Module 2-B Arizona Child Care Association: Employee Orientation 1

Module 2: Safety, Health, Nutrition

Section B: Healthy Practices for Children and Staff

Introduction
A healthy environment for the children and staff in the child care center requires an understanding of
infection control and maintaining a clean classroom environment. As an early childhood professional,
part of your responsibility includes maintaining and modeling healthy practices for the children in your
classroom. In this section you will learn some of the basic procedures of cleanliness and infection
control for keeping children and yourself healthy. In addition to taking care of the children, it is
important to take care of yourself by eating nutritious meals, getting enough sleep, and following
infection control practices.

Learning Objectives
After you complete this section you will able to:

 Explain 4 strategies of classroom infection control.

 Explain the hand washing process.

 Explain diaper changing procedures.

 List 5 characteristics of a clean classroom.

Guiding Your Learning

As you work through this section think about the following questions:

 How would you define a healthy child care environment?

 What are the responsibilities of an early childhood teacher in providing children with a healthy child
care environment?

 Look for specific guidelines for infection control and providing a healthy environment.

 Reflect on the reasons for providing specific procedures and guidelines for cleanliness and health in
early care and education programs.
Module 2-B Arizona Child Care Association: Employee Orientation 2

NOTE: The information contained in these sections are partial summaries of the DHS Child Care
Licensing Regulations, are not intended to replace or provide an official interpretation of the Arizona
Administrative Code and Arizona Revised Statutes for Child Care Facilities.

Summary of Key Arizona Child Care Licensing Standards

Article 3: Facility Administration

R9-5-301. General Licensee Responsibilities

F. Requires that all staff have a TB test.

G. Requires that a staff member with current CPR-First Aid training is in the child care center, on field
trips, and with children during transportation.

J. Every September a licensee shall provide to parents of enrolled children information related to
recommendations for influenza vaccinations for children.

K. Staff members who do not have proof of immunity against a communicable disease must be excluded
from the center from the beginning through the end of an outbreak of the disease.

R9-5-305. Child Immunization Requirements

All children enrolled in a child care program must have a record of all immunizations on file. Two
exceptions are granted; one is based on a doctor’s statement regarding health concerns for the child;
the second exception is based on religious beliefs.

Article 5 Facility Program and Equipment

R9-5-501 General Child Care Program, Equipment, and Health and Safety Standards

C 9. This regulation provides direction on procedures for the handling of children’s personal products
including sun screen, diaper ointment, and toothpaste.
C 11. This regulation states that the staff are responsible for monitoring enrolled children for
overheating or overexposure to the sun.

R9-5-502. Supplemental Standards for Infants

This section pertains to ensuring that soft items such as pillows, comforters, bumper pads or stuffed
toys are not in an infant’s crib while the infant is in the crib.

Regulations for infants include placing the infants on their back for sleeping and the requirement to
obtain written, current, and dated feeding instructions for each infant from a parent or health
professional.

R9-5-503 Standards for Diaper Changing

Module 2-B Arizona Child Care Association: Employee Orientation 3

The regulations in this area provide standards and specific direction for diaper changing.

R9-5-504. Supplemental Standards for 1-year-old and 2-year-old children

Center administration and teachers who work with the enrolled child are required to consult with the
enrolled child’s parent to develop a toilet training plan for each child. The regulation states that staff
members cannot force toilet training on an enrolled child.

R9-5-512 Cleaning and Sanitation

The cleaning and sanitation of the facility are addressed in this section including pest control, facility
cleanliness including floors, bathrooms (toilets, floors, and fixtures), laundry area, kitchen facilities, trash
collection, classroom materials, and furniture and equipment.
All staff members and children are required to wash their hands with soap and running water after
toileting.

R9-5-515 Illness and Infestation

A child or staff person who is ill or has a contagious condition cannot remain at the center. When center
staff or children become ill with certain communicable diseases or conditions, a written notice should be
provided and or posted to all parents and staff regarding the disease.

R9-5-516 Medications
Enrolled children may take prescription or non-prescription medications with written authorization and
specific directions from the child’s parents or a health care provider. This regulation provides specific
directions and requirements for administering children’s medication and storage of medication.

A Healthy Environment
In thinking about a healthy child care environment, you might envision young children playing outside,
enjoying meals and snacks, taking a nap, actively engaged with other children in learning experiences,
and exploring the properties of sand and water. All of these common child care activities are
appropriate and help children develop physically, intellectually, and emotionally. However, as young
children explore their environment, investigate materials, and play with other children, share meals, and
toys, they will, at some point, encounter the germs that can cause infectious diseases or illnesses.
Researchers have found that children in child care do become sick more frequently and the illnesses
tend to last longer than children who are at home. The good news is that 90% of the infections are mild
and require no treatment. The incidence of illnesses decreases after the child has spent one full year in
a child care program. The most vulnerable members of an early child care community are infants,
pregnant women, and children with health issues.
Module 2-B Arizona Child Care Association: Employee Orientation 4

The causes of infectious diseases in child care programs are viruses, bacteria, and parasites (typically
stomach related illnesses). Infectious diseases are spread when a germ comes in contact with a person,
a surface, food or water. One of the reasons that child care centers have a higher incidence of
infectious diseases is that infants, toddlers, and preschool children have not been exposed to the wide
variety of germs within the broader community and have yet to build up their immunity system. Once
young children have been exposed, they are more likely to spread the disease since they are not yet
skilled in personal hygiene practices that help minimize the spread of disease. If you observe young
children, you will notice that they will touch their nose or month and then immediately touch a toy or
another surface. This action contributes to the spread of infectious diseases. Young children also put
everything in their mouths to explore and learn about the world around them.

The symptoms of infectious diseases include: cough, congestion, runny nose, stomach related
symptoms including vomiting or diarrhea, a rash, fever, sore throat, ear ache, head ache or other body
aches, and changes in behavior. Infectious diseases are spread when an ill person comes in contact with
another person or an object they have touched.

Immunizations have helped to stop the spread of many childhood diseases such as measles and
chickenpox. Flu shots are often recommended for young children and adults who work with young
children. It is important that young children receive immunizations when they attend a child care
program. Staff members need to have up-to-date immunizations to prevent the spread of infectious
diseases.

Standard/Universal Precautions must be implemented whenever a bodily fluid is present. Bodily fluids
are any natural fluids or secretions such as blood, urine, feces, mucus semen, or saliva. When bodily
fluids are present, the provider must to the following:

1. Cover any sores, blisters or open wounds.

2. Use protective barriers such as latex gloves.

3. Try to contain the bodily fluid as much as possible by not moving the child. Bring first aid or care
to him/her.

4. Clean and sanitize anything that might have come in contact with a bodily fluid.

5. Dispense needles in authorized Sharp containers.

6. Wash hands after being exposed to a bodily fluid.

Module 2-B Arizona Child Care Association: Employee Orientation 5

Other ways that early childhood teachers and parents can control the spread of infectious diseases is
through proper nutrition, enough sleep, exercise, and following healthy practices. Healthy practices
may be referred to as infection control. Although infection control may sound like a medical term, the
concept can be applied to child care programs. Infection control in a child care center includes the
following practices:

 Hand washing

 Diaper changing

 Cleaning and sanitizing surfaces and equipment

 Daily Health Check

 Excluding children or staff members who are ill

Hand washing is one of the best ways to prevent the spread of disease. Hand washing, when done
correctly and on a regular basis, is the single most effective way to prevent the spread of communicable
diseases. Hand washing methods are easy for children learn and have been found to significantly
decrease the spread of infectious diseases in child care environments.

Hand Washing Methods

1. Wet the hands with warm, running water.
2. Apply small amount of liquid soap.
3. Wash the fronts, backs, and in between the fingers while rubbing the hands together for 20 seconds.
4. Rinse all the soap and soil from the hands with warm, running water. All the water should go down
the drain.
5. Dry the hands completely with a single use, disposable paper towel.
6. Turn off the water with a paper towel to prevent re-contaminating the hands by germs and soil on
the faucet handles.
7. Discard paper towels immediately into the trash container. Do not reuse the paper towels for any
other purpose.

Teachers can provide young children with fun activities that provide instruction on the correct way to
wash their hands. Singing songs, such as the ABC song or Row, Row, Your Boat, while the children wash
their hands is one way to ensure that children spend the correct amount of time to remove dirt and
germs from their hands. Teachers can reinforce correct hand washing methods by being a role model
and washing their hands with the children and providing instruction on hand washing procedures during
activity times. Pictures of children hand washing in the children’s bathrooms can encourage and remind
older child of the hand washing process.

Hand washing at regular times and after specific activities are other factors in successfully using hand
washing to reduce infections. The following chart provides a list of the times that teachers and children
should wash their hands.
Module 2-B Arizona Child Care Association: Employee Orientation 6

When do you wash your hands in an early childhood program?

Center Staff Children
 When first arriving at the program  When arriving at the program
 Before and after giving First Aid, changing  Before eating meals or snacks
bandages or taking a temperature  Before activities that can include fingers or
 Before and after preparing food items that can go into the mouth, such as clay,
activities, meals or snacks play dough, water table or food, etc.
 Before and after giving medications or  After using the toilet or having a diaper changed
treatments  After playing with animals or pets
 After using the toilet or assisting a child  After prolonged coughing, sneezing, vomiting or
to use the toilet wiping at the nose and mouth
 After diapering a child  After outdoor play, especially before meals or
 After prolonged coughing/sneezing nap time
episodes  After messy activities
 After caring for or handling pets or their
cages/enclosures
 After tending to a sick child, adult or pet
 After handling items soiled with body
fluids such as blood, stool, urine, mucus.

Taken from: Arizona Health and Safety Policy Manual for Child Care Centers - Spring 2006 page 30

Proper Diaper Changing procedures are another daily routine that can reduce the incidence of
infectious diseases throughout the child care center. Contamination from bodily fluids associated with
diaper changing can contain germs that cause infectious diseases that may spread throughout the
center if proper diapering procedures are not followed. When infant and toddler teachers use the
proper diapering procedures, the spread of germs can be reduced by sanitizing diaper changing surfaces
and structured hand washing methods during the diaper changing process. Although the multi-step
diapering process can look intimidating at first, the steps for proper diapering become part of the daily
care giving routine while protecting the health of the children, teachers, parents, and the community.
DHS provides a form titled Diaper Changing Procedure which can be posted at each diaper changing
area in all classrooms where children’s diapers are changed. Hand washing and sanitizing the diaper
area are the primary procedures in the diaper changing process.

Note: Non-porous gloves such as latex must be used in the diapering process and are used when there
is contact with blood. The use of gloves does not replace hand washing procedures. Once the gloves
have been removed, the final step is following the correct hand washing process.
Module 2-B Arizona Child Care Association: Employee Orientation 7

As one of the main activities in infant and toddler classrooms, the diapering and toileting training
processes offers opportunities for individual interaction between the teacher and the child. Diapering
provides ideal opportunities for building the nurturing relationship that promotes attachment between
the child’s teacher and the child. Respectful interactions include explaining the steps of the diaper
changing process to the infant, “We are going to change your diaper.” Or “We are almost finished
changing your diaper. We just need to wash your hands.” Diaper changing areas may have interesting
pictures posted in washable frames that provide opportunities for infants to name items in the pictures.
The interaction between the teacher and the child during these routine processes are perfect times to
build language skills as the teacher talks to the infant and responds to their vocalizations.

Diaper changes are part of the documentation requirements on the Arizona Child Care Licensing Infant
Daily Log. Being responsible for numerous children can make tracking difficult. Keeping accurate
documentation ensures that all the children’s basic needs are met. Keeping track of diaper changes can
help you evaluate the child’s health and readiness for toilet training.

** Ask your Center Director for specific center policies and procedures for diaper changing.

Toilet Learning or Potty Training is a big step in the life of a young child as they move toward gaining
more independence. The Arizona Child Care Licensing Regulations require that child care staff and
parents develop a joint plan for toilet training each child. Each child shows signs of readiness for toilet
learning at different ages. Children’s readiness to use the toilet includes both physical and emotional
development. As children showing signs of readiness for learning to use the toilet the child’s parents,
toddler teaching staff, and administration should participate in developing an individual plan for the
child. In addition to the child’s readiness, their various cultural perspectives regarding toilet learning
need to be considered in working with parents on toilet learning plan.

The Licensing Regulations state that young children shall not be forced to use the toilet. Learning to use
the toilet should be a positive experience for the child. Behavioral approaches to potty training that
force the child to sit on the toilet, tease, or make negative comments about the toddler may create
major emotional issues for the child. Parents or teachers who force toddlers to participate in potty
training may create power struggles with the child which creates negative feelings about toileting.

All children have toileting accidents during the toilet training process. When accidents occur during
toilet training, change the child quickly while remaining positive and providing reassurance that
accidents do happen and they will be successful in learning to use the toilet. When children have toilet
accidents, change the child following infection control standards that include sanitizing the area where
the child is changed, disposing of single use training pants, and following the correct hand washing
process for the child and yourself. Soiled clothing must be put in a plastic bag and then placed in a
covered container. Never put soiled clothing in a child’s cubby or backpack.
Module 2-B Arizona Child Care Association: Employee Orientation 8

Assessing the child’s readiness for toilet training is outlined by considering the child, parent permission,
and teachers in a series of steps as suggested by Wittmer and Petersen (2010).

The Child The Parent The Teacher

 Indicates an interest in  Is willing to work  Have positive and proactive
using the potty collaboratively with the relationship with the parent
 Follows simple directions toddler teacher(s) to create that includes daily
 Is able to communicate a consistent approach to communication
needs to adults toilet training  Has developed a trusting
 Is not in a resistance stage  Agrees that the child is relationship with the child
of development ready for toilet training  Has the training and
 Is willing and able to sit on  There are no major changes experience to provide the
the toilet or transitions occurring in child with a positive toilet
 Is able to pull pants off and the family or child’s life training experience
on
 Diapers are dry for a longer
period of time
 Asks to wear underwear
 The child has been in the
classroom for a period of
time and is familiar with the
teachers and environment

**Ask your Center Director for specific toilet training guidelines and policies for the center.

Sudden Infant Death Syndrome (SIDS)

Sudden Infant Death Syndrome is the most common cause of death in infants over one month of age.
Although there are no known causes for SIDS there are several factors that have been identified as
increasing the chances of infant deaths from SIDS. Some of the factors include:

 Infants sleeping on their tummies

 Infants sleeping on a soft mattress or with soft bedding

 Exposure to tobacco smoke before or after birth

 Prenatal exposure to alcohol

 Premature birth

 Low birth weight

Module 2-B Arizona Child Care Association: Employee Orientation 9

The Safe to Sleep Campaign provides guidelines and information on Sudden Infant Death Syndrome in
an online brochure that describes what a safe sleep environment looks like. Teachers and parents can
reduce the incidence of SIDS by following these practices:

 Infants should always be placed to sleep on their backs

 Do not offer infants who use pacifiers a pacifier at bedtime until they are one year of age

 Provide infants with a firm and smooth sleeping surface

 Remove all blankets, toys and loose bedding from the crib

 The room environment should be kept warm; do not overheat a room

 Do not overdress an infant to the extent that the child is overheated

 Smoking should not be allowed in areas where children sleep, live, or play

 Make sure nothing covers the baby’s head

Classroom Cleanliness is important in preventing the spread of infectious diseases and in creating a
warm and inviting environment for the children.

Think about a time when your home was disorganized and in need of a good cleaning. How did you feel
when you walked in after a long day at work? Now think about a time when you had cleaned and
organized your home. How did you feel when you walked in the house after a long day at work?

Many people feel overwhelmed and disorganized when their surroundings are messy and chaotic.
Young children respond in the same way. An environment that is clean and organized provides children
with a sense of security in their surroundings that encourages exploration and sense of calmness that
influences their behavior. Organizing materials and equipment to prevent clutter helps to create a clean
and safe environment. Sometimes it is difficult in an early childhood classroom to determine if the
classroom is clean, dirty, or temporarily messy due to children’s active play. As individuals we all have
our own perspective on what is clean or dirty, organized or messy. Use the following chart to think
about what you consider clean, active play messy, or messy and dirty. Talk with your Center Director
about the expectations of classroom cleanliness.
Module 2-B Arizona Child Care Association: Employee Orientation 10

Is this a clean classroom, a dirty classroom, or a temporarily messy classroom?

Description Clean Dirty Temporarily
Messy
1. All the tables and chairs are clean.
2. It is the end of choice time and the art table is covered with
pictures cut from magazines, glue bottles, and construction
paper.
3. The carpeted area of the classroom has stains.
4. The sink in the art area is stained with paint and has bottles of
paint and paint brushes sitting on the counter next to the
sink.
5. The shelves in the block area are labeled with the block
shapes and are free of dust. The wooden blocks appear to
have been sprayed and wiped dry.
6. Children are playing in the book area. There are books on the
floor and flannel board pieces that have not been put away.
7. Children are playing in the sensory table which is filled with
cornmeal, small dinosaurs, and cars. There is cornmeal on the
floor.
8. In the manipulative area the shelves are labeled with different
types of blocks and toys. The labels have started to peel off of
the shelves. The bins are broken and the blocks and toys are
dirty and mixed together in the different boxes.
9. It is naptime and the children are resting on their mats. There
is food on the floor under the table and the tables are sticky
with the remains of food from lunch.
10. Children are playing dress-up. The clothes are on the floor.
Some of the clothes are dirty. The plastic dishes are dirty and
the dolls are not wearing clothes and are dirty.
A clean environment provides the children with a healthy environment that helps reduce the spreading
of infectious diseases. Maintaining a clean classroom involves cleaning and sanitizing or disinfecting the
equipment, learning materials, floors, bathrooms, diapering areas, tables, chairs, countertops, and other
fixtures or equipment that children come in contact with during their daily routines. Sanitizing will
reduce but not eliminate the germs that cause infectious diseases. Disinfecting will destroy the majority
of infectious bacteria. The three methods to sanitize or disinfect are through immersing in a disinfectant
solution, wiping with a disinfectant solution, or spraying with a disinfectant solution. The most effective
disinfectant solution is also the most cost effective. A combination of cool water and bleach can be
Module 2-B Arizona Child Care Association: Employee Orientation 11

mixed each day and used to disinfect the classrooms, bathrooms, diapering areas, and the child care
facility.

The Arizona Department of Licensing provides a schedule to disinfect and a recipe for a general use
bleach solution:

Recipe for Bleach GENERAL PURPOSE and

DIAPER AREA Solution
Mix the solution daily and label
each bottle of solution with the date.
1/4 cup bleach
1 gallon of cool water
OR
1 tablespoon bleach
1 quart cool water

Recipe for SOAKING Solution

(For use on toys, eating utensils, etc.)
1 tablespoon bleach
1 gallon cool water
(Soak 2 Minutes and Air Dry)

To learn about how often and the type of disinfectant solution to use, review the handout: Arizona Child
Care Center Cleaning and Sanitation Guidelines.

**Ask your Center Director about the specific sanitation guidelines and procedures at the center.

Daily Health Checks can help prevent the spread of infectious diseases. Daily health checks are
conducted by the classroom teacher when the child arrives and throughout the day if necessary. The
daily health check provides a way to identify children who may be ill and address their health needs in a
timely manner. Typically a daily health check occurs as the parent arrives and shares information with
the teacher about the child including schedule differences and any differences in health or behavior.
Examples may include differences in the child’s appetite, complaining of not feeling well, sleepy, or
accidents that may have occurred at home. The sharing of information about the child’s health occurs
again when the parent picks up the child. The teacher shares the same types of information about the
child’s behavior, eating patterns, general wellness, and accidents or incidents. Health checks provide
one way that parents and teachers can work together to ensure that children are in good health. If the
child has symptoms of an illness the parent and teacher can decide if it is safe for the child to be at the
center. Children who are ill or contagious must be excluded from the child care program until they are
no longer contagious. If a child has a contagious disease, a notice that provides information and
symptoms of the illness must be posted in the center to notify parents. A child may not be at the
Module 2-B Arizona Child Care Association: Employee Orientation 12

program until he/she is symptom free for 24 hours or provide a note from the child’s doctor that the
child is not contagious.

Signs that a child is contagious:

 Fever of 100˚ axillary (under the arm) if other signs and symptoms of illness are present (e.g.
diarrhea, rash, earache, sore throat) or Fever of 101˚ axillary (under the arm) or greater, even if
no other signs and symptoms are present
 Sores that are open, infected, or not easily covered
 Vomiting more than twice in 24 hours
 Diarrhea more than three times in 6 hours
 Earache that is causing severe discomfort
 Red eyes with discharge
 Lice or nits
 Scabies
 Ringworm
 Undiagnosed rash

**Ask Your Center Director about specific procedures for daily health checks at the center.

Children may attend the center while on medication if they do not have a contagious illness. If your
program allows the administering of medications parents must provide signed medication authorization
for prescribed medications to be given to their child. If a child in your class takes medication while at
the center, talk with your Center Director about the specific medication policies and procedures.
Remember, that only medications that have written parent authorizations may be given to a child in
care.

Teacher Health
Teachers who work in child care centers need to know it is important to take care of yourself as well as
the children. Eating healthy foods, getting enough rest, making certain your immunizations are up-to-
date, and taking time to exercise are all important steps in maintaining your health.

Your responsibility is to provide a healthy, safe, and nurturing environment for young children.
Developing relationships with children are equally as important as maintaining a clean environment.
The children are always the first priority. Incorporate the daily routines involved in maintaining a
healthy environment with the classroom activities and daily schedule. Use your creativity and ask others
for suggestions on how to combine the multiple responsibilities of an early learning teacher.
Module 2-B Arizona Child Care Association: Employee Orientation 13

Applying Your Knowledge

How does this information affect your work with young children?

Following infection control practices is a critical part of your responsibility as a child care professional.
Young children are more susceptible to infectious diseases. By following hand washing, sanitation, and
infection control practices the incidence of infectious diseases in child care centers may be decreased.

Check Your Understanding

 Name 4 infection control methods to use in a child care center.

 Explain the steps in the hand-washing process and reasons hand washing is important in a child care
center.

 Name three times when children should wash their hands during their child care day.

 Name three times when staff should wash their hands while working with young children.

 List the steps in diaper changing.

 Name three people who are important in determining when a child is ready for toilet training.

 Name three characteristics of a clean classroom.

Resources

Printable Resources

DHS - Cleaning and Sanitation Guidelines

http://www.azdhs.gov/als/childcare/documents/providers/forms/cleaning_sanitation_guidelines.pdf

DHS – Diaper Changing Procedure

http://www.azdhs.gov/als/childcare/documents/providers/forms/diaper_changing_procedure.pdf

DHS – Hand Washing Tip Sheet http://www.azdhs.gov/als/childcare/documents/providers/helping-

hands/handwashing.pdf

What does a safe sleep environment look like? SIDS Reduction

https://www.nichd.nih.gov/publications/pubs/Documents/safe_sleep_environ_sheet_2012.pdf

DHS - Tummy Time Tip Sheet http://www.azdhs.gov/als/childcare/documents/providers/helping-hands/tummy-

time.pdf
Module 2-B Arizona Child Care Association: Employee Orientation 14

Videos

DHS – Diaper Changing Areas http://www.youtube.com/playlist?list=PLE5A9923B23D9AE01

DHS -Infant Classroom/General Diapering Information

http://www.youtube.com/playlist?list=PLE5A9923B23D9AE01

References

American Academy of Pediatrics: Infectious Diseases Curriculum – Participants Manual

http://www.healthychildcare.org/ParticipantsManualID.html

National Institute of Child Health and Human Development, Safe to Sleep Campaign, What Does A Safe Sleep
Environment Look Like?
https://www.nichd.nih.gov/publications/pubs/Documents/safe_sleep_environ_sheet_2012.pdf

Wittmer, D. S. & Petersen, S.H. . (2010) Infant and toddler development and responsive program planning: A
relationship-based approach, Second Edition. Pearson.
Module 2-B Arizona Child Care Association: Employee Orientation 15

Module 2-Section C Worksheet

Name 4 infection control methods to use in a child care center.

1. 3.

2. 4.

Explain the steps in the hand-washing process and reasons hand washing is important in a child care center.

Name three times when children should wash their Name three times when staff should wash their hands
hands during their child care day. while working with young children.

1. 1.

2. 2.

3. 3.

List the steps in diaper changing.

Name three people who are important in determining

when a child is ready for toilet training. Name three characteristics of a clean classroom.

1. 1.

2. 2.

3. 3.