliances, kitchen implements, cleaning supplies and play equipment. The maintenance of all of these items is just as important as building and grounds maintenance and should be checked on a daily basis. 14 National Childcare Accreditation Council, Extracted from ‘Putting Children First’ (March 2011 p.24) http://ncac.acecqa.gov.au/educator-resources/pcf-articles/FF-SunSafetyinChildCareMar2011.pdf Learner Guide A1 - Ensure the Health and Safety of Children Page 38 A1 Certificate III in Early Childhood Education and Care In addition, some items may be safe for one age group to use, but be a hazard for younger children. Furniture, equipment and toys need to be matched to the developmental level of the children. Children may need to be shown how to use some items properly, particularly new equipment. Access by children to unsafe or unsuitable equipment or areas needs to be prevented to minimise risk of accidents. Toys and safety Here are things early childhood educators should take note when evaluating toys for possible hazard risks: • If an object can fit into a 35mm film canister, it is capable of choking a child under the age of three. Check toys for small parts which can be easily put into the mouth, nose or ears. • “Dead” batteries in toys should always be thrown out as they can leak poisons or liquid that can damage skin or eyes. Batteries can also cause serious poisoning if swallowed. • Check labels on toys for age recommendations, instructions for use and for information about whether the toy is non-toxic and non-flammable. • Never purchase toys that are inappropriate for a child’s age and level of development. • Warnings that a toy is not suitable for children under three mean there are small parts which could be swallowed. It is not an indication of intelligence or skill level. • Ride-on toys should be suitable to the child’s age. They should be stable with good brakes that the rider can apply easily. • Check toys regularly for sharp edges, rough surfaces or broken pieces as they can cause cuts and splinters. • Be careful of toys that make loud noises as they can damage hearing, especially toys which are placed near the ear, such as toy phones and walkie talkies. • When buying tents, masks, helmets, etc., check for good ventilation/air space. • When selecting toys, choose well-made and hard-wearing toys that can tolerate/adapt to rough play without falling apart. • Choose washable, non-breakable toys for babies. • Choose toys that have no gaps or holes which could entrap a child’s fingers. • Make sure paints, colours and glues are non-toxic. Look for labelling that states this. Learner Guide A1 - Ensure the Health and Safety of Children Page 39 A1 Certificate III in Early Childhood Education and Care • Always remove burst or uninflated balloons from the play areas of small children as they can cause choking. • Toys filled with liquid should be thrown out immediately if they begin to leak. • Do not let children play with projectile toys. If you decide to provide a projectile toy, only choose ones that have soft, one piece darts or non-removable suction caps. A1F7: Removing any hazards immediately or securing the area to prevent children accessing the hazard. Safety in an education and care setting is an important issue because young children explore their world with all their senses, including touching and mouthing anything within their reach. For this reason, it is very important to remove any potential hazards within their reach. A hazard is defined as anything that has the potential to cause harm. A hazard may be a substance, a piece of equipment or a work procedure or, in the education and care sector, a child’s condition. Risk, on the other hand, is defined as the chance or likelihood that harm will occur from the hazard. The likelihood is described as “the expectancy of harm occurring”. It can range from “never” to “certain” and depends on a number of factors. 15 Not all risks can be removed completely, but they can almost always be reduced. If you have identified potential risks in the children’s environment, whether you are at the centre or out on an excursion with the children, it is critical that you put risk reduction strategies in place to minimise the potential for harm. Risk reduction strategies are the measures or actions that are taken to remove or reduce the risk. This could include things like covers on power points that are within children’s reach or putting up signs to secure an area. Risk management will be discussed more thoroughly in Module 7: Participate in work health and safety. 15 The Excellence Gateway Treasury, Key Skills in Childcare: Risk Assessment (pdf). http://archive.excellencegateway.org.uk/media/KSSP/risk_assessment_cc.pdf (2006) Learner Guide A1 - Ensure the Health and Safety of Children Page 40 A1 Certificate III in Early Childhood Education and Care Outdoor hazards. The following are some examples of potential hazards that may be present in an education and care centre. The following hazards are found in Cybertots Virtual Child Care Centre: Fences. The grounds of a childcare centre must be fully enclosed as per state/territory regulations. Inspection of boundary fences should be part of the centre’s daily safety check. Water trolley. This damaged water trolley is a hazard. It needs removing and repairing as the bent leg could break. When the water trolley is fixed and in use again, any children involved in water play would need to be highly supervised. If you go inside for lunch or to rest, the water should be emptied out of the water trolley and new water put in when it is time to use it again. Water left sitting still in the sun can breed dangerous bacteria, so you should change the water regularly to reduce this hazard. Learner Guide A1 - Ensure the Health and Safety of Children Page 41 A1 Certificate III in Early Childhood Education and Care Wheel toys. Wheel toys are low risk areas. However, be aware that children who are just beginning to walk will need assistance. Sandpits. Sandpits must be covered at night and raked regularly to dispose of any animal faeces, other contaminants or potentially dangerous objects. This age group requires supervision in the sandpit to ensure they play with the sand and sand toys appropriately. Sand can scratch the eye and cause serious injury. Learner Guide A1 - Ensure the Health and Safety of Children Page 42 A1 Certificate III in Early Childhood Education and Care Glazed areas. Any glazed area accessible to children must be safely glazed in accordance with Australian Standards, or requires guard rails or barriers to prevent a child striking or falling against the glass. Indoor Hazards. Now it’s time to have a look inside. This is the indoor area for the 0-2 year olds. Glazed areas. Any glazed area accessible to children must be safely glazed in accordance with Australian Standards, or requires guard rails or barriers to prevent a child striking or falling against the glass. Learner Guide A1 - Ensure the Health and Safety of Children Page 43 A1 Certificate III in Early Childhood Education and Care Heaters. Heaters must meet all state/territory regulations both for childcare facilities and for general safety. Heaters must have a low temperature exterior to minimise burn and fire risk. Cords. Cords on curtains or blinds must meet safety regulations or be out of reach of children as they can pose a strangulation risk. Learner Guide A1 - Ensure the Health and Safety of Children Page 44 A1 Certificate III in Early Childhood Education and Care Sofas and/or cots. Sofas, cots etc. shouldn’t be placed within reach of curtain/blind cords. This can be hazardous for children who may either become entangled in them, or be tempted to climb on the furniture to reach them. Toys. These toys look pretty safe, as long as children are supervised playing with them. Babies in particular put everything into their mouths, so it’s particularly important to check their toys daily for loose or damaged parts that could be a choking hazard. Other potential hazards. Attention needs to be paid to the following potential hazards. ● Electrical – cords, adaptors and power boards need to be out of children’s risk. Unused power points must have protective caps. Learner Guide A1 - Ensure the Health and Safety of Children Page 45 A1 Certificate III in Early Childhood Education and Care ● Water – all children require supervision around water to prevent drowning. Spills need to be mopped up immediately. Hot water requires a regulator to prevent scalds. A cup of tea can burn a child. ● Surfaces – the floor or ground can present a tripping hazard if they are not level. ● Plastic - bags or wrappings can cause suffocation. ● Chemicals - such as cleaning products pose a risk of adverse reaction, burns or even poisoning. ● Sun exposure – it doesn’t take much sun for a young child’s skin to burn. Children are also much more susceptible to dehydration so plenty of water to drink is essential. Check out the Sun care policy in the Cybertots Intranet for more info on this. ● Animals- insects, snakes, spiders, dogs, swooping magpies. ● Environment – gas leaks, water leaks, fire, storms, earthquakes. ● Human – aggressive children, aggressive or intoxicated parents, intruders. Have a closer look at the photographs. Try to identify at least 3 more potential risks and write these down in the space provided below. Then think of 1 way to reduce the risk for each hazard and write it down next to the risk it addresses. Hazard/Potential Risk Risk Reduction Strategy 1. 2. 3. A1G: Contribute to the ongoing management of allergies. As you have learned earlier, an anaphylaxis and/or asthma emergency are exceptions to the authorisation requirement when administering medication. The Education and Care Services National Law and National Regulations state that: “Medication may be administered to a child without an authorisation in case of an anaphylaxis or asthma emergency.” It also goes on to state that when medication is administered, the approved provider or nominated supervisor of the education and care service or family day care educator must ensure that a parent of the child and emergency services are notified as soon as possible. Learner Guide A1 - Ensure the Health and Safety of Children Page 46 A1 Certificate III in Early Childhood Education and Care This exception, however, does not negate a service’s responsibility of creating an individual health plan in partnership with parents whose children have special medical needs. Schools and childcare services need to develop prevention and management strategies in consultation with the child and the child’s parents. Jarrad, one of the children at Cybertots, is allergic to nuts. He can have an anaphylactic attack within seconds just by touching or tasting any nut products, such as peanut butter. The centre has established guidelines for managing children’s medical conditions. This includes developing a Medical Action Plan (MAP) for each affected child which spells out step by step exactly what needs to happen in a medical emergency. A MAP is based on an emergency plan put together by a health professional, for example, the family doctor, and given to the child’s family. The parents would make copies of this plan and give them to anyone who has Jarrad in their care, so they can follow the plan exactly and know what to do. To remind staff of Jarrad’s medical condition, and also to help alert any new or relief staff, a photo of Jarrad and a statement that clearly explains his allergy have been posted on the main board in the staff room. Attached to this is Jarrad’s Medical Action Plan. This MAP will also be in Jarrad’s records/file. Jarrad’s parents have left an EpiPen (an injection of adrenaline) at Cybertots to be used if he has an anaphylactic attack. The EpiPen is kept in a safe and accessible place in the first aid box - out of reach of the children but easily retrieved by staff. All qualified staff have completed extra training in how to use the EpiPen, and unqualified staff know what to do to support them. A1G1: Identifying and recognising signs, symptoms and key characteristics of allergies and anaphylaxis. 16 The signs and symptoms of a food allergic reaction may occur almost immediately after eating or most often within 20 minutes to 2 hours after eating. Rapid onset and development of potentially life threatening symptoms are characteristic markers of anaphylaxis. Allergic symptoms may initially appear mild or moderate but can progress very quickly. The most dangerous allergic reactions (anaphylaxis) involve the respiratory system (breathing) and/or cardiovascular system (heart and blood pressure). 16 Allergy and Anaphylaxis Australia, Allergy and Anaphylaxis. http://www.allergyfacts.org.au/allergy-and-anaphylaxis/what-is-anaphylaxis (2010) Learner Guide A1 - Ensure the Health and Safety of Children Page 47 A1 Certificate III in Early Childhood Education and Care Common signs and symptoms. Mild to moderate allergic reaction Severe allergic reaction- ANAPHYLAXIS • Hives, welts or body redness • Difficult and/or noisy breathing • Swelling of the face, lips, eyes • Swelling of the tongue • Vomiting, abdominal pain (these are signs of a severe allergic reaction/anaphylaxis in someone with severe insect allergy) • Swelling or tightness in the throat • Difficulty talking and/or hoarse voice • Wheeze or persistent cough • Persistent dizziness or collapse in its place • Pale and floppy (in young children) • Tingling of the mouth A1G2: Applying organisational risk-management strategies for children with severe allergies. The key to prevention of anaphylaxis is identifying triggers and preventing exposure to these triggers. Preventing and managing anaphylaxis involves partnership between parents and staff. Both have responsibilities to undertake in the prevention and management of the children’s anaphylactic reactions. Parents of children who are at risk of anaphylaxis must: • inform staff of the diagnosis and its cause. • discuss prevention strategies with staff. • work with staff to develop an Individual Anaphylaxis Health Care Plan. • provide the school or childcare service with an Australasian Society of Clinical Immunology & Allergy action plan, or copies of the plan, that is signed by the child’s medical practitioner and has an up-to-date photograph. • supply the child’s adrenaline auto injector and ensure it has not expired. Staff who are responsible for the care of children at risk of anaphylaxis must obtain training in how to recognise and respond to an anaphylactic reaction, including administering an adrenaline auto injector. Learner Guide A1 - Ensure the Health and Safety of Children Page 48 A1 Certificate III in Early Childhood Education and Care It is recommended that staff involved should: • know the identity of children who are at risk of anaphylaxis. • liaise regularly with parents. • follow information contained in the child’s Individual Anaphylaxis Health Care Plan. • obtain training in how to recognise and respond to an anaphylactic reaction, including administering an adrenaline auto injector. • ensure the adrenaline auto injector is stored correctly (at room temperature and away from light) in an unlocked, easily accessible place. • know where the adrenaline auto injector is located in the event of a reaction, follow the procedures in the child’s Australasian Society of Clinical Immunology & Allergy action plan. The information just provided was taken from the Government of Western Australia Department of Health website. As with most safety and health concerns involving children, it is best that you consult your service’s standards, policies and procedures on the management of an anaphylaxis. A1G3: Following organisational policies and legislative requirements in relation to medication for anaphylaxis. Adrenaline given as an injection using an auto injector (such as an EpiPen® or Anapen®) into the outer mid-thigh muscle is the most effective first aid treatment for anaphylaxis. Children at risk of recurrent anaphylaxis are advised by their medical practitioners to carry adrenaline in an auto-injector for use in an emergency. Children between 10 - 20kg are prescribed a Junior auto injector, which has a smaller dosage of adrenaline. Adrenaline auto injectors are designed so that anyone can use them in an emergency. Parents should provide schools and education and care settings with the child’s adrenaline auto injector and Australasian Society, of Clinical Immunology & Allergy Action Plan for their child, which should be stored unlocked and easily accessible to staff. If a child is treated with an adrenaline auto injector, an ambulance must be called immediately and the child taken to a hospital. As with most safety and health concerns involving children, it is best that you also consult your service’s standards, policies and procedures on administering medication for anaphylaxis. Learner Guide A1 - Ensure the Health and Safety of Children Page 49 A1 Certificate III in Early Childhood Education and Care A1H: Contributing to the ongoing management of asthma. One in 10 children is diagnosed with asthma. It is one of the most common reasons children visit the doctor and go to hospital. It is not fully understood why children develop asthma, though people with asthma often have a family history of asthma, eczema and hay fever (allergic rhinitis). There is no way of knowing whether a child will continue to have asthma, although there are some risk factors for continuing asthma in some children. Asthma is different for everyone—people can have different triggers, symptoms and medications for their asthma, and these can also change. Young children can be prescribed asthma medication, depending on how frequently they experience symptoms and how unwell they become. All young children with asthma should have a blue reliever puffer, spacer and mask to relieve symptoms if they have an asthma attack. Some children also have preventer medications, which need to be used daily for the period specified by their doctor, even when the child is well. All children with asthma should have a written plan which outlines their asthma care. All educators and staff should be trained to administer asthma first aid. This includes administration of salbutamol via the child’s own blue reliever puffer, or one from an asthma emergency kit. It’s best to use a spacer and mask to make sure the medication is delivered effectively.17 A1H1: Identifying signs, symptoms and triggers of asthma Asthma is a chronic lung disease that affects the airways. Children with asthma have airways that are inflamed. Inflamed airways are very sensitive, so they tend to react strongly to things called “triggers.” When the airways react to a trigger, they become narrower due to swelling and squeezing of the airways by the small muscles around them. This results in less air getting through to the lungs and less air getting out. Symptoms of asthma include acute episodes of: • Coughing • Wheezing (a whistling or squeaky sound during breathing) • Chest tightness • Shortness of breath Symptoms can vary in severity; they can be mild or moderate and affect activity levels, or they can be severe and life threatening. 17 Early Childhood Australia, Asthma and Asthma Management, http://www.earlychildhoodaustralia.org.au/every_child_magazine/every_child_index/asthma-and-asthma-management.html Learner Guide A1 - Ensure the Health and Safety of Children Page 50 A1 Certificate III in Early Childhood Education and Care Asthma triggers and symptoms vary from one person to another. Some children have asthma symptoms only occasionally, while others have symptoms almost all the time. With proper control of asthma, children should have minimal or no asthma symptoms. Common Asthma Triggers Although triggers that cause an asthma episode vary among individuals, there are several common triggers. • allergens such as pollen, animal dander, dust mites, cockroaches, and moulds; • irritants such as cold air, perfume, pesticides, strong odours, weather changes, cigarette smoke, and chalk dust; • respiratory infections such as a cold or the flu; and • physical exercise, especially in cold weather. A1H2: Identifying children who have an asthma management plan and following that plan. Effective asthma management in an education and care setting can help improve a child’s learning environment, reduce absences, and help children feel safe. Educators and staff need to know which children have asthma and understand their individual needs regarding their asthma. An Asthma Action Plan is a written set of instructions prepared with the child’s doctor or nurse that helps to manage his or her asthma. A written Asthma Action Plan outlines: 1. what medication to take every day (even when a child is feeling well); 2. how to tell if asthma is getting worse; 3. what steps should be taken if symptoms are getting worse; and 4. what to do if a child has an asthma attack. Having a written asthma action plan can help to: • reduce the chances of needing to go to hospital, or for an urgent doctor visit; • improve lung function; and • reduce the number of days off care or school due to asthma. Sometimes plans are based on symptoms, while others are based on the child’s “peak flow score”. The child’s doctor or nurse and parents usually decide together what will work best for the child. Learner Guide A1 - Ensure the Health and Safety of Children Page 51 A1 Certificate III in Early Childhood Education and Care A1H3: Following organisational policies and legislative requirements in relation to medication for asthma. In managing children’s asthma, it’s important that you are aware of all policies and procedures your service has in place. These procedures may usually include: • scheduling times to talk with parents/carers about their child’s health care needs; • identifying and promoting times for information updates, e.g. start of year, transition points, excursions and camps; • encouraging the provision of Asthma Plans at these times; • explaining your service’s Asthma Policy to the family; • ensuring all supervising staff are aware of each child’s triggers and symptoms, and where to access their Asthma Plan; • establishing routine systems and contact persons for dependable communication with the family; and • informing parents/carers of all asthma incidents and use of medication. Learner Guide A1 - Ensure the Health and Safety of Children Page 52 A1 Certificate III in Early Childhood Education and Care Appendix 1: Giving Medicines to Children Safely and Effectively 18 1. Read the medicine labels and packaging. Do this when you are buying a medicine and each time before giving a medicine to a child. The labels and packaging provide important information that will help you to prevent medicine mistakes. The following important information is always printed on the medicine’s packaging or label. Read it carefully when you are buying a medicine and before giving a medicine to a child each time. Active ingredient This is the chemical in the medicine that makes it work. Knowing the active ingredient(s) can help to prevent accidentally double dosing with another medicine that contains the same active ingredient(s). Also, some medical conditions, allergies and other medicines may affect which medicine is most suitable to give a child Strength Medicines are available in a number of different strengths, so it’s important that you always check the strength to ensure you’re giving the right dose. The strength of liquid medicines is usually expressed as mg/mL: the amount of active ingredient in milligrams (mg) per millilitre (mL) of liquid. Strengths are expressed differently for other formulations, such as mg per tablet or mg per suppository. It’s important to choose a strength that’s suitable for the child’s age. Do not give adult strengths of medicines to young children. Formulation Children’s medicines come in different forms. The main forms of medicine for babies and young children are drops, suspensions and elixirs. Some medicines are available in other forms that are suitable for children, such as soluble or chewable tablets and suppositories. Check the formulation of the medicine to ensure it is suitable for the child and that you administer it the correct way. Dosing instructions Always follow instructions on the label or packaging to ensure that you give the correct dose. Don’t exceed the recommended daily dose or frequency of dosing. The dose of a medicine for 18 NPS MEDICINEWISE, Kids and Medicines, http://www.nps.org.au/conditions-and-topics/topics/how-to-be-medicinewise/ages-life-stages/children Learner Guide A1 - Ensure the Health and Safety of Children Page 53 A1 Certificate III in Early Childhood Education and Care a young child usually depends on their weight. Use the weight of the child and dosing instructions on the medicine’s packaging to calculate how much medicine to give. 2. Know the child’s weight. Calculating the correct dose for a child usually requires their weight. Young children’s bodies are small, so even small dosing errors can cause them harm. Giving the right dose (or amount) of a medicine based on a child’s weight is important so that they receive the safest and most effective dose. Use the weight of the child and the dosing instructions on the medicine’s packaging to calculate how much medicine to give. Never guess the amount of medicine to give a child or try to figure it out from adult dosing instructions. To weigh a child accurately you will need a set of scales, ideally digital scales that measure in kilograms, placed on a hard surface. If you don’t have scales at home, your pharmacist, health clinic or doctor can help. An easy way to weigh a child 1. Weigh yourself and write down your weight. 2. Hold the child and weigh yourself again. Write down your combined weight. 3. Subtract the first weight from the second to get the child’s weight. If a child is particularly large or small for their age, check the dose with a pharmacist or doctor before giving it. 3. Measure liquid medicines accurately. Use an oral syringe to accurately measure and give the right dose. Do not use a kitchen teaspoon — this is not an accurate way to measure the right dose. Oral syringes are available in different sizes, ranging from 0.5 mL to over 20 mL. Before buying or using an oral syringe, check the markings to make sure it can measure the right dose. If the medicine doesn’t come with an oral syringe, or you don’t have one, ask for one at the pharmacy. You can also use the device that comes with the medicine — such as a dropper or medicine cup — if it has one. 4. Keep track of the medicines given. A written record of the medicines given to a child can help to prevent dosing errors, particularly when more than one person cares for the child. Make sure that everyone — including family members, child care staff or baby sitters — is given clear written instructions about when and how to give a medicine to the child. Learner Guide A1 - Ensure the Health and Safety of Children Page 54 A1 Certificate III in Early Childhood Education and Care Record the following important information each time you give medicine to a child • Weight of the child • Date and time the medicine was given • Active ingredient and brand name • Strength of the medicine • Exact dose given and the daily total • Reason why the medicine was given • Who the medicine was given by. Take this information with you so that the doctor or pharmacist knows what medicine(s) have been given to a child. 5. Ask questions if you’re ever unsure about anything. Learn the Top 5 questions to ask when measuring and giving medicines to children. Top 5 questions when measuring and giving a child’s dose of medicine • What is the active ingredient in the medicine? • Have I calculated the right dose based on the child’s weight and strength of the medicine? • What is the safest and most appropriate device for measuring the child’s dose? • How do I measure and give the dose accurately? • Have I recorded what, when and how much medicine was given? Learner Guide A1 - Ensure the Health and Safety of Children Page 55 A1 Certificate III in Early Childhood Education and Care This page has been left intentionally blank. Learner Guide A1 - Ensure the Health and Safety of Children Page 56 A1