Asthma is highly prevalent in children aged 0-5 years and children in this age group have the highest rates of emergency department and hospital visits for asthma. In California, nearly 50,000 licensed child care centers, preschools, and family child care provides serve over 1 million children. Many other young children attend license-exempt facilities which are not covered under regulations that apply to licensed settings. Both types of child care are addressed in this Plan. With some children spending up to 60 hours a week in child care settings, it is critical that each of these settings provides a healthy and safe environment for all children, especially children with special health care needs such as asthma. Uncontrolled asthma symptoms may interfere with the physical, social, and emotional development of children.
While child care facilities encounter many of the same challenges that confront schools, there are many issues and concerns that are unique to this setting and age group. In 2002, CDPH surveyed center-based site directors, teachers and providers to assess asthma knowledge and the presence of triggers. The survey results indicated that environmental risk factors are commonly present in child care centers and that knowledge among child care staff about asthma varies widely. In recent years, several prominent organizations in California have collaborated to develop high quality asthma education and training materials specifically for early care and education providers in California. One example is the video, Asthma Care Training for Child Care Providers, which was produced in both English and Spanish by Emergency Medical Services Authority (EMSA). In addition, national health professional organizations have developed specific key recommendations for making child care safer for children with asthma. Addressing asthma-related environmental issues within the many diverse child care settings will require continued coordination and outreach at many levels.
Success in meeting the child care objectives and strategies will result in better policies and practices that encourage safer child care environments for infants and young children with asthma; consistent education for staff to recognize asthma and respond effectively; and new resources to sustain and disseminate these advances.
- 4B.1. Ensure the health and well-being of children with asthma in child care settings through a set of comprehensive and coordinated asthma policies and procedures.
-
4B.1.1. At the state level, develop and promote guidelines and training on the management of asthma in child care settings and trigger reduction strategies. Include a comprehensive set of model policies and procedures (Figure 13. Model Asthma Policies and Procedures for Child Care Centers).
4B.1.2. Tailor outreach materials and training to child care providers in a variety of settings (e.g., rental facilities, churches, schools, homes, centers) to encourage the adoption of model policies.
4B.1.3. Increase state funding to support child care services, facilities improvements, and appropriate health and safety training.Figure 13. Model Asthma Policies and Procedures for Child Care Centers
The American Public Health Association (APHA) and the American Academy of Pediatrics (AAP) have jointly published Caring for Our Children: National Health and Safety Performance Standards: Guidelines for Out-of-Home Child Care Programs (http://nrc.uchsc.edu/CFOC). This report includes six key recommendations for making child care centers safer for children with asthma that are adapted as follows:
1. Each child with asthma should have a special care plan prepared for the facility by the child's source of health care, to include:
- Written instructions regarding how to avoid the conditions that are know to trigger ashtma symptoms for the child;
- Indications for treatment of the child's asthma in the child care facility;
- Names, doses, and method of administration of any medications, e.g., inhalers, the child should receive for an acute episode and for ongoing prevention; and
- When the next update of the special care is due.
2. Based on the child's special care plan, the child's caregivers should receive training, demonstrate competence in, and implement measures for:
- Preventing exposure of the asthmatic child to conditions likely to trigger the child's asthma;
- Recognizing the symptoms of asthma; and
- Treating acute episodes.
3. Parents and staff should arrange for the facility to have necessary medications and equipment to manage the child's asthma while the child is at the child care facility.
4. Properly trained caregivers should prompty and properly administer prescribed medications according to the training provided and in accordance with the special care plan.
5. The facility should notify parents of any change in asthma symptoms when that change occurs.
6. The facility should reduce these common asthma triggers by:
- Encouraging the use of allergen impermeable nap mats or crib/mattress covers;
- Prohibiting pets (particularly furred or feathered pets);
- Prohibiting smoking inside the facility or on the playground;
- Discouraging the use of perfumes, scented cleaning products, and other fumes;
- Quickly fixing leaky plumbing or other sources of excess water;
- Ensuring frequent vacuuming of carpet and upholstered furniture at times when the children are not present;
- Storing all food in airtight containers, cleaning up all food crumbs or spilled liquids, and properly disposing of garbage and trash;
- Using integrated pest management techniques to get rid of pests (using the least hazardous treatments first and progressing to more toxic treatments only as necessary); and
- Keeping children indoors when local weather forecasts predict unhealthy ozone levels or high pollen counts.
Source: http://nrc.uchsc.edu/CFOC/
For mor information on healthy child care, visit: www.nccic.org/hcca/
- 4B.2. Increase the availability of child care health consultants, health personnel and technical assistance resources to help child care providers manage asthma.
-
4B.2.1. Increase the number of child care health consultants and/or nurses in all counties as a training and technical assistance resource for licensed child care facilities.
4B.2.2. Establish linkages between the child care, health care, and school communities to provide clinical and health education consultation services as needed.
- 4B.3. Work with the California Department of Social Services (Community Care Licensing) to ensure that laws and regulations for licensed child care facilities adequately address asthma-related and indoor environmental quality issues, that education about
-
4B.3.1. Engage interested stakeholders to evaluate existing laws and regulations to determine their adequacy for addressing asthma-related and indoor environmental quality issues in licensed child care facilities. Recommend changes and new laws/regulations as appropriate.
4B.3.2. Assess whether licensed child care centers and family child care homes meet all relevant laws and regulations. Expand support resources to help licensed child care facilities comply (Figure 14. Legal Protections Afforded to Children with Asthma).
Figure 14. Legal Protections Afforded to Children with Asthma
Federal Americans with Disabilities Act and Child Care
Chronic breathing problems are classified as disabilities, which mean that children with asthma are protected under the Americans with Disabilities Act (ADA). ADA states that children with disabilities cannot be excluded from child care unless their presence would pose a "direct threat" to the health or safety of others or require a fundamental alteration of the program. ADA also requires child care programs to make "reasonable modifications" to policies and practices to integrate children with disabilities. For more information on what this means, visit the Federal Department of Justice website at www.usdoj.gov/crt/ada/childq&a.htm.
California Law
While limited, California does have some regulations that have applicability to children with asthma and with which all licensed child care facilities must comply. Exceptions or variations for licensed family/home day care are noted where applicable.
Trigger Reduction
-
Pest management and pesticide use: 22 CCR 101238(a)(1) states that the licensee shall take measures to keep the center free of flies, other insects and rodents. In 2006, the "parents' right-to-know" law about pesticide application at school sites (California Education Code Section 17610-17612) was extended to licensed day care facilities. This regulation also requires the Department of Pesticide Regulations to send licensed facilities information on Integrated Pest Management (IPM). Family day care centers are exempt from the reporting requirements, but do receive the IPM information.
-
Smoking: Health and Safety (H&S) Code Section 1596.795(b) bans smoking anywhere on day care premises. Family day cares are required to prohibit smoking only when children are present.
Treatment, Management, and Staff Training
-
Section 1596.798 of H&S Codes gives child care staff permission to administer inhaled medications. It also requires any licensee or staff person who obtains or renews a pediatric first air certificate to complete formal training in how to administer inhaled medication to children with respiratory needs.
-
- 4B.4. Minimize exposure to contaminated outdoor air and promote safe and healthy child care facility outdoor environments.
-
4B.4.1. Establish and communicate guidance for child care centers and family child care homes on best practices for recognizing and managing unhealthy air quality days for children with respiratory diseases and all children.4B.4.2. Consider the development of guidelines for locating new licensed child care centers as far as possible from sources of outdoor air pollution such as freeways, busy roads, and stationary pollution sources (similar to existing regulations for new school construction).4B.4.3. Promote low-allergen landscaping practices for child care settings.