Tonniges, T.F. (1997). Promoting optimal health in child care settings. Healthy Child Care America, 1(3), 1-5.

Health care professionals, child care providers, and parents have many opportunities to improve the health of children in child care settings.

A child care provider turns hand washing into a lesson on disease prevention for the children in her care. A pediatrician offers to give a talk on child development to the staff at a nearby preschool. A mother and father study the health and safety policies of several child care programs before deciding where to enroll their child.

What these three scenarios share is their simplicity - and their power. Small but meaningful efforts such as these, multiplied by millions, can combine to exert a profound impact on the health and safety of our nation's youngsters in out-of-home child care settings.

It begins with linkages. The three groups with the greatest responsibility for children's well-being - parents, child care providers, and health care professionals - already have much in common. The first step is to recognize those shared goals. The next step is to strengthen the connections by sharing more information and working together to promote optimal child health.

What Health Care Professionals Can Do

• Support parents who are searching for child care by providing information about different types of child care arrangements and how to assess them.

  As advocates for young children, pediatricians, pediatric nurse practitioners, and others who provide pediatric primary care are well-advised to take a personal interest in the issues and concerns that affect children in child care. Many primary care clinicians don't think of the primary care office as a place to discuss child care health and safety issues. And many parents don't think of the child care setting as having a significant influence on their child's health and development.

  Well-child visits are an exceptionally good opportunity for health professionals and parents to talk together about the relationship between quality child care and improved child health.

• Offer a list of reputable child care centers or family child care homes to parents looking for out-of-home care or refer parents to a local child care resource and referral agency.

• Provide a list of health and safety questions families can ask when making a selection. Include questions about caregiver-to-child ratios, group size, staff turnover, level of caregiver qualifications and continuing education opportunities, and health exclusion and medication administration policies. What are the program's protocols regarding hand washing and diapering?

• Has an outside agency inspected playground equipment for safety? Are staff trained in first aid and CPR? How does the program handle special needs, such as allergies, developmental delays, seizures, or diabetes? Encourage parents to provide relevant medical information to their child's caregiver. Some parents may hesitate to offer medical information to an out of home facility, because they don't understand why it might be relevant or may fear their child will be excluded from the program. Offer to speak to the caregiver directly to discuss any medical conditions such as developmental disabilities, asthma, lead poisoning, or hearing or vision difficulties.

• Become a health consultant or adviser to a child care program. Offer to serve as a resource for emergencies (a meningitis outbreak, for example) or help staff develop or update health protocols and policies. Work with staff to iron out inconsistencies between pediatric treatment guidelines, state health regulations, and program guidelines.

• Give a talk once or twice a year to child care providers on an agreed upon topic, such as infectious disease prevention, identification of developmental delays, behavioral management, the signs of potential child abuse, or other topics of interest to you.

• Hold an annual child care fair in your office. Invite representatives from several local child care centers and homes to be on hand to answer parents' questions and distribute literature. Invite a kindergarten teacher to speak about how parents and caregivers can help children become ready to enter elementary school. Ask a representative from the local or state health department to discuss child care health and safety regulations.

• Devote a space on medical charts and physical forms to describe the child care arrangements. Increases in respiratory infections, diarrhea, and otis media naturally occur with the grouping of children. Contacting or being available to support child care providers to assist in health and safety issues will help these children.

What Child Care Providers Can Do

• Ensure that each child in your care is receiving primary health care provided by a pediatrician, other primary care physician, or a pediatric nurse practitioner. Pediatric primary health care is best delivered within the context of a "medical home," where a well-trained pediatric health care professional delivers care in a manner that is accessible, family-centered, continuous, comprehensive, coordinated, and compassionate. The pediatric health care professional should be able to manage or facilitate all aspects of pediatric care and develop a relationship of mutual responsibility and trust with the child and family.

• Identify the medical home for children in your program when they enroll by asking parents to provide this information on the application form. (To receive copies of the American Academy of Pediatrics (AAP) policy statement about the medical home through the AAP FaxBack system, simply call 847/758-0391, follow the easy directions provided by the voice prompt and request document number 9262.)

• Position your program as a resource for families who do not have a medical home by providing a list of pediatric primary care health professionals in the community. Families who do not have insurance often will take their children to a free health fair to obtain the required immunizations.

  Although these children will receive needed immunizations, they are receiving care outside of a medical home and therefore may lack other needed health care services such as well-child examinations. Recent federal and state changes in Medicaid and medical insurance for low-income children should make it easier to connect uninsured children to a medical home.

• Contact the maternal and child health staff of the city or county public health unit. Public health nurses can often serve as valuable liaisons with parents and child care providers.

• Designate a member of your staff to serve as your program's health care advocate or coordinator. This person can oversee the development and revision of health and safety policies and procedures; establish liaisons with pediatricians, nursing professionals, and community health agencies; plan health and safety training sessions for staff; assure annual vision and hearing screenings through primary care offices or local health departments; and serve as the key contact for pediatricians or other primary care clinicians who wish to discuss a child's special needs or status.

• Become informed about common medical problems, like asthma, and have a medical treatment plan on site.

• Become an advocate for breastfeeding. Explain to infant caregivers that breastfeeding provides advantages with regard to general health, growth, and development, while significantly decreasing risk for a large number of acute and chronic diseases. Breastfeeding can reduce the amount of time infants are sick because breastfed infants are better protected from infections than formula-fed infants.

  Support mothers who wish to continue breastfeeding after they return to work by establishing a system and designating a location for the storage of expressed breastmilk. Try to time the baby's feeding so the baby will be hungry when the mother is ready to nurse. Offer mothers a comfortable and private place to nurse at lunch time or when they come to pick up their babies. Develop a formal policy in support of breastfeeding and communicate this policy directly to each new mother as she enters the program. (For information about the AAP policy statement on breastfeeding, contact the AAP Department of Community Pediatrics at 800/433-9016, ext. 4729. For copies of the new brochure Working and breastfeeding: Can you do it? Yes you can! produced by the National Healthy Mothers, Healthy Babies Coalition, contact Best Start Social Marketing at 800/277-4975 or e-mail [beststart@mindspring.com].)

• Align your program with health professionals or health organizations interested in serving as advisors or consultants to your program.

• Recognize your program's enormous potential to complement and augment the work of health care professionals in educating families about child development, health, and safety. Share information on child passenger safety issues and make sure children are transported in the safest way possible to and from the child care setting and while on field trips.

• Sponsor a health fair or educational seminar for parents. Request suggestions on subject matter from local health professionals and invite them to speak. (A large selection of brochures and other medical and health promotional materials are available through the AAP Department of Marketing and Publications, 800/433-9016.)

• Take advantage of opportunities to teach children about health and safety. Have children help prepare healthy snacks; explain how and why they need to use playground equipment in a safe manner; role model good hygiene and safety practices; talk about how hand washing helps prevent the spread of germs that can make them sick; invite the local fire department to give a presentation on fire prevention; implement unique exercise programs; and give children healthy snacks for birthday and holiday celebrations.

What Parents Can Do

• Become an effective advocate for your child's health and safety by educating yourself about the components of quality child care. Contact the AAP for information about the Healthy Child Care America campaign at 888/227-5409. Contact the National Association for the Education of Young Children at 800/424-2460 and the Child Care Action Campaign at 212/239-0138 for other information and resources.

• Know the state and local health and safety regulations for child care programs in your area. When choosing out-of-home care for your child, ask to see a copy of the facility's health and safety policies and procedures manual. Does the caregiver meet the state regulations regarding emergency resuscitation and CPR?

• Make sure you understand the program's policies and procedures for managing mildly ill children, and have alternate arrangements for such situations.

• Ask caregivers for examples of how they incorporate basic health messages into daily routines and special activities. Do they teach children about healthy foods or sponsor safety presentations?

• Observe how caregivers handle food and bottle preparation and diapering of babies to see if they follow proper hand washing and sanitation procedures.

Whether you are a parent, child care provider or health professional, recognize the enormous power at your disposal to improve the health and safety of children in child care settings by sharing information and partnering with each other. Child care settings offer a valuable opportunity for health promotion and disease prevention. By working together, we can make a difference.

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