Use of a statewide system to improve health and safety in child care facilities

Integrative literature review: sleep patterns in infants attending nurseries

OBJECTIVE

To identify evidence available in the literature about sleep patterns of infants attending nurseries.

METHOD

An integrative review of studies published in Portuguese, English or Spanish available in full text on LILACS, CINAHL, and PubMed databases. The following descriptors sono, lactente and creches or berçários (in Portuguese) and sleep, infant and childcare or nurseries were used for LILACS, CINAHL and Pubmed, respectively. Nine studies were selected and analyzed.

RESULTS

The main component explored in the studies about sleep pattern is the sleep position of the infants, due to its association with sudden infant death syndrome. The results pointed to the need to promote and develop written guidelines regarding behavioral practices to reduce the risk of this phenomenon.

CONCLUSION

Evidence has identified sleep issues, mainly regarding the sleep position of the infant and the environment where the infant sleeps, showing that it is critical to set routines and interventions to improve the quality of sleep care of infants attending nurseries.

Quality and safety in home and ambulatory settings

Much of the work in quality and patient safety has been based in hospitals and other acute care settings, yet it has become increasingly apparent that there are errors in delivery of care in other settings, all of which require attention. This article reviews sources of errors in 3 nonacute settings: the home, children's day care, and ambulatory surgery centers. Also described are standards that have been developed to guide practice, as well as specific regulatory agencies that are involved and some of the safeguards that have been instituted in each of the settings to protect against errors.

Child care health consultation improves health and safety policies and practices

OBJECTIVE

To evaluate the effects of county-level child care health consultation intervention programs on child care centers' health and safety policies and practices.

METHODS

A 3-year experimental study was conducted in 5 California counties and 111 licensed child care centers (73 intervention, 38 comparison) participated at the baseline and postintervention times. Trained research assistants conducted objective observations with a Policies Checklist and Health and Safety Checklist, which were composed of key national health and safety standards.

RESULTS

At baseline, both groups were not significantly different on the Policies Checklist and the Health and Safety Checklist. At the post-intervention time, intervention centers had significantly more and higher-quality written health and safety policies on 9 of the 10 policies rated (medication administration, care of mildly ill children, exclusion of ill children, cleaning and sanitizing, handwashing, daily health checks, inclusion of children with special needs, emergency preparedness, staff health) than comparison centers. At the postintervention time, intervention centers improved their health and safety practices in the areas of emergency preparedness and handwashing, controlling for consultation model, time in study, and director turnover. Both groups improved their indoor and outdoor facilities and overall Health and Safety Checklist means.

CONCLUSIONS

Child care health consultation programs can improve the written health and safety policies and may improve practices in child care centers.

Child health in child care: a multi-state survey of Head Start and non-Head Start child care directors

INTRODUCTION

Directors of Head Start (HS) and non-Head Start (non-HS) child care centers were surveyed to compare health consultation and screening for and prevalence of health risks among enrolled children.

METHODS

Directors of licensed centers from five states were surveyed from 2004 to 2005. Data were analyzed using cross-tabulation and logistic regression techniques.

RESULTS

A total of 2753 surveys were completed. HS centers were more likely than non-HS centers to consult health professionals (P < .0001). More than 90% of HS centers screened for health problems compared with 64.9% of non-HS centers (P < .0001). Almost all HS centers provided parents with child health information. Children at HS centers were at high risk for dental problems. Less than 3% of HS center directors, versus 11.3% of non-HS directors (P < .0002), reported TV viewing for more than an hour a day.

DISCUSSION

Children in HS centers were more likely to receive health consultations and screenings, were at higher risk for dental problems, and watched less TV compared with children in non-HS centers. HS centers promoted health significantly more frequently than did non-HS centers.

Sudden infant death syndrome (SIDS) and child care centres (CCC)

Our aim was to review the risk of sudden infant death syndrome (SIDS) when infants are in child care (CC), to discuss factors potentially responsible for SIDS in this setting and to describe the impact of previous information campaigns on SIDS in CC. There is a remarkably increased risk of SIDS in CC settings. Special education focussing on a safe sleeping environment has resulted in a decrease of practices known to be associated with SIDS. However, despite a safe sleep environment SIDS prevalence remains disproportionately high.

CONCLUSION

Efforts must continue to ensure safe sleeping practices in CC facilities. The possibility of other explanations for the increased prevalence of SIDS in CC settings, such as changes in infant care or stress, must be considered as well.

Opportunities for health promotion education in child care

OBJECTIVES

Comprehensive health promotion education is not feasible through pediatric office visits alone. Opportunities may exist for enhanced health promotion in child care settings. The objectives of this study were to understand the attitudes toward, barriers to, and strategies for incorporating health promotion activities in child care settings as well as topics that are deemed most useful from the perspectives of parents, child care directors, and health consultants. We also sought to understand the health consultants' (health professionals serving as consultants to child care centers) current and desired roles in leading health promotion activities in child care settings.

METHODS

We conducted simultaneous surveys of all licensed child care center directors and their health consultants in Boston. A total of 240 parents in 16 randomly selected centers were also surveyed.

RESULTS

A total of 97 (65%) directors in the 150 child care centers identified responded. A total of 71% (56 of 79) of consultants and 58% (138 of 240) of parents responded. Parents (89%), child care directors (88%), and health consultants (80%) believe that health promotion activities through child care centers would improve the health knowledge and behaviors of preschool children. A total of 45% of parents reported already receiving useful health information from child care staff and materials distributed in child care. Most topic areas that were suggested to parents were considered useful, with the greatest utility in the areas of behavior/discipline, child development, and emergency management. No significant barriers were identified by health professionals. Lack of funds (63%) and lack of someone to provide information (59%) were the top barriers identified by directors. An educational session on health topics by health care professionals was believed to be the best strategy to improve health promotion education for families. Among the health consultants, 83% of nurses or nurse practitioners said that they would be able to provide health education in child care compared with 53% of physicians.

CONCLUSION

Parents, child care center directors, and health professionals believe that enhancing health promotion education in child care could improve child health. Collaboration between pediatricians and early care and education professionals has the potential to improve the breadth and effectiveness of health promotion education. Effective strategies are necessary to optimize access to health professionals by early educators, and effectively utilize the unique skills and preferences of physicians and nurses to promote health education in child care.