Chapter05

CHAPTER 5:
Facilities, Supplies, Equipment, and Environmental Health

5.1 Overall Requirements

5.1.1 General Location, Layout, and Construction of the Facility

STANDARD 5.1.1.1: Location of Center

A center should not be located in a private residence unless that portion of the residence is used exclusively for the care of children during the hours of operation.

RATIONALE: Centers in these standards are generally defined as “providing care and education for any number of children in a non-residential setting or thirteen or more children in any setting.” When there are a large number of children in care who may span the age groups of infants, toddlers, preschool, and school-age children, special sanitation and design are needed to protect children from injury and prevent transmission of disease. Undivided attention must be given to these purposes during child care operations.

COMMENTS: The portion of a private residence used as a child care facility is variable and unique to each specific situation. If other people will be using the private residence during the child care facility’s hours of operation, then the caregiver/teacher must arrange the residence so that the activities of these people do not occur in the area designated for child care.

TYPE OF FACILITY: Center

STANDARD 5.1.1.2: Inspection of Buildings

Newly constructed, renovated, remodeled, or altered buildings should be inspected by a public inspector to assure compliance with applicable building and fire codes before the building can be made accessible to children.

RATIONALE: Building codes are designed to ensure that a building is safe for occupants. Environmental health recommendations are designed to ensure the building and property are free of health hazards for children and workers.

COMMENTS: Any building not used for child care for a period of time should be inspected for compliance with applicable building and fire codes. Review of environmental health hazards by county or city public health environmental offices can help to meet safety requirements.

TYPE OF FACILITY: Center

STANDARD 5.1.1.3: Compliance with Fire Prevention Code

Every twelve months, the child care facility should obtain written documentation to submit to the regulatory licensing authority that the facility complies with a state-approved or nationally recognized Fire Prevention Code. If available, this documentation should be obtained from a fire prevention official with jurisdiction where the facility is located. Where fire safety inspections or a Fire Prevention Code applicable to child care centers is not available from local authorities, the facility should arrange for a fire safety inspection by an inspector who is qualified to conduct such inspections using the National Fire Protection Association’s NFPA 101: Life Safety Code.

RATIONALE: Regular fire safety checks by trained officials will ensure that a child care facility continues to meet all applicable fire safety codes. NFPA 101: Life Safety Code addresses child care facilities in two chapters devoted exclusively to this occupancy – chapter 16, “New Day-Care Occupancies” and chapter 17, “Existing Day-Care Occupancies” (1).

TYPE OF FACILITY: Center

REFERENCES:

1. National Fire Protection Association (NFPA). 2009. NFPA 101: Life Safety Code. 2009 ed. Quincy, MA: NFPA.

STANDARD 5.1.1.4: Accessibility of Facility

The facility should be accessible for children and adults with disabilities, in accordance with Section 504 of the Rehabilitation Act of 1973 and the Americans with Disabilities Act (ADA). Accessibility includes access to buildings, toilets, sinks, drinking fountains, outdoor play areas, meal and snack areas, and all classroom and therapy areas.

RATIONALE: Accessibility has been detailed in full, in Section 504 of the Rehabilitation Act of 1973. It is also a key component of the ADA, barring discrimination against anyone with a disability.

COMMENTS: Any facility accepting children with motor disabilities must be accessible to all children served. Small family home caregivers/teachers may be limited in their ability to serve such children, but are not precluded from doing so if there is a reasonable degree of compliance with this standard. Accommodation of adaptive equipment for all children should be made to ensure access to all activities of the care setting. Access to public and most private facilities is a key to the implementation of the ADA. If toilet learning/training is a relevant activity, the facility may be required to provide adapted toilet equipment.

For more information on requirements regarding accessibility, consult the Americans with Disabilities Act Accessibility Guidelines for Buildings and Facilities (ADAAG), available at http://www.access-board.gov/adaag/html/adaag.htm, and the U.S. Access Board’s play area accessibility guidelines at http://www.access-board.gov/play/guide/intro.htm.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

STANDARD 5.1.1.5: Environmental Audit of Site Location

An environmental audit should be conducted before construction of a new building; renovation or occupation of an older building; or after a natural disaster, to properly evaluate and, where necessary, remediate or avoid sites where children’s health could be compromised (1,3).

The environmental audit should include assessments of:

Potential air, soil, and water contamination on child care facility sites and outdoor play spaces;
Potential toxic or hazardous materials in building construction; and
Potential safety hazards in the community surrounding the site.

A written environmental audit report that includes any remedial action taken should be kept on file.

RATIONALE: Evaluation of potential health and safety risks associated with the physical site location of a child care facility will identify any remedial action required or whether the site should be avoided if children’s health could be compromised.

Children are much more vulnerable to exposures of contaminated environmental media materials than adults because their bodies are developing; they eat more, drink more, and breathe more in proportion to their body size; and their behavior, such as crawling and hand-to-mouth activity, can expose them more to chemicals (4).

Awareness of remedial action required or sites to avoid will reduce exposure to conditions that cause injury or adversely affect health.

Epidemiological studies indicate a relationship between outdoor air pollution and adverse respiratory effects on children (2). Research suggests that exposure to air pollution is a function of proximity to roadways (5-7).

The soil in play areas should not contain hazardous levels of any toxic chemical or substance. Soil contaminated with toxic materials can poison children. For example, ensuring that soil in play areas is free of dangerous levels of lead helps prevent lead poisoning (8-10).

Existing buildings may contain potentially toxic or hazardous construction materials (e.g., lead paint, asbestos) that may be released during renovation work. Assessing the presence of such materials enables the management of potential exposures through removal, containment, or by other means (11).

COMMENTS: Potential safety hazards in the community surrounding the site location of a child care facility may include:

Proximity to hazardous industrial air emissions;
Proximity to toxic or hazardous substances in adjacent or nearby property;
Proximity to transportation hazards (e.g., local automobile traffic, major roadways, airports, railroads);
Proximity to utilities (e.g., drinking water reservoirs or storage tanks, electrical sub-stations, high-voltage power transmission lines, pressurized gas transmission lines);
Proximity to explosive or flammable products (e.g., propane tanks).

Possible options for reducing exposure to potential safety hazards in the community may include:

Locating the site of a child care facility at a safe distance from the hazard; and/or
Providing a physical barrier to prevent children from being exposed to the safety hazards (e.g., fencing).

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. Etzel, R. A., S. J. Balk, eds. 2004. Pediatric environmental health. 2nd ed. Elk Grove Village, IL: American Academy of Pediatrics.

2. American Academy of Pediatrics, Committee on Environmental Health. 2004. Policy statement: Ambient air pollution: Health hazards to children. Pediatrics 114:1699-1707.

3. U.S. Environmental Protection Agency. 2010. Siting of school facilities. http://cfpub.epa.gov/schools/top_sub.cfm?t_id=45&s_id=64/.

4. U.S. Environmental Protection Agency. Human health risk assessment. http://www.epa.gov/risk/health-risk.htm.

5. Boothe V. L., D. G. Shendell. 2008. Potential health effects associated with residential proximity to freeways and primary roads: Review of scientific literature, 1999-2006. J Environmental Health 70:33-41, 55-56.

6. Zhou Y., J. I. Levy. 2007. Factors influencing the spatial extent of mobile source air pollution impacts: A meta-analysis. BMC Public Health 7:89. http://www.biomedcentral.com/content/pdf/
1471-2458-7-89.pdf.

7. Zhua Y., W. C. Hinds, S. Kim, S. Shen, C. Sioutas. 2002. Study of ultrafine particles near a major highway with heavy-duty diesel traffic. Atmospheric Environment 36:4323–35.

8. U.S. Environmental Protection Agency. 2010. The lead-safe certified guide to renovate right. http://www.epa.gov/lead/pubs/renovaterightbrochure.pdf.

9. Burke, P., J. Ryan. 2001. Providing solutions for a better tomorrow: Reducing the risks associated with lead in soil. Washington, DC: U.S. Environmental Protection Agency. http://www.epa.gov/nrmrl/pubs/600f01014/600f01014.pdf.

10. Centers for Disease Control and Prevention (CDC). 2005. Preventing lead poisoning in young children. Atlanta, GA: CDC. http://www.cdc.gov/nceh/lead/publications/prevleadpoisoning.pdf.

11. Fiene, R. 2002. 13 indicators of quality child care: Research update. Washington, DC: U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation. http://aspe.hhs.gov/hsp/ccquality-ind02/.

STANDARD 5.1.1.6: Structurally Sound Facility

Every exterior wall, roof, and foundation should be structurally sound, weather-tight, and water-tight to ensure protection from weather and natural disasters.

Every interior floor, wall, and ceiling should be structurally sound and should be finished in accordance with local building codes to control exposure of the occupants to levels of toxic fumes, dust, and mold.

RATIONALE: Both the design of structures and the lack of maintenance can lead to exposure of children to physical injury, mold, dust, pests, and toxic materials (1).

COMMENTS: Child care operations sometimes use older buildings or buildings designed for purposes other than child care.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. Whole Building Design Guide Secure/Safe Committee. 2010. Ensure occupant safety and health. National Institute of Building Sciences. http://www.wbdg.org/design/ensure_health.php.

STANDARD 5.1.1.7: Use of Basements and Below Grade Areas

Finished basements or areas that are partially below grade may be used for children who independently ambulate and who are two years of age or older, if the space is in compliance with applicable building and fire codes. Environmental health factors may be reviewed with county or city public health departments.

RATIONALE: Basement and partially below grade areas can be quite habitable and should be usable as long as building, fire safety (1), and environmental quality is satisfactory.

COMMENTS: To “independently ambulate” means that children are able to walk from place to place with or without the use of assistive devices.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. National Fire Protection Association (NFPA). 2009. NFPA 101: Life Safety Code. 2009 ed. Quincy, MA: NFPA.

STANDARD 5.1.1.8: Buildings of Wood Frame Construction

Infants and toddlers should be housed and cared for only on the ground floor in buildings of wood frame construction. Preschool-age and school-age children should be able to use floors other than the ground floor in a building of wood construction if the building has required exits and care is provided in:

A daylight-lit basement with exits that are no more than a half flight high;
A tri-level facility with half flights of stairs;
A facility that is protected throughout by an automatic sprinkler system, which has its exit stairs enclosed by minimum one-hour fire barriers with openings in those barriers protected by minimum one-hour fire doors;
Any door encountered along the egress route should be easy for caregivers/teachers and older preschool-age children to open.

RATIONALE: Fire and building safety experts recommend that children be permitted above ground level only in buildings of wood construction with certain exceptions (1).

COMMENTS: Infants and toddlers should always be on the main floor with access directly to the outdoors. Doors along the egress route need to be easy to open. Consult local or state fire safety codes and child care licensing laws for restrictions on floor occupancy by age groups.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. National Fire Protection Association (NFPA). 2009. NFPA 101: Life Safety Code. 2009 ed. Quincy, MA: NFPA.

STANDARD 5.1.1.9: Unrelated Business in a Child Care Area

Child care areas should not be used for any business or purpose unrelated to providing child care when children are present in these areas.

If unrelated business is conducted in child care areas when the child care facility is not in operation, activities associated with such business should not leave any residue in the air or on the surfaces, or leave behind materials or equipment, that could be harmful to children.

RATIONALE: Some activities that leave a harmful residue are smoking, ammunition reloading, soldering, woodworking, and welding (1). Examples of materials or equipment that could be harmful are small screws, nails, and electric tools with sharp blades. Child care requires child-oriented, child-safe areas where the child’s needs are primary.

COMMENTS: Employers should inform caregivers/teachers about harmful residues or equipment that may potentially remain from unrelated business activity so that such residues or equipment can be removed.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. U.S. Environmental Protection Agency, U.S. Consumer Product Safety Commission. 2010. The inside story: A guide to indoor air quality. http://www.epa.gov/iaq/pubs/insidest.html.

STANDARD 5.1.1.10: Office Space

Office space separate from child care areas should be provided for administration and staff in centers. Children should not have access to this area unless they are supervised by staff.

RATIONALE: For the efficient and effective operation of a center, office areas where activities incompatible with the care of young children are conducted should be separate from child care areas. These office areas can be expected to contain supplies, equipment and records/documents that should not be accessible to children. Office staff should be free from the distractions of child care (1,2).

COMMENTS: Child care staff should have access to an area that is separate from the child care areas where they can meet personal needs such as a break room, adult bathroom, resource library, etc.

TYPE OF FACILITY: Center

REFERENCES:

1. National Association for the Education of Young Children (NAEYC). 1977. Planning environments for young children. Washington, DC: NAEYC.

2. Murph, J. R., S. D. Palmer, D. Glassy, eds. 2005. Health in child care: A manual for health professionals. 4th ed. Elk Grove Village, IL: American Academy of Pediatrics.

STANDARD 5.1.1.11: Separation of Operations from Child Care Areas

Rooms or spaces that are used for the following activities or operations should be separated from the child care areas and the egress route should not pass through such spaces:

Commercial-type kitchen;
Boiler, maintenance shop;
Janitor closet and storage areas for cleaning products, pesticides, and other chemicals;
Laundry and laundering supplies;
Woodworking shop;
Flammable or combustible storage;
Painting operation;
Rooms that are used for any purpose involving the presence of toxic substances;
Area for medication storage.

Areas that have combustibles should be protected by fire-resistant barriers. The egress route and the fire-resistant separation should be approved by the appropriate regulatory agencies responsible for building and fire inspections. In small and large family child care homes, a fire-resistant separation should not be required where the food preparation kitchen contains only a domestic cooking range and the preparation of food does not result in smoke or grease-laden vapors escaping into indoor areas. Where separation is provided between the egress route and the hazardous area, it should be safe to use such route, but egress should not require passage through the hazardous area.

RATIONALE: Hazards and toxic substances must be kept separate in a locked closet or room from space used for child care to prevent children’s and staff members’ exposure to injury (1).

Cleaning agents must be inaccessible to children (out of reach and behind locked doors). Food preparation surfaces must be separate from diaper changing areas including sinks for handwashing. Children must be restricted from access to the stove when cooking surfaces are hot.

COMMENTS: In small family child care homes, mixed use of rooms is common (2). Some combined use of space for food preparation, storage of cleaning equipment and household tools, laundry, and diaper changing requires that each space within a room be defined according to its purpose and that exposure of children to hazards be controlled. Food preparation should be separate from all exposure to possible cross-contamination.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. National Fire Protection Association (NFPA). 2009. NFPA 101: Life Safety Code. 2009 ed. Quincy, MA: NFPA.

2. Olds, A. R. 2001. Child care design guide. New York: McGraw-Hill.

STANDARD 5.1.1.12: Multiple Use of Rooms

Playing, eating, and napping may occur in the same area (exclusive of diaper changing areas, toilet rooms, kitchens, hallways, and closets), provided that:

The room is of sufficient size to have a defined area for each of the activities allowed there at the time the activity is under way;
The room meets other building requirements;
Programming is such that use of the room for one purpose does not interfere with use of the room for other purposes.

RATIONALE: Except for toilet and diaper changing areas, which must have no other use, the use of common space for different activities for children facilitates close supervision of a group of children, some of whom may be involved simultaneously in more than one of the activities listed in the standard (1).

COMMENTS: Compliance is measured by direct observation.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. Olds, A. 2001. Zoning a group room. In Child care design guide, 137-65. New York: McGraw-Hill.

5.1.2 Space per Child

STANDARD 5.1.2.1: Space Required per Child

In general, the designated area for children’s activities should contain a minimum of forty-two square feet of usable floor space per child. A usable floor space of fifty square feet per child is preferred.

This excludes floor area that is used for:

Circulation (e.g., walkways around the activity area);
Classroom support (e.g., staff work areas and activity equipment storage that may be adjacent to the activity area);
Furniture (e.g., bookcases, sofas, lofts, block corners, tables and chairs);
Center support (e.g., administrative office, washrooms, etc.)

Usable, indoor floor space for the children’s activity area depends on the design and layout of the child care facility, and whether there is an opportunity and space for outdoor activities.

RATIONALE: Numerous studies have explored child care space requirements that are necessary to:

Provide an environment that is highly functional for program delivery and to encourage strong, positive staff-to-child relationships;
Accommodate the recommended group size and staff-to-child ratio; and
Efficiently use space and incorporates ease of supervision.
Recommendations from research studies range between forty-two to fifty-four square feet per child (1).

Studies have shown that the quality of the physical designed environment of early child care centers is related to children’s cognitive, social, and emotional development (e.g., size, density, privacy, well-defined activity settings, modified open-plan space, a variety of technical design features and the quality of outdoor play spaces). In addition to meeting the needs of children, caregivers/teachers require space to implement programs and facilitate interactions with children.

A review of the literature indicates that in the past ten years, there has been growing research and study into how the physical design of child care settings affects child development. Historically, a standard of thirty-five square feet was used. Recommendations from research studies range between forty-two to fifty-four square feet per child. Comments from researchers indicate that other factors must also be considered when assessing the context of usable floor space for child care activities (1,5-8).

Although each child’s development is unique to that child, age groups are often used to categorize developmental needs. To meet these needs, the use of activity space for each age group will be inherently different.

Child behavior tends to be more constructive when sufficient space is organized to promote developmentally appropriate skills. Crowding has been shown to be associated with increased risk of developing upper respiratory infections (2). Also, having sufficient space will reduce the risk of injury from simultaneous activities.

Children with special health care needs may require more space than typically developing children (1).

COMMENTS: The usable floor space for children’s activities in this standard refers to indoor space that is used as the primary play space. Consideration should also be given to the presence or absence of secondary indoor play space that might be shared between programs as well as to outdoor play space.

Staff-child ratios (i.e., the number of staff required per number of children) should also be taken into account since staff consumes floor area space as well as children. Group size for various age groups should also be considered. Since groups of infants are smaller than groups of preschoolers, “infant and toddler rooms tend to be small, while preschool and school-age rooms are a bit generous at full capacity” (1). Infant and toddler rooms often dedicate a considerable amount of inflexible space to cribs and diaper changing areas. Sufficient space to accommodate these activities, space for adult seating to care for infants, and space for safe mobility of infants and toddlers requires that the per child square foot requirements are applied for their areas also.

Square footage estimates should only be intended as guidelines. Especially in child care facilities with fewer than fifty children, “plugging in” the square footage into a formula to calculate space required usually does not work (1).

It is important to keep in mind that state licensing regulations specify minimum space requirements and that they must be legally adhered to. Such requirements vary from state to state (3). For Federal child care centers, the U.S. General Services Administration’s (GSA) child care design standards require a minimum of forty-eight and one-half square feet per child in the classroom (4).

Although providing adequate space for implementing a program of activities that meets the developmental needs of children is important in providing quality child care, how that space is actually used is likely more critical (8). It has been observed that child care facilities operating in older buildings with less than ideal space can still deliver quality child care programs to meet the needs of children. Nevertheless, the amount of activity space required per child should take the known research into consideration.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. Olds, A. R. 2001. Child care design guide. New York: McGraw-Hill.

2. Fleming, D. W., S. L. Cochi, A. W. Hightower, et al. 1987. Childhood upper respiratory tract infections: To what degree is incidence affected by daycare attendance? Pediatrics 79:55-60.

3. National Child Care Information and Technical Assistance Center and the National Association for Regulatory Administration. 2009. The 2007 licensing child care study. http://www.naralicensing.org/associations/4734/files/2007 Licensing Study_full_report.pdf.

4. U.S. General Services Administration (GSA). 2003. Child care center design guide. New York: GSA Public Buildings Service, Office of Child Care. http://www.gsa.gov/graphics/pbs/designguidesmall.pdf.

5. Beach J., M. Friendly. 2005. Child care centre physical environments. Working Documents, Child Care Resource and Research Unit. http://www.childcarequality.ca/wdocs/QbD
_PhysicalEnvironments.pdf.

6. Moore, G. T., T. Sugiyama, L. O’Donnell. 2003. Children’s physical environments rating scale. Paper presented at the Australian Early Childhood Education 2003 Conference, Hobart, Australia. http://sydney.edu.au/architecture/documents/ebs/AECA_2003_paper.pdf.

7. White, R., V. Stoecklin. 2003. The great 35 square foot myth. http://www.whitehutchinson.com/children/articles/
35footmyth.shtml.
8. The Family Child Care Accreditation Project, Wheelock College. 2005. Quality standards for NAFCC accreditation. 4th ed. Salt Lake City, UT: National Association for Family Child Care. http://www
.nafcc.org/documents/QualStd.pdf.

STANDARD 5.1.2.2: Floor Space Beneath Low Ceiling Heights

In a room where the entire ceiling height is less than seven and a half feet above the floor, the floor area should not be counted in determining compliance with the space requirements specified in Standard 5.1.2.1.

In a room where the ceiling is at different levels at least two-thirds of the usable floor area should have a ceiling height of at least seven and one-half feet and one-third of the usable floor area should have a ceiling height of greater than six feet eight inches. Floor areas beneath ceiling heights less than six-feet eight-inches tall should not be considered (1).

RATIONALE: Ceiling height must be adequate for caregivers/teachers to supervise and reach children who require assistance.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. National Fire Protection Association (NFPA). 2009. NFPA 101: Life Safety Code. 2009 ed. Quincy, MA: NFPA.

STANDARD 5.1.2.3: Areas for School-Age Children

When school-age children are in care for periods that exceed two hours before or after school, a separate area away from areas for younger children should be available for school-age children to do homework. Areas used for this purpose should, in addition to meeting the other facility standards have:

Table space;
Chairs;
Adequate ventilation;
Lighting of 40 to 50 foot-candles in the room;
Lighting of 50 to 100 foot-candles on the surface used as a desk (1).

RATIONALE: School-age children need a quiet space for reading and to do homework so they are not forced to work against the demands for attention that younger children pose. In family child care homes such an area might be within the same room and separated by a room dividing arrangement of furniture.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

5.1.3 Openings

STANDARD 5.1.3.1: Weather-Tightness and Water-Tightness of Openings

Each window, exterior door, and basement or cellar hatchway should be weather-tight and water-tight when closed.

RATIONALE: Children’s environments must be protected from exposure to moisture, dust, and temperature extremes.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

STANDARD 5.1.3.2: Possibility of Exit from Windows

All windows in areas used by children under five years of age should be constructed, adapted, or adjusted to limit the exit opening accessible to children to less than four inches, or be otherwise protected with guards that prevent exit by a child, but that do not block outdoor light. Where such windows are required by building or fire codes to provide for emergency rescue and evacuation, the windows and guards, if provided, should be equipped to enable staff to release the guard and open the window fully when evacuation or rescue is required. Opportunities should be provided for staff to practice opening these windows, and such release should not require the use of tools or keys. Children should be given information about these windows, relevant safety rules, as well as what will happen if the windows need to be opened for an evacuation.

RATIONALE: To prevent children from falling out of windows, standards from the U.S. Consumer Product Safety Commission (CPSC) and the ASTM International (ASTM) require the opening size to be four inches to prevent the child from getting through or the head from being entrapped (1,2). Some children may be able to pass their body through a slightly larger opening but then get stuck and hang from the window opening with their head trapped inside. Caregivers/teachers must not depend on screens to keep children from falling out of windows. Windows to be used as fire exits must be immediately accessible. Staff should supervise children when they are near these windows, and incorporate safety information and relevant emergency procedures and drills into their day-to-day curriculum so that children will better understand the safety issues and what will happen if they need to leave the building through the windows.

COMMENT: “Screens” are intended to prevent flying insects from coming into the facility whereas window “guards” are the type of devices commonly used to provide building security and prevent intruders.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. U.S. Consumer Product Safety Commission (CPSC). 2000. New standards for window guards to help protect children from falls. Release #00-126. Washington, DC: CPSC. http://www.cpsc.gov/CPSCPUB/PREREL/prhtml00/00126.html.

2. ASTM International. ASTM F2090-08 Standard specification for window fall prevention devices with emergency escape (egress) release mechanisms. West Conshohocken, PA: ASTM.

STANDARD 5.1.3.3: Screens for Ventilation Openings

All openings used for ventilation should be screened against insect entry.

RATIONALE: Screens prevent the entry of insects, which may bite, sting, or carry disease.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

STANDARD 5.1.3.4: Safety Guards for Glass Windows/Doors

Glass windows and glass door panels within thirty-six inches of the floor should have safety guards (such as rails or mesh) or be of safety-grade glass or polymer and equipped with a vision strip.

RATIONALE: Glass panels can be invisible to an active child or adult (1). When a child collides with a glass panel, serious injury can result from the collision impact or the broken glass.

COMMENTS: In areas where glass windows are repeatedly broken, installation of polymer material should be considered.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. International Code Council (ICC). 2009. 2009 international building code. Washington, DC: ICC.

STANDARD 5.1.3.5: Finger-Pinch Protection Devices

Finger-pinch protection devices should be installed wherever doors, cupboards/cabinets, and gates are accessible to children. These devices include:

Flexible plastic and rubber devices that cover the gap created at the front and rear hinge-sides of a door or gate when it is opened;
Other types of flexible coverings for these gaps;
Adjustable door closing devices that slow the rate of door closing. Slowing the door closing rate helps prevent finger pinching in the latch area of the door or abrupt closing of the door against a small child.

RATIONALE: Finger-pinch injuries in doors are a significant cause of injury among claims against liability insurance in child care. Closing doors and gates create significant exposure to children for bruised, cut, or smashed fingers, torn or cracked fingernails, broken bones, and even amputations. Finger-pinch injuries happen very quickly, often before staff can react. Finger-pinch protection devices ensure that this type of injury does not occur.

COMMENTS: A child doesn’t have to pass through a door or gate to acquire a finger-trapping injury. A child can be on the outside of one of these doors and still get their fingers trapped while it is being closed. Young children are vulnerable to injury when they fall against the rear hinge-side of doors and gates, striking the projecting hinges. The installation of rear finger-pinch protection devices will eliminate this problem, too (1). Piano hinges are not recommended to alleviate this problem as they tend to sag over time with heavy use.

Costs of these devices vary significantly, as do method and extent of protection, product durability and warranty; the different products may not provide equally suitable protection. Whatever hardware is selected should prevent (not just discourage) the entry of a finger into the danger zone from both sides of the door or gate and should protect the door or gate through the full extent of its swing (i.e., it should be capable of protecting doors and gates that open 180 degrees). Attachment should use screws rather than glue for a stronger, more durable connection.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. Moseley, G. 2008. Closing the door on finger injuries. Doors and Hardware 72:38-41.

STANDARD 5.1.3.6: Directional Swing of Indoor Doors

Doors, other than exit stair enclosure doors, from a building area with fewer than fifty persons should swing in the direction of most frequent travel. Doors from a building area with more than fifty persons and exit stair enclosure doors should swing in the direction of egress travel (the path for going out). An exception is that boiler room doors should swing into the room.

RATIONALE: Proper door swings provide easy, quick passage and prevent injuries. Boiler room doors should swing inward to help contain explosions.

The NFPA 101: Life Safety Code from the National Fire Protection Association (NFPA), and the model building codes in wide use throughout the United States, require that doors serving an area with fifty or more persons swing in the direction of egress travel (1). This is important because large numbers of persons might push against each other leaving those up against a door without the ability to step back and allow the door to swing back into the room.

COMMENTS: Doors in homes usually open inward. The requirement for door swing may be addressed in local building codes.

TYPE OF FACILITY: Center

REFERENCES:

1. National Fire Protection Association (NFPA). 2009. NFPA 101: Life Safety Code. 2009 ed. Quincy, MA: NFPA.

5.1.4 Exits

STANDARD 5.1.4.1: Alternate Exits and Emergency Shelter

Each building or structure, new or old, should be provided with a minimum of two exits, at different sides of the building or home, leading to an open space at ground level. If the basement in a small family child care home is being used, one exit must lead directly to the outside. Exits should be unobstructed, allowing occupants to escape to an outside door or exit stair enclosure in case of fire or other emergency. Each floor above or below ground level used for child care should have at least two unobstructed exits that lead to an open area at ground level and thereafter to an area that meets safety requirements for a child care indoor or outdoor area. Children should remain there until their parents/guardians can pick them up, if reentry into the facility is not possible.

Entrance and exit routes should be reviewed and approved by the applicable fire inspector. Exiting should meet all the requirements of the current edition of the NFPA 101: Life Safety Code from the National Fire Protection Association (NFPA).

RATIONALE: Unobstructed exit routes are essential for prompt evacuation. The purpose of having two ways to exit when child care is provided on a floor above or below ground level is to ensure an alternative exit if fire blocks one exit (1).

COMMENTS: Using an outdoor playground as a safe place to exit to may not always be possible. Where the playground is fully surrounded by fencing, it is important that a gate that staff is trained, authorized, and equipped to open, be provided to permit travel away from the building should fire expose children and staff to radiant heat and smoke. Some authorities will permit a fenced area with sufficient accumulation space at least fifty feet from the building to serve in lieu of a gated opening. Some child care facilities do not have a playground located adjacent to the child care building and use local parks as the playground site. Access to these parks may require crossing a street at an intersection with a crosswalk. This would normally be considered safe, especially in areas of low traffic; however, when sirens go off, a route that otherwise may be considered safe becomes chaotic and dangerous. During evacuation or an emergency, children, as well as staff, become excited and may run into the street when the playground is not fenced or immediately adjacent to the center (1).

In the event of a fire, staff members and children should be able to get at least fifty feet away from the building or structure. If the children cannot return to their usual building, a suitable shelter containing all items necessary for child care must be available where the children can safely remain until their parents/guardians come for them. An evacuation plan should take into consideration all available open areas to which staff and children can safely retreat in an emergency (1).

For information about the NFPA 101: Life Safety Code, contact the NFPA.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. National Fire Protection Association (NFPA). 2009. NFPA 101: Life Safety Code. 2009 ed. Quincy, MA: NFPA.

STANDARD 5.1.4.2: Evacuation of Children with Special Health Care Needs and Children with Disabilities

In facilities that include children who have physical disabilities or other developmental disabilities, all exits and steps necessary for evacuation should have ramps approved by the local building inspector and be clearly marked or identified. Children who have ambulatory difficulty, mobility limitations or impairments, use wheelchairs or other equipment that must be transported with the child (such as an oxygen ventilator) should be located on the ground floor of the facility or provisions should be made for efficient emergency evacuation to a safe sheltered area. Children who have special medical or dietary needs should have their medical equipment brought along during an evacuation.

RATIONALE: The facility must meet building code standards for the community and also the requirements under the Americans with Disabilities Act (ADA) and their access guidelines (1). All children must be able to exit the building quickly in case of emergency. Locating children in wheelchairs or those with special equipment on the ground floor may eliminate the need for transporting these children down the stairs during an emergency evacuation. In buildings where the ground floor cannot be used for such children, arrangements must be made to move children to a safe location, such as a fire tower stairwell, during an emergency exit. Children with diabetes, asthma, or special medical diets may need medication or special foods brought along during an evacuation.

COMMENTS: Assuring physical access to a facility also requires that a means of evacuation meeting safety standards for exit accommodates any children with special health care needs in care.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. U.S. Architectural and Transportation Barriers Compliance Board (Access Board). 2002. Americans with disabilities act accessibility guidelines for buildings and facilities (ADAAG). http://www.access
-board.gov/adaag/ADAAG.pdf.

STANDARD 5.1.4.3: Path of Egress

The minimum width of any path of egress should be thirty-six inches. An exception is that doors should provide a minimum clear width of thirty-two inches. The width of doors should accommodate wheelchairs and the needs of individuals with physical disabilities.

Where exits are not immediately accessible from an open floor area, safe and continuous passageways, aisles, or corridors leading to every exit should be maintained and should be arranged to provide access for each occupant to at least two exits by separate ways of travel. Doorways, exit access paths, passageways, corridors and exits should be kept free of materials, furniture, equipment and debris to allow unobstructed egress travel from inside the child care facility to the outside.

RATIONALE: Unobstructed access to exits is essential to prompt evacuation (1). The hallways and door openings must be wide enough to permit easy exit in an emergency. The actual exit is the enclosed stair or the actual door to the outside; doors from most rooms and the travel along a corridor are considered exit access or the path of egress. The NFPA 101: Life Safety Code from the National Fire Protection Association (NFPA) permits the usual thirty-six inches minimum to be reduced to a clear opening of thirty-two inches for doors (1). This is consistent with Americans with Disabilities Act Accessibility Guidelines for Buildings and Facilities (ADAAG) as it affords enough width for a person in a wheelchair to maneuver through the door opening (2).

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. National Fire Protection Association (NFPA). 2009. NFPA 101: Life Safety Code. 2009 ed. Quincy, MA: NFPA.

2. U.S. Architectural and Transportation Barriers Compliance Board (Access Board). 2002. Americans with disabilities act accessibility guidelines for buildings and facilities (ADAAG). http://www
.access-board.gov/adaag/ADAAG.pdf.

STANDARD 5.1.4.4: Locks

In centers, no door should have a lock or fastening device that prevents free egress from the interior. Free egress means that building occupants, without the use of a tool, key or special knowledge are able to operate the door, under all lighting conditions, using not more than one releasing operation. In all child care facilities, all door hardware in areas that school-age children use should be within the reach of the children. In centers, doors serving areas with more than 100 occupants should be permitted to be latched only if provided with panic hardware (latch release hardware that can be opened by pressure in the direction of travel).

In large or small family child day care homes, a double-cylinder deadbolt lock which requires a key to unlock the door from the inside should not be permitted on any door along the escape path from any child care except the exterior door, and then only if the key required to unlock the door is kept hanging at the door.

If emergency exits lead to potentially unsafe areas for children (such as a busy street), alarms or other signaling devices should be installed on these exit doors to alert the staff in case a child attempts to leave. An alarm or signaling system should also be in place in the case of a child with special behavior support needs who poses a risk for running out of a room or building.

RATIONALE: Children, as well as staff members, must be able to evacuate a building in the event of a fire or other emergency. Nevertheless, the caregiver/teacher must assure security from intruders and from unsupervised use of the exit by children.

COMMENTS: Double-cylinder deadbolt locks that require a key to unlock the door from the inside are often installed in private homes for added security. In such situations, these dead bolt locks should be present only on exterior doors and should be left in the unlocked position during the hours of child care operation. Locks that prevent opening from the outside, but can be opened without a key from the inside should be used for security during hours of child care operation. Double cylinder deadbolt locks should not be used on interior doors, such as closets, bathrooms, storage rooms, and bedrooms (1).

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. National Fire Protection Association (NFPA). 2009. NFPA 101: Life Safety Code. 2009 ed. Quincy, MA: NFPA.

STANDARD 5.1.4.5: Closet Door Latches

Closet doors accessible to children should have an internal release for any latch so a child inside the closet can open the door.

RATIONALE: Closet doors that can be opened from the inside prevent entrapment (1).

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. National Fire Protection Association (NFPA). 2009. NFPA 101: Life Safety Code. 2009 ed. Quincy, MA: NFPA.

STANDARD 5.1.4.6: Labeled Emergency Exits

In centers, required exits should be clearly identified and visible at all times during operation of the child care facility. The exits for egress should be arranged or marked so the path to safety outside is unmistakable.

RATIONALE: As soon as children can learn to recognize exit signs and pathway markings, they will benefit from having these paths of egress clearly marked. Adults who come into the building as visitors need these markings to direct them as well (1).

TYPE OF FACILITY: Center

REFERENCES:

1. National Fire Protection Association (NFPA). 2009. NFPA 101: Life Safety Code. 2009 ed. Quincy, MA: NFPA.

STANDARD 5.1.4.7: Access to Exits

Each room of a child care facility should be provided with direct access to:

An exit to the outside; or
A corridor or hallway providing direct access to an exit to the outside.

Where it is necessary to pass through an adjacent room for access to a corridor or exit, any doors providing passage to and through such room should not be latched or locked, or otherwise barricaded, to prevent access.

No obstructions should be placed in the corridors or passageways leading to the exits.

RATIONALE: A room that requires exit through another room to get to an exit path can entrap its occupants when there is a fire or emergency condition if passage can be impeded by a barrier or door that is latched (1).

An obstruction in the path of exit can lead to entrapment, especially in an emergency situation where groups of people may be exiting together.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. National Fire Protection Association (NFPA). 2009. NFPA 101: Life Safety Code. 2009 ed. Quincy, MA: NFPA.

5.1.5 Steps and Stairs

STANDARD 5.1.5.1: Balusters

Protective handrails and guardrails should have balusters/spindles at intervals of less than three and a half inches or have sufficient protective material to prevent a three and a half inch sphere from passing through if caring for children two years and over. If caring for children under the age of two years, balusters/spindles should be spaced at intervals less than two and three-eighths inches or have sufficient protective material to prevent a sphere with a diameter of two and three-eighths inches from passing through.

RATIONALE: A child’s head may be small enough to be entrapped in a space more than three and a half inches wide (1). Infants and young toddlers may crawl or play close to railings around stairs. Because they may have access to railings, it is recommended to follow the same recommendation for the spacing of balusters/spindles for stair railings as the slats on a crib.

COMMENTS: Building codes vary from state to state and many regulations for balusters/spindles do not meet the recommendations for intervals less than three and a half inches. Some building codes are for intervals of four inches or greater. Because of this discrepancy and the expense of adding balusters/spindles, using a protective material may be the only option. Recommendations as stated above should be considered for remodeling or new construction.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. U.S. Consumer Product Safety Commission (CPSC). 2008. Public playground safety handbook. Bethesda, MD: CPSC. http://www
.cpsc.gov/cpscpub/pubs/325.pdf.

STANDARD 5.1.5.2: Handrails

Handrails should be provided on both sides of stairways, be securely attached to the walls or stairs, and at a maximum height of thirty-eight inches.

The outside diameter of handrails should be between one and one-quarter inches and two inches.

When railings are installed on the side of stairs open to a stairwell, access to the stairwell should be prevented by a barrier so a child cannot use the railings as a ladder to jump or fall into the stairwell.

RATIONALE: Model codes, including the National Fire Protection Association’s NFPA 101: Life Safety Code, require handrails to be mounted in the height range of thirty-four to thirty-eight inches (1). Such handrails are equally usable by children. The stair researcher, Jake Pauls, has filmed small children effectively using handrails mounted as high as thirty-eight inches. This comes naturally to the children because they are used to reaching up to take an adult’s hand while walking. There is no justification for forcing the center or home to incur the added expense of installing a second set of handrails closer to the floor.

Railings on both sides ensure a readily available handhold (whether right handed or left handed) in the event of a fall down the stairs. When handrails are installed to allow children a handhold, the stairwell should be designed so the railing does not provide the child with a ladder to climb.

COMMENTS: Open stairwells can be enclosed with rigid vertical materials to prevent children from climbing and falling over the rail. Handrails are for purposes of providing a graspable rail for help in arresting falls on stairs. Guards are for purposes of preventing falls over an open side where there is more than thirty inches vertical distance to fall.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. National Fire Protection Association (NFPA). 2009. NFPA 101: Life safety code. 2009 ed. Quincy, MA: NFPA.

STANDARD 5.1.5.3: Landings

Landings should be provided beyond each interior and exterior door that opens onto a stairway. Landing width should not be less than the width of stairway it serves and must be at least the width of stairway in direction of travel, but need not be more than forty-eight inches. When fully open, the door should not project more than seven inches into the landing. Dimensions (length and width) of the landing are equal to or greater than the width of the door.

RATIONALE: Landings are necessary to accommodate the swing of the door without pushing the person on the stairway into a precarious position while trying to leave the stairway (1).

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. International Code Council (ICC). 2009. 2009 international building code. Washington, DC: ICC.

STANDARD 5.1.5.4: Guards at Stairway Access Openings

Securely installed, effective guards (such as gates) should be provided at the top and bottom of each open stairway in facilities where infants and toddlers are in care. Gates should have latching devices that adults (but not children) can open easily in an emergency. “Pressure gates” or accordion gates should not be used. Gate design should not aid in climbing. Gates at the top of stairways should be hardware mounted (e.g., to the wall) for stability. Basement stairways should be shut off from the main floor level by a full door. This door should be self-closing and should be kept locked to entry when the basement is not in use. No door should be locked to prohibit exit at any time.

RATIONALE: Falls down stairs and escape upstairs can injure infants and toddlers. A gate with a difficult opening device can cause entrapment in an emergency (1).

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. U.S. Consumer Product Safety Commission (CPSC). Old accordion style baby gates are dangerous. http://www.cpsc.gov/CPSCPUB/PUBS/5085.pdf.

5.1.6 Exterior Areas

Note to Reader: See Chapter 6 for Outdoor Play Area Requirements

STANDARD 5.1.6.1: Designated Walkways, Bike Routes, and Drop-Off and Pick-Up Points

Safe pedestrian crosswalks, drop-off and pick-up points, and bike routes in the vicinity of the facility should be identified, written in the facility’s procedures, and communicated to all children, parents/guardians, and staff. Parking for drop-off and pick-up should not require street-side removal of children from a vehicle.

RATIONALE: In 2008, one-fifth (20%) of all children between the ages of five and nine who were killed in traffic crashes were pedestrians (1). Identification and communication of safe routes practices may reduce the potential of injuries resulting from children darting into traffic (2). Providing bike route information may encourage the use of this health-promoting, economical, and environmentally friendly mode of transportation.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. U.S. Department of Transportation, National Highway Traffic Safety Administration (NHTSA). 2008. Traffic Safety Facts 2008: Pedestrians. Washington, DC: NHTSA. http://www-nrd.nhtsa.dot.gov/Pubs/811163.PDF.

2. U.S. General Services Administration (GSA). 2003. Child care center design guide. New York: GSA Public Buildings Service, Office of Child Care. http://www.gsa.gov/graphics/pbs/designguidesmall.pdf.

STANDARD 5.1.6.2: Construction and Maintenance of Walkways

Inside and outside stairs, ramps, porches, and other walkways to the structure should be constructed for safe use as required by the local building code and should be kept in sound condition, well-lighted, and in good repair (1). Walkways must be cleared and maintained during inclement weather to prevent falls.

RATIONALE: Prevention of slipping and tripping hazards is key to preventing injuries from falls.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. Whole Building Design Guide Secure/Safe Committee. 2010. Ensure occupant safety and health. National Institute of Building Sciences. http://www.wbdg.org/design/ensure_health.php.

STANDARD 5.1.6.3: Drainage of Paved Surfaces

All paved surfaces should be well-drained to avoid accumulation of water and ice.

RATIONALE: Well-drained paved surfaces help prevent injury and deterioration of the surface by discouraging the accumulation of water and ice (1).

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. Whole Building Design Guide Secure/Safe Committee. 2010. Ensure occupant safety and health. National Institute of Building Sciences. http://www.wbdg.org/design/ensure_health.php.

STANDARD 5.1.6.4: Walking Surfaces

All walking surfaces, such as walkways, ramps, and decks, should have a non-slip finish and be free of loose material (e.g., gravel, sand), water, and ice. Sand may be used on walkways during ice and snow conditions.

All walking surfaces and other play surfaces should be free of holes and abrupt irregularities in the surface.

RATIONALE: Slippery and uneven walking surfaces can lead to injury even during activities of children and adults that do not involve play (1).

COMMENTS: An example of a non-slip finish is asphalt or asphalt with a covering of sand for icy walkways.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. Whole Building Design Guide Secure/Safe Committee. 2010. Ensure occupant safety and health. National Institute of Building Sciences. http://www.wbdg.org/design/ensure_health.php.

STANDARD 5.1.6.5: Areas Used by Children for Wheeled Vehicles

The area used by children for wheeled vehicles should have a flat, smooth, non-slippery surface. A physical barrier should separate this area from the following:

Traffic;
Streets;
Parking;
Delivery areas;
Driveways;
Stairs;
Hallways used as fire exits;
Balconies;
Pools and other areas containing water.

RATIONALE: Uneven or slippery riding surfaces can lead to injury (1). Physical separation from environmental obstacles is necessary to prevent potential collision, injuries, falls, and drowning.

TYPE OF FACILITY: Center

REFERENCES:

1. U.S. General Services Administration (GSA). 2003. Child care center design guide. New York: GSA Public Buildings Service, Office of Child Care. http://www.gsa.gov/graphics/pbs/designguidesmall.pdf.

STANDARD 5.1.6.6: Guardrails and Protective Barriers

Guardrails, a minimum of thirty-six inches in height, should be provided at open sides of stairs, ramps, and other walking surfaces (e.g., landings, balconies, porches) from which there is more than a thirty-inch vertical distance to fall. Spaces below the thirty-six inches height guardrail should be further divided with intermediate rails or balusters as detailed in the next paragraph.

For preschoolers, bottom guardrails greater than nine inches but less or equal to twenty-three inches above the floor should be provided for all porches, landings, balconies, and similar structures. For school age children, bottom guardrails should be greater than nine inches but less or equal to twenty inches above the floor, as specified above.

For infants and toddlers, protective barriers should be less than three and one-half inches above the floor, as specified above. All spaces in guardrails should be less than three and a half inches. All spaces in protective barriers should be less than three and one-half inches. If spaces do not meet the specifications as listed above, a protective material sufficient to prevent the passing of a three and one-half inch diameter sphere should be provided.

Where practical or otherwise required by applicable codes, guardrails should be a minimum of forty-two inches in height to help prevent falls over the open side by staff and other adults in the child care facility.

RATIONALE: Structures such as porches, landings, balconies, and other similar structures that are raised more than thirty inches above an adjacent ground or floor, pose increased risk for fall injuries. Spaces between three and one-half inches and nine inches are a head entrapment hazard (1).

Guardrails are designed to protect against falls from elevated surfaces, but do not discourage climbing or protect against climbing through or under. Protective barriers protect against all three and provide greater protection. Guardrails are not recommended to use for infants and toddlers; protective barriers should be used instead.

A top guardrail with a minimum height of forty-two inches serves the needs of all occupants – children as well as adults (2). The minimum thirty-six-inch guardrail height detailed in this standard is based solely on the needs of children.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. U.S. Consumer Product Safety Commission (CPSC). 2008. Public playground safety handbook. Bethesda, MD: CPSC. http://www
.cpsc.gov/cpscpub/pubs/325.pdf.

2. National Fire Protection Association (NFPA). 2009. NFPA 101: Life safety code. 2009 ed. Quincy, MA: NFPA.

STANDARD 5.1.6.7: Location of Satellite Dishes

A satellite dish should not be located within playgrounds or other areas accessible to children. If a satellite dish is on the premises, it should be surrounded by a fence (at least four feet high) that prevents children from climbing and gaining access to the satellite dish.

RATIONALE: Children are at risk for injury if they are allowed to climb on or play near satellite dishes. Natural barriers are not recommended due to the fact that they can change with seasons and weather, affecting the effectiveness of the barrier.

COMMENTS: Satellite dishes come in many sizes. Smaller diameter satellite dishes between eighteen to thirty inches are often mounted on a rooftop or the side of a building. Older, large six-foot diameter satellite dishes may be mounted on the ground.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. Olds, A. R. 2001. Child care design guide. New York: McGraw-Hill.

5.2 Quality of the Outdoor and Indoor Environment

5.2.1 Ventilation, Heating, Cooling, and Hot Water

STANDARD 5.2.1.1: Fresh Air

As much fresh outdoor air as possible should be provided in rooms occupied by children. Windows should be opened whenever weather and the outdoor air quality permits or when children are out of the room (1). When windows are not kept open, rooms should be ventilated, as specified in Standards 5.2.1.1-5.2.1.6. The specified rates at which outdoor air must be supplied to each room within the facility range from fifteen to sixty cubic feet per minute per person (cfm/p). The rate depends on the activities that normally occur in that room.

RATIONALE: The health and well-being of both the staff and the children can be greatly affected by indoor air quality. The air people breathe inside a building is contaminated with organisms shared among occupants and sometimes the indoor air is more polluted than the outdoor air. Young children may be affected more than adults by air pollution. Air quality significantly impacts people’s health. The health impacts from exposure to air pollution (indoor and outdoor) can include: decreased lung function, asthma, bronchitis, emphysema, and even some types of cancer. Children are particularly vulnerable to air pollution because their lungs are still developing and they breathe more air per pound of body weight than adults do. Indoor air pollution is often greater than outdoor levels of air pollution due to a general lack of adequate air filtration and ventilation (4). The presence of dirt, moisture, and warmth encourages the growth of mold and other contaminants, which can trigger allergic reactions and asthma (2). Children who spend long hours breathing contaminated or polluted indoor air are more likely to develop respiratory problems, allergies, and asthma (3-5).

Although insulation of a building is important in reducing heating or cooling costs, it is unwise to try to seal the building completely. Air circulation is essential to clear infectious disease agents, odors, and toxic substances in the air. Levels of carbon dioxide are an indicator of the quality of ventilation (6). Air circulation can be adjusted by a properly installed and adjusted heating, ventilation, air conditioning, and cooling (HVAC) system as well as by using fans and open windows.

COMMENTS: For further information on air quality and on ventilation standards related to type of room use, contact the American Society of Heating, Refrigerating, and Air-Conditioning Engineers (ASHRAE), the U.S. Environmental Protection Agency (EPA) Public Information Center, the American Gas Association (AGA), the Edison Electric Institute (EEI), the American Lung Association (ALA), the U.S. Consumer Product Safety Commission (CPSC), and the Safe Building Alliance (SBA).

For child care, ANSI/ASHRAE 62.1-2007 calls for 10 cfm/person plus 0.18 cfm/sq.ft. of space. ANSI/ASHRAE 62-1989 or ASHRAE Standard 55-2007 is information on Thermal Environmental Conditions for Human Occupancy.

Qualified engineers can ensure heating, ventilation, air conditioning (HVAC) systems are functioning properly and that applicable standards are being met. The American Society of Heating, Refrigerating, and Air-Conditioning Engineers (ASHRAE) Website (http://www.ashrae.org) includes the qualifications required of its members and the location of the local ASHRAE chapter. The contractor who services the child care HVAC system should provide evidence of successful completion of ASHRAE or comparable courses. Caregivers/teachers should understand enough about codes and standards to be sure the facility’s building is a healthful place to be.

Indoor air quality is important to children who have asthma. A checklist from the National Heart, Lung and Blood Institute, How Asthma Friendly is your Child Care Setting? (available at http://www.nhlbi.nih.gov/health/public/lung/asthma/chc_chk.pdf), can help caregivers/teachers create a more asthma-friendly environment.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. American Society of Heating, Refrigeration and Air-conditioning Engineers (ASHRAE), American Institute of Architects, Illuminating Engineering Society of North America, U.S. Green Building Council, U.S. Department of Energy. 2008. Advanced energy design guide for K-12 school buildings, 148. Atlanta, GA: ASHRAE.

2. U.S. Environmental Protection Agency. IAQ tools for schools program. http://www.epa.gov/iaq/schools/.

3. U.S. Environmental Protection Agency (EPA). 2008. Care for your air: A guide to indoor air quality. Washington, DC: EPA. http://www
.epa.gov/iaq/pdfs/careforyourair.pdf.

4. U.S. Environmental Protection Agency, Consumer Product Safety Commission. 2010. The inside story: A guide to indoor air quality. http://www.epa.gov/iaq/pubs/insidest.html.

5. American Lung Association, American Lung Association, U.S. Consumer Product Safety Commission, U.S. Environmental Protection Agency (EPA). 1994. Indoor air pollution: An introduction for health professionals. Cincinnati: EPA National Service Center for Environmental Publications. http://www.epa.gov/iaq/pdfs/indoor
_air_pollution.pdf.

6. Daneault, S., M. Beusoleil, K. Messing. 1992. Air quality during the winter in Quebec day-care centers. Am J Public Health 82:432-34.

STANDARD 5.2.1.2: Indoor Temperature

A draft-free temperature of 68°F to 75°F should be maintained at thirty to fifty percent relative humidity during the winter months. A draft-free temperature of 74°F to 82°F should be maintained at thirty to fifty percent relative humidity during the summer months (1,3). All rooms that children use should be heated and cooled to maintain the required temperatures and humidity.

RATIONALE: These requirements are based on the standards of the American Society of Heating, Refrigerating, and Air-Conditioning Engineers (ASHRAE), which take both comfort and health into consideration (1,3). High humidity can promote growth of mold, mildew, and other biological agents that can cause eye, nose, and throat irritation and may trigger asthma episodes in people with asthma (2). These precautions are essential to the health and well-being of both the staff and the children. When planning construction of a facility, it is healthier to build windows that open. Some people need filtered air that helps control pollen and other airborne pollutants found in raw outdoor air.

COMMENTS: Simple and inexpensive devices that measure the ambient relative humidity indoors may be purchased in hardware stores or toy stores that specialize in science products. The ASHRAE Website (http://www.ashrae.org) has a list of membership chapters, and membership criteria that help to establish expertise on which caregivers/teachers could rely in selecting a contractor.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. American Society of Heating, Refrigeration and Air-conditioning Engineers, American Institute of Architects, Illuminating Engineering Society of North America, U.S. Green Building Council, U.S. Department of Energy. 2008. Advanced energy design guide for K-12 school buildings, 148. Atlanta, GA: ASHRAE.

2. U.S. Environmental Protection Agency (EPA). 2008. Care for your air: A guide to indoor air quality. Washington, DC: EPA. http://www
.epa.gov/iaq/pdfs/careforyourair.pdf.

3. American Society of Heating, Refrigerating and Air-conditioning Engineers (ASHRAE). 2007. Standard 55-2007: Thermal conditions for human occupancy. Atlanta: ASHRAE.

STANDARD 5.2.1.3: Heating and Ventilation Equipment Inspection and Maintenance

All heating and ventilating equipment, including heaters, stoves used for heating (or furnaces), stovepipes, boilers, and chimneys, should be inspected and cleaned before each cooling and heating season by a qualified heating/air conditioning contractor, who should verify in writing that the equipment is properly installed, cleaned, and maintained to operate efficiently and effectively. The system should be operated in accordance with operating instructions and be certified that it meets the local building code by a representative of the agency that administers the building code. Documentation of these inspections and certification of safety should be kept on file in the facility.

RATIONALE: Routinely scheduled inspections and proper operation ensure that equipment is working properly. Heating equipment is the second leading cause of ignition in fatal house fires (1). Heating equipment that is kept in good repair is less likely to cause fires.

COMMENTS: Qualified engineers can ensure heating, ventilation, air conditioning (HVAC) systems are functioning properly and that applicable standards are being met. The American Society of Heating, Refrigerating, and Air-Conditioning Engineers (ASHRAE) Website (http://www.ashrae.org) includes the qualifications required of its members and the location of the local ASHRAE chapter. The contractor who services the child care HVAC system should provide evidence of successful completion of ASHRAE or comparable courses. Caregivers/teachers should understand enough about codes and standards to be sure the facility’s building is a healthful place to be.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. Chowdhury, R., M. Greene, D. Miller. 2008. 2003-2005 residential fire loss estimates. Washington, DC: U.S. Consumer Product Safety Commission. http://www.cpsc.gov/library/fire05.pdf.

STANDARD 5.2.1.4: Ventilation When Using Art Materials

Areas where arts and crafts activities are conducted should be well-ventilated. Materials that create toxic fumes or gases such as spray adhesives and paints should not be used when children are present. Material Safety Data Sheets (MSDS) should be obtained and kept for all chemicals used.

RATIONALE: Some art and craft supplies contain toxic ingredients, including possible human carcinogens, creating a significant risk to the health and well-being of children. Art supplies containing toxic chemicals can also produce fumes that trigger asthma, allergies, headaches, and nausea (1). Art and craft materials should conform to all applicable ACMI safety standards. Materials should be labeled in accordance with the chronic hazard labeling standard, ASTM D4236-94(2005) (1). Children in grade six and lower should only use non-toxic art and craft materials (1,2). Labels are required on art supplies to identify any hazardous ingredients, risks associated with their use, precautions, first aid, and sources of further information.

COMMENTS: Staff should be educated to the possibility that some children may have special vulnerabilities to certain art materials (such as children with asthma or allergies). Not allowing food and drink near supplies prevents the possible cross contamination of materials and reduces potential injuries from poisoning. For more information on poisoning, contact the poison center at 1-800-222-1222.

See the How Asthma Friendly is Your Child Care Setting? checklist at http://www.nhlbi.nih.gov/health/public/lung/asthma/chc_chk.pdf to learn more about creating an asthma-friendly indoor environment.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. Art and Creative Materials Institute. 2010. Safety - what you need to know. http://www.acminet.org/Safety.htm.

2. Art and Creative Materials Institute, Arts, Crafts, and Theater Safety, Inc., National Art Education Association, U.S. Consumer Product Safety Commission (CPSC). Art and craft safety guide. Bethesda, MD: CPSC. http://www.cpsc.gov/cpscpub/pubs/
5015.pdf.

STANDARD 5.2.1.5: Ventilation of Recently Carpeted or Paneled Areas

Doors and windows should be opened in areas that have been recently carpeted or paneled using adhesives until the odors are no longer present. Window fans, room air conditioners, or other means to exhaust emission to the outdoors should be used.

RATIONALE: Adhesives that contain toxic materials can cause significant symptoms in occupants of buildings where these materials are used. Many carpets contain polybrominated diphenyl ethers (PBDEs) to retard flames. PBDEs are associated with several adverse health effects in animal studies including changes in memory and learning, interference with thyroid function, endocrine disruption, and cancer (2). One study found that toddlers and preschoolers typically had three times more of these compounds in their blood as their mothers (1).

COMMENTS: Facilities should choose carpeting or other flooring options that are PBDE-free. Low-odor, water-based, non-toxic products should be encouraged.

For more information on “safe” levels of home indoor air pollutants, contact the U.S. Environmental Protection Agency (EPA) or the U.S. Consumer Product Safety Commission (CPSC).

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. Lunder, S., A. Jacob. 2008. Fire retardants in toddlers and their mothers: Levels three times higher in toddlers than moms. Environmental Working Group. http://www.ewg.org/reports/pbdesintoddlers/.

2. U.S. Environmental Protection Agency. Pollution prevention and toxics: Polybrominated diphenylethers (PBDEs). http://www
.epa.gov/oppt/pbde/.

STANDARD 5.2.1.6: Ventilation to Control Odors

Odors in toilets, bathrooms, diaper changing, and other inhabited areas of the facility should be controlled by ventilation and appropriate cleaning and disinfecting. Toilets and bathrooms, janitorial closets, and rooms with utility sinks or where wet mops and chemicals are stored should be mechanically ventilated to the outdoors with local exhaust mechanical ventilation to control and remove odors in accordance with local building codes. Chemical air fresheners or air sanitizers should not be used. Adequate ventilation should be maintained during any cleaning, sanitizing or disinfecting procedure to prevent children and caregivers/teachers from inhaling potentially toxic fumes.

RATIONALE: Chemical air fresheners and chemical air sanitizers may cause nausea or an allergic response in some children (2). Ventilation and sanitation help control and prevent the spread of disease and contamination. The Material Safety Data Sheet (MSDS) for every chemical product that the facility uses should be checked and available to anyone who uses or who might be exposed to the chemical in the child care facility to be sure that the chemical does not pose a risk to children and adults.

COMMENTS: The MSDS gives legally required information about the presence of Volatile Organic Compounds (VOCs) and the risk of exposure from all the chemicals in the product. The Occupational Safety and Health Administration (OSHA) requires the availability of the MSDS to the workers who use chemicals (1). In addition these sheets should be available to anyone who might be exposed to the chemical in the child care facility.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. U.S. Occupational Safety and Health Administration. 2009. Hazard communication: Foundation of workplace chemical safety programs. http://www.osha.gov/dsg/hazcom/index.html.

2. Elliott, L., M. P. Longnecker, G. E. Kissling, S. J. London. 2006. Volatile organic compounds and pulmonary function in the Third National Health and Nutrition Examination Survey, 1988-1994. Environmental Health Perspective 114:1210-14.

STANDARD 5.2.1.7: Electric Fans

Electric fans, if used, should bear the safety certification mark of a nationally recognized testing laboratory and be inaccessible to children (1). The cords to fans should also be inaccessible to children.

RATIONALE: Children having access to electric fans might insert their fingers or objects and otherwise interfere with the safe operation of the fan. Access to the cords of electric fans could result in a child pulling the fan onto him/herself.

COMMENTS: The Occupational Safety and Health Administration (OSHA) has a program that recognizes Nationally Recognized Testing Laboratories. Private sector organizations are listed at http://www.osha.gov/dts/otpca/nrtl/
index.html#nrtls.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. U.S. Occupational Safety and Health Administration. 2010. Certification of workplace products by nationally recognized testing laboratories. http://www.osha.gov/dts/shib/shib021610.html.

STANDARD 5.2.1.8: Maintenance of Air Filters

Filters in forced-air heating and cooling system equipment should be checked and cleaned or replaced according to the manufacturer’s instructions on a regular basis, at least every three months (and more often if necessary) (1).

RATIONALE: Clogged filters will impede proper air circulation required for heating and ventilation. Poor air flow causes pressure imbalances in the system and can result in the premature failure of equipment. Low air flow can reduce heating and cooling performance of the system and cause cooling coils to freeze up.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. U.S. Environmental Protection Agency. 2009. Indoor air quality for schools program: Update. http://www.epa.gov/iaq/schools/pdfs/publications/iaqtfs_update17.pdf.

STANDARD 5.2.1.9: Type and Placement of Room Thermometers

Thermometers that will not easily break and that do not contain mercury should be placed on interior walls in every indoor activity area at children’s height.

RATIONALE: The temperature of the room can vary between the floor and the ceiling. Because heat rises, the temperature at the level where children are playing can be much cooler than at the usual level of placement of interior thermometers (the standing, eye level of adults). Mercury, glass, or similar materials in thermometers can cause injury and poisoning of children and adults. Mercury is a potent neurotoxin that can damage the brain and nervous system (1). Placing a safe digital thermometer at the children’s height allows proper monitoring of temperature where the children are in the room. A thermometer should not break easily if a child or adult bumps into it.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. U.S. Environmental Protection Agency. 2010. Mercury: Health effects. http://www.epa.gov/mercury/effects.htm.

STANDARD 5.2.1.10: Gas, Oil, or Kerosene Heaters, Generators, Portable Gas Stoves, and Charcoal and Gas Grills

Unvented gas or oil heaters and portable open-flame kerosene space heaters should be prohibited. Gas cooking appliances, including portable gas stoves, should not be used for heating purposes. Charcoal grills should not be used for space heating or any other indoor purposes.

Heat in units that involve flame should be vented properly to the outside and should be supplied with a source of combustion air that meets the manufacturer’s installation requirements.

RATIONALE: Due to improper ventilation, worn or faulty parts, or malfunctioning equipment, dangerous gases can accumulate and cause a fire or carbon monoxide poisoning. Carbon monoxide is a colorless, odorless, gas that is formed when carbon-containing fuel is not burned completely and can cause illness or death. See Standard 5.2.9.5 on installation of carbon monoxide detectors.

Many burns have been caused by contact with space heaters and other hot surfaces such as charcoal and gas grills (1). If charcoal grills are used outside, adequate staff ratios must be maintained and the person operating the grill should not be counted in the ratio.

COMMENTS: For more information on carbon monoxide poisoning and poison prevention, contact your local poison center by calling 1-800-222-1222.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. Palmieri, T. L., D. G. Greenhalgh. 2002. Increased incidence of heater-related burn injury during a power crisis. Arch Surg 137:1106-8.

STANDARD 5.2.1.11: Portable Electric Space Heaters

Portable electric space heaters should:

Be attended while in use and be off when unattended;
Be inaccessible to children;
Have protective covering to keep hands and objects away from the electric heating element;
Bear the safety certification mark of a nationally recognized testing laboratory;
Be placed on the floor only and at least three feet from curtains, papers, furniture, and any flammable object;
Be properly vented, as required for proper functioning;
Be used in accordance with the manufacturer’s instructions;
Not be used with an extension cord.

The heater cord should be inaccessible to children as well.

RATIONALE: Portable electric space heaters are a common cause of fires and burns resulting from very hot heating elements being too close to flammable objects and people (1).

COMMENTS: To prevent burns and potential fires, space heaters must not be accessible to children. Children can start fires by inserting flammable material near electric heating elements. Curtains, papers, and furniture must be kept away from electric space heaters to avoid potential fires. Some electric space heaters function by heating oil contained in a heat-radiating portion of the appliance. Even though the electrical heating element is inaccessible in this type of heater, the hot surfaces of the appliance can cause burns. Cords to electric space heaters should be inaccessible to the children. Heaters should not be placed on a table or desk. Children and adults can pull an active unit off or trip on the cord.

To prevent burns or potential fires, consideration must be given to the ages and activity levels of children in care and the amount of space in a room. Alternative methods of heating may be safer for children. Baseboard electric heaters are cooler than radiant portable heaters, but still hot enough to burn a child if touched.

If portable electric space heaters are used, electrical circuits must not be overloaded. Portable electric space heaters are usually plugged into a regular 120-volt electric outlet connected to a fifteen-ampere circuit breaker. A circuit breaker is an overload switch that prevents the current in a given electric circuit from exceeding the capacity of a line. Fuses perform the same function in older systems. If too many appliances are plugged into a circuit, calling for more power than the capacity of the circuit, the breaker reacts by switching off the circuit. Constantly overloaded electrical circuits can cause electrical fires. If a circuit breaker is continuously switching the electric power off, reduce the load to the circuit before manually resetting the circuit breaker (more than one outlet may be connected to a single circuit breaker). If the problem persists, stop using the circuit and consult an electrical inspector or electrical contractor.

The Occupational Safety and Health Administration (OSHA) has a program that recognizes Nationally Recognized Testing Laboratories. Private sector organizations are listed on their Website at http://www.osha.gov/dts/otpca/nrtl/index
.html#nrtls.

Manufacturer’s instructions should be kept on file.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. U.S. Consumer Product Safety Commission (CPSC). 2001. What you should know about space heaters. Washington, DC: CPSC. http://www.nnins.com/documents/WHATYOUSHOULDKNOWABOUTSPACEHEATERS.pdf.

STANDARD 5.2.1.12: Fireplaces, Fireplace Inserts, and Wood/Corn Pellet Stoves

Fireplaces, fireplace inserts, and wood/corn pellet stoves should be inaccessible to children. Fireplaces, fireplace inserts, and wood/corn pellet stoves should be certified to recognized national performance standards such as Underwriters Laboratories (UL) or the American National Standards Institute (ANSI) and Environmental Protection Agency (EPA) standards for air emissions. The front opening should be equipped with a secure and stable protective safety screen. Fireplaces, fireplace inserts, and wood/corn pellet stoves should be installed in accordance with the local or regional building code and the manufacturer’s installation instructions. The facility should clean the chimney as necessary to prevent excessive build-up of burn residues or smoke products in the chimney.

RATIONALE: Fireplaces provide access to surfaces hot enough to cause burns. Children should be kept away from fire because their clothing can easily ignite. Children should be kept away from a hot surface because they can be burned simply by touching it. Improperly maintained fireplaces, fireplace inserts, wood/corn pellet stoves, and chimneys can lead to fire and accumulation of toxic fumes.

A protective safety screen over the front opening of a fireplace will contain sparks and reduce a child’s accessibility to an open flame.

Heating equipment is the second leading cause of ignition of fatal house fires (1). This equipment can become very hot when in use, potentially causing significant burns.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. Chowdhury, R., M. Greene, D. Miller. 2008. 2003-2005 residential fire loss estimates. Washington, DC: U.S. Consumer Product Safety Commission. http://www.cpsc.gov/library/fire05.pdf.

STANDARD 5.2.1.13: Barriers/Guards for Heating Equipment and Units

Heating equipment and units, including hot water heating pipes and baseboard heaters with a surface temperature hotter than 120°F, should be made inaccessible to children by barriers such as guards, protective screens, or other devices.

RATIONALE: A mechanical barrier separating the child from the source of heat can reduce the likelihood of burns (1,2).

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. Ytterstad, B., G. S. Smith, C. A. Coggan. 1998. Harstad injury prevention study: Prevention of burns in young children by community based interventions. Inj Prev 4:176-80.

2. McLoughlin, E., C. J. Vince, A. M. Lee, et al. 1982. Project burn prevention: Outcomes and implications. Am J Public Health 72:
241-47.

STANDARD 5.2.1.14: Water Heating Devices and Temperatures Allowed

Facilities should have water heating devices connected to the water supply system as required by the regulatory authority. These facilities should be capable of heating water to at least 120°F. Hot water temperature at sinks used for handwashing, or where the hot water will be in direct contact with children, should be at a temperature of at least 60°F and not exceeding 120°F. Scald-prevention devices, such as special faucets or thermostatically controlled valves, should be permanently installed, if necessary, to provide this temperature of water at the faucet. Where a dishwasher is used, it should have the capacity to heat water to at least 140°F for the dishwasher (with scald preventing devices that prohibit the opening of the dishwasher during operation cycle).

RATIONALE: Hot water is needed to clean and sanitize dishes and food utensils adequately and sanitize laundry. Tap water burns are a common source of scald injuries in young children (1). Children under six years of age are the most frequent victims of non-fatal burns (1). Water heated to temperatures greater than 120°F takes less than thirty seconds to burn the skin (1). If the water is heated to 120°F it takes two minutes to burn the skin (2). That extra two minutes could provide enough time to remove the child from the hot water source and avoid a burn.

COMMENTS: Anti-scald aerators designed to fit on the end of a modern bathroom and kitchen faucets, and anti-scald bathtub spouts, are also available. Only devices approved by the American National Standards Institute (ANSI) or the Canadian Standards Association (CSA) should be considered. A number of other scald-prevention devices are available on the market. Consult a plumbing contractor for details.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. D’Souza, A. L., N. G. Nelson, L. B. McKenzie. 2009. Pediatric burn injuries treated in US emergency departments between 1990 and 2006. Pediatrics 124:1424-30.

2. Erdmann, T. C., K. W. Feldman, F. P. Rivara, D. M. Heimbach, H. A. Wall. 1991. Tap water burn prevention: The effect of legislation. Pediatrics 88:572-77.

STANDARD 5.2.1.15: Maintenance of Humidifiers and Dehumidifiers

If humidifiers or dehumidifiers are used to maintain humidity, as specified in Standard 5.2.1.2, the facility should follow the manufacturer’s cleaning, drainage, and maintenance instructions to avoid growth of bacteria and mold and subsequent discharge into the air.

RATIONALE: Bacteria and mold often grow in the tanks and drainage hoses of portable and console room humidifiers and can be released in the mist. Breathing dirty mist may cause lung problems ranging from flu-like symptoms to serious infection, and is of special concern to children and staff with allergy or asthma (1). Humidifiers or dehumidifiers may be required to meet American National Standards Institute (ANSI) and Association of Home Appliance Manufacturers (AHAM) humidifier standards and must not introduce additional hazards.

COMMENTS: Improperly maintained humidifiers may become incubators of biological organisms and increase the risk of disease. Film or scum appearing on the water surface, on the sides or bottom of the tank, or on exposed motor parts may indicate that the humidifier tank contains bacteria or mold. Also, increased humidity enhances the survival of dust mites, and many children are allergic to dust mites.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. U.S. Consumer Product Safety Commission (CPSC). CPSC issues alert about care of room humidifiers: Safety alert–dirty humidifiers may cause health problems. Document #5046. Washington, DC: CPSC. http://www.cpsc.gov/cpscpub/pubs/
5046.html.

5.2.2 Lighting

STANDARD 5.2.2.1: Levels of Illumination

Natural lighting should be provided in rooms where children work and play for more than two hours at a time. Wherever possible, windows installed at child’s eye level should be provided to introduce natural lighting. All areas of the facility should have glare-free natural and/or artificial lighting that provides adequate illumination and comfort for facility activities. The following guidelines should be used for levels of illumination:

Reading, painting, and other close work areas: fifty to 100 foot-candles on the work surface;
Work and play areas: thirty to fifty foot-candles on the surface;
Stairs, walkways, landings, driveways, entrances: at least twenty foot-candles on the surface;
Sleeping and napping areas: no more than five foot-candles during sleeping or napping except for infants and children who are resting in the same room that other children are involved with activities.

RATIONALE: These levels of illumination facilitate cleaning, reading, comfort, completion of projects, and safety (3). Too little light, too much glare and confusing shadows are commonly experienced lighting problems. Inadequate artificial lighting has been linked to eyestrain, headache, and non-specific symptoms of illness (1).

Natural lighting is the most desirable lighting of all. Windows installed at children’s eye level not only provide a source of natural light, they also provide a variety of perceptual experiences of sight, sound, and smell, which may serve as learning activities for children and a focus for conversation. The visual stimulation provided by a window is important to a young child’s development (1,2). Natural lighting provided by sky lights exposes children to variations in light during the day that is less perceptually stimulating than eye-level windows, but is still preferable to artificial lighting.

A study on school performance shows that elementary school children seem to learn better in classrooms with substantial daylight and the opportunity for natural ventilation (4).

Lighting levels should be reduced during nap times to promote resting or napping behavior in children. During napping and rest periods, some degree of illumination must be allowed to ensure that staff can continue to observe children. While decreased illumination for sleeping and napping areas is a reasonable standard when all the children are resting, this standard must not prevent support of individualized sleep schedules that are essential for infants and may be required by other children from time to time.

COMMENTS: When providing artificial lighting, consider purchasing energy-efficient bulbs or lamps (e.g., compact fluorescent lights [CFL] or light emitting diode [LED] bulbs) to help benefit our children’s environment (5-7). Saving electricity reduces carbon monoxide emissions, sulfur oxide, and high-level nuclear waste (8). CFLs contain very small amounts of mercury and care should be taken to ensure the lights are not at risk for breaking and are disposed of properly. In rooms that are used for many purposes, providing the ability to turn on and off different banks of lights in a room, or installation of light dimmers, will allow caregivers/teachers to adjust lighting levels that are appropriate to the activities that are occurring in the room.

Contact the lighting or home service department of the local electric utility company to have foot-candles measured.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. Greiner, D., D. Leduc, eds. 2008. Well beings: A guide to health in child care. 3rd ed. Ottawa, ON: Canadian Paediatric Society.

2. Greenman, J. 1998. Caring spaces, learning places: Children’s environments that work. Redmond, WA: Exchange Press.

3. IESNA School and College Lighting Committee. 2000. Recommended practice on lighting for educational facilities. ANSI/IESNA RP-3-00. New York: Illuminating Engineering Society of North America.

4. Heschong, L. 2002. Daylighting and human performance. ASHRAE J (June): 65-67.

5. American Society of Heating, Refrigeration and Air-conditioning Engineers, American Institute of Architects, Illuminating Engineering Society of North America, U.S. Green Building Council, U.S. Department of Energy. 2008. Advanced energy design guide for K-12 school buildings, 148. Atlanta, GA: ASHRAE.

6. Kats, G. 2006. Greening America’s schools: costs and benefits. http://www.usgbc.org/ShowFile.aspx?DocumentID=2908.

7. Tanner, C. 2008. Explaining relationships among student outcomes and the school’s physical environment. J Advanced Academics 19:444-71.

8. Maine Senate Democrats. 2007. Legislative leaders change to high-efficiency light bulbs. http://www.maine.gov/tools/whatsnew/index.php?topic=Senatedemsall&id=43036&v=Article.

STANDARD 5.2.2.2: Light Fixtures Including Halogen Lamps

Light fixtures containing shielded or shatterproof bulbs should be used throughout the child care facility. When portable halogen lamps are provided, they should be installed securely to prevent them from tipping over, and a safety screen must be installed over the bulb.

RATIONALE: Use of shielded or shatterproof bulbs prevents injury to people and contamination of food. Halogen lamps burn at a temperature of approximately 1200°F and are a potential burn or fire hazard (1). Halogen lighting provides a more energy-efficient alternative to illuminate a room. Halogen bulbs are incorporated into freestanding lamps. Many of the older-style lamps do not have a protective screen to prevent children from touching the hot bulb or placing flammable materials on the bulb. Some portable lamps have a design that places the halogen bulb on the top of a tall pole. Although the base of these lamps is relatively heavy in weight, children can easily tip the lamps on their side and cause a potential fire hazard.

COMMENTS: Halogen lamps are also incorporated into light fixtures that are mounted permanently on the ceiling or walls. The fixtures are usually placed out of the reach of children and, if properly installed, should not pose a safety hazard.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. Lamp Section, National Electrical Manufacturers Association (NEMA). 2003. Tungsten-halogen lamps (bulbs): Ultraviolet, rupture, and high temperature risks. Rosslyn, VA: NEMA. http://www.nema
.org/gov/env_conscious_design/lamps/upload/LSD 1 T-H Lamps v2_4 2003 C6.pdf.

STANDARD 5.2.2.3: High Intensity Discharge Lamps, Multi-Vapor, and Mercury Lamps

High intensity discharge lamps, multi-vapor, and mercury lamps should not be used for lighting the interior of buildings unless provided with special bulbs that self-extinguish if the outer glass envelope is broken.

RATIONALE: Multi-vapor and mercury lamps can be harmful when the outer bulb envelope is broken, causing serious skin burns and eye inflammation (1).

COMMENTS: High intensity lamps are not appropriate for internal illumination of child care facilities since the level of lighting generated is generally too strong for the size of a typical room and/or generates too much glare.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. Balk, S. J., S. S. Aronson. 2003. Mercury in the environment: A danger to children. Child Care Info Exch (July/Aug): 58-60.

STANDARD 5.2.2.4: Emergency Lighting

Emergency lighting approved by the local authority should be provided in corridors, stairwells, and at building exits. Open flames should not be used as emergency lighting in child care facilities.

RATIONALE: Provision of emergency lighting in corridors and stairwells enables safe passage to emergency exits or shelter-in-place locations in the event of an electrical power outage (1). Open flames such as candles, flares, and lanterns are not safe.

COMMENTS: In many places, daylight hours end while child care is still in session, especially in the fall and winter seasons. If electric power outages are frequent, consideration should be given to providing emergency lighting in each room that is accessible to children. In child care homes, battery-powered household emergency lights that insert into electrical wall outlets (to remain charged) may be sufficient, depending on the location of the electrical outlets in corridors, stairwells, and near building exits.

A battery-operated flashlight is the preferred type of portable emergency lighting in child care facilities. In some jurisdictions, fixed mounted emergency lighting may be required. Ask the local fire marshal for fire safety code requirements. Although candles are sometimes recommended in emergency situations for portable lighting, they pose a significant fire hazard and should not be used.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. National Fire Protection Association (NFPA). 2009. NFPA 101: Life Safety Code. 2009 ed. Quincy, MA: NFPA.

5.2.3 Noise

STANDARD 5.2.3.1: Noise Levels

Measures should be taken in all rooms or areas accommodating children to maintain the decibel (db) level at or below thirty-five decibels for at least 80% of the time as measured by an acoustical engineer or, more practically, by the ability to be clearly heard and understood in a normal conversation without raising one’s voice. These measures include noncombustible acoustical ceiling, rugs, wall covering, partitions, or draperies, or a combination thereof.

RATIONALE: Excessive sound levels can be damaging to hearing, reduce effective communication, and reduce psychosocial well-being. The level of noise that causes hearing loss commonly experienced by children with fluid in their middle ear space is thirty-five decibels (1). This level of hearing loss correlates with decreased understanding of language. By inference, this level of ambient noise may interfere with the ability of children to hear well enough to develop language normally (2,3).

Research on the effects of ambient noise levels in child care settings has focused on a) concern with damage to the child’s auditory system and b) non-auditory effects such as physiological effects (e.g., elevated blood pressure levels), motivational effects, and cognitive effects (3). Although noise sources may be located outside the child care facility, sometimes the noise source is related to the design of the child care spaces within the facility. In the article “Design of Child Care Centers and Effects of Noise on Young Children,” Maxwell states “spaces must allow for the fact that children need to make noise but the subsequent noise levels should not be harmful to them or others in the center” (3).

COMMENTS: When there is new construction or renovation of a facility, consideration should be given to a design that will reduce noise from outside. High ceiling heights may contribute to noise levels. Installing acoustical tile ceilings reduce noise levels as well as curtains or other soft window treatments over windows and wall-mounted cork boards (4).

While carpets can help reduce the level of noise, they can absorb moisture and serve as a place for microorganisms to grow. Area rugs should be considered instead of carpet because they can be taken up and washed often. Area rugs should be secured with a non-slip mat or other method to prevent tripping hazards.

Caregivers/teachers who need extensive help with sound abatement should consult a child care health consultant for additional ideas or with an acoustical engineer to measure noise levels within the facility. For further assistance on finding an acoustical engineer, contact the Acoustical Society of America.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. Lazaridis, E., J. C. Saunders. 2008. Can you hear me now? A genetic model of otitis media with effusion. J Clin Invest 118:471-74.

2. Newman, R. 2005. The cocktail party effect in infants revisited: Listening to one’s name in noise. Devel Psych 41:352-62.

3. Maxwell, L. E., G. W. Evans. Design of child care centers and effects of noise on young children. Design Share. http://www
.designshare.com/research/lmaxwell/noisechildren.htm.

4. Manlove, E. E., T. Frank. 2001. Why should we care about noise in classrooms and child care settings? Child Youth Care Forum 30:55-64.

5.2.4 Electrical Fixtures and Outlets

STANDARD 5.2.4.1: Electrical Service

Facilities should be supplied with electric service. Outlets and fixtures should be installed and connected to the source of electric energy in a manner that meets the National Electrical Code, as amended by local electrical codes (if any), and as certified by an electrical code inspector.

RATIONALE: Proper installation of outlets and fixtures helps to prevent injury.

COMMENTS: State or local electrical codes may apply. For further information, see the National Fire Protection Association’s (NFPA) National Electrical Code and the NFPA 101: Life Safety Code from the NFPA (1).

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. National Fire Protection Association (NFPA). 2009. NFPA 101: Life Safety Code. 2009 ed. Quincy, MA: NFPA.

STANDARD 5.2.4.2: Safety Covers and Shock Protection Devices for Electrical Outlets

All electrical outlets accessible to children who are not yet developmentally at a kindergarten grade level of learning should be a type called “tamper-resistant electrical outlets.” These types of outlets look like standard wall outlets but contain an internal shutter mechanism that prevents children from sticking objects like hairpins, keys, and paperclips into the receptacle (2). This spring-loaded shutter mechanism only opens when equal pressure is applied to both shutters such as when an electrical plug is inserted (2,3).

In existing child care facilities that do not have “tamper-resistant electrical outlets,” outlets should have “safety covers” that are attached to the electrical outlet by a screw or other means to prevent easy removal by a child. “Safety plugs” should not be used since they can be removed from an electrical outlet by children (2,3).

All newly installed or replaced electrical outlets that are accessible to children should use “tamper-resistant electrical outlets.”

In areas where electrical products might come into contact with water, a special type of outlet called Ground Fault Circuit Interrupters (GFCIs) should be installed (2). A GFCI is designed to trip before a deadly electrical shock can occur (1). To ensure that GFCIs are functioning correctly, they should be tested at least monthly (2). GFCIs are also available in a tamper-resistant design.

RATIONALE: Tamper-resistant electrical outlets or securely attached safety covers prevent children from placing fingers or sticking objects into exposed electrical outlets and reduce the risk of electrical shock, electrical burns, and potential fires (2). GFCIs provide protection from electrocution when an electric outlet or electric product may come into contact with water (1).

Approximately 2,400 children are injured annually by inserting objects into the slots of electrical outlets (2,3). The majority of these injuries involve children under the age of six (2,3).

Plastic safety plugs inserted into electric outlets are not the safest option since they can easily be removed by children and, depending on their size, present a potential choking hazard if placed in a child’s mouth (3).

COMMENTS: One type of outlet cover replaces the outlet face plate with a plate that has a spring-loaded outlet cover, which will stay in place when the receptacle is not in use. For receptacles where the facility does not intend to unplug the appliance, a more permanent cap-type cover that screws into the outlet receptacle is available. Several effective outlet safety devices are available in home hardware and infant/children stores (4).

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. National Fire Protection Association (NFPA). 2010. NFPA 70: National electrical code. 2011 ed. Quincy, MA: NFPA.

2. Electrical Safety Foundation International (ESFI). 2008. Know the dangers in your older home. Rosslyn, VA: ESFI. http://esfi.org/index
.cfm/pk/download/id/10802/pid/3003/.

3. National Fire Protection Association. National electrical code fact sheet: Tamper-resistant electrical receptacles. http://www.nfpa
.org/itemDetail.asp?categoryID=1508&itemID=36117&URL=Safety Information/For consumers/Causes/Electrical/Tamper-resistant electrical receptacles&cookie_test=1/.

4. National Electrical Manufacturers Association. Real safety with tamper-resistant receptacles. http://www.childoutletsafety.org.

STANDARD 5.2.4.3: Ground-Fault Circuit-Interrupter for Outlets Near Water

All electrical outlets located within six feet of a sink or other water source must have a ground-fault circuit-interrupter (GFCI), which should be tested at least once every three months using the test button located on the device.

RATIONALE: This provision eliminates shock hazards. GFCIs provide protection from electrocution when an electric outlet or electric product may come into contact with water (1).

COMMENTS: Electrical receptacles of the type often found in bathrooms of new homes have a GFCI built into the receptacle. The GFCI does not necessarily have to be near the sink. An electrical receptacle can be protected by a special type of circuit breaker (which has a built-in GFCI) in the electrical panel (1).

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. National Fire Protection Association (NFPA). 2011. NFPA 70: National electrical code. 2011 ed. Quincy, MA: NFPA.

STANDARD 5.2.4.4: Location of Electrical Devices Near Water

No electrical device or apparatus accessible to children should be located so it could be plugged into an electrical outlet while a person is in contact with a water source, such as a sink, tub, shower area, water table, or swimming pool.

RATIONALE: Contact with a water source while using an electrical device provides a path for electricity through the person who is using the device (1,2). This can lead to electrical injury.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. National Fire Protection Association (NFPA). 2011. NFPA 70: National electrical code. 2011 ed. Quincy, MA: NFPA.

2. U.S. Consumer Product Safety Commission (CPSC). CPSC safety alert: Install Ground-Fault Circuit-Interrupter Protection for Pools, Spas and Hot Tubs. http://www.cpsc.gov/cpscpub/pubs/5039.html.

STANDARD 5.2.4.5: Extension Cords

The use of extension cords should be discouraged; however, when used, they should bear the listing mark of a nationally recognized testing laboratory, and should not be placed through doorways, under rugs or carpeting, behind wall-hangings, or across water-source areas. Electrical cords (extension and appliance) should not be frayed or overloaded.

RATIONALE: Electrical malfunction is a major cause of ignition of fatal house fires. The U.S. Consumer Product Safety Commission (CPSC) reports that from 2002-2004 extension cords and other electric cords were the ignition sources of fires that caused an average of sixty deaths and 150 burn injuries each year (1). Extension cords should not be accessible to children, whether in use or when temporarily not in use but plugged in. There is risk of electric shock to a child who may poke a metal object into the extension cord socket (2).

COMMENTS: The Occupational Safety and Health Administration (OSHA) has a Link to a list of Nationally Recognized Testing Laboratories at http://www.osha.gov/dts/otpca/nrtl/index.html#nrtls.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. Chowdhury, R., M. Greene, D. Miller. 2008. 2003-2005 residential fire loss estimates. Washington, DC: U.S. Consumer Product Safety Commission. http://www.cpsc.gov/library/fire05.pdf.

2. U.S. Consumer Product Safety Commission. Extension cords fact sheet. http://www.cpsc.gov/cpscpub/pubs/16.html.

STANDARD 5.2.4.6: Electrical Cords

Electrical cords should be placed beyond children’s reach.

RATIONALE: Severe injuries have occurred in child care when children have pulled appliances like crock-pots down onto themselves by pulling on the cord (1). Injuries have occurred in child care when children pulled appliances such as tape players down on themselves by pulling on the cord (2). When children chew on an appliance cord, they can reach the wires and suffer severe disfiguring mouth injuries (3).

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. Lowell, G., K. Quinlan, L. J. Gottlieb. 2008. Preventing unintentional scald burns: Moving beyond tap water. Pediatrics 122:799-804.

2. U.S. Consumer Product Safety Commission. CPSC safety alert. The tipping point: Preventing TV, furniture, and appliance tip-over deaths and injuries. http://www.cpsc.gov/cpscpub/pubs/5004.pdf.

3. Healthy Children. 2010. Health issues: Electric shock. http://www
.healthychildren.org/English/health-issues/injuries-emergencies/pages/Electric-Shock.aspx.

5.2.5 Fire Warning Systems

STANDARD 5.2.5.1: Smoke Detection Systems and Smoke Alarms

In centers with new installations, a smoke detection system (such as hard-wired system detectors with battery back-up system and control panel) or monitored wireless battery operated detectors that automatically signal an alarm through a central control panel when the battery is low or when the detector is triggered by a hazardous condition should be installed with placement of the smoke detectors in the following areas:

Each story in front of doors to the stairway;
Corridors of all floors;
Lounges and recreation areas;
Sleeping rooms.

In large and small family child care homes, smoke alarms that receive their operating power from the building electrical system or are of the wireless signal-monitored-alarm system type should be installed. Battery-operated smoke alarms should be permitted provided that the facility demonstrates to the fire inspector that testing, maintenance, and battery replacement programs ensure reliability of power to the smoke alarms and signaling of a monitored alarm when the battery is low and that retrofitting the facility to connect the smoke alarms to the electrical system would be costly and difficult to achieve.

Facilities with smoke alarms that operate using power from the building electrical system should keep a supply of batteries and battery-operated detectors for use during power outages.

RATIONALE: Because of the large number of children at risk in a center, up-to-date smoke detection system technology is needed. Wireless smoke alarm systems that signal and set off a monitored alarm are acceptable. In large and small family child care homes, single-station smoke alarms are acceptable. However, for all new building installations where access to enable necessary wiring is available, smoke alarms should be used that receive their power from the building’s electrical system. These hard-wired detecting systems typically have a battery operated back-up system for times of power outage. The hard-wired and wireless smoke detectors should be interconnected so that occupants receive instantaneous alarms throughout the facility, not just in the room of origin. Single-station batteries are not reliable enough; single-station battery-operated smoke alarms should be accepted only where connecting smoke detectors to existing wiring would be too difficult and expensive as a retrofitted arrangement.

COMMENTS: Some state and local building codes specify the installation and maintenance of smoke detectors and fire alarm systems. For specific information, see the NFPA 101: Life Safety Code (1) and the NFPA 72: National Fire Alarm and Signaling Code from the National Fire Protection Association.

The Federal Emergency Management Agency (FEMA) has an online coloring book that can be printed and used to teach children about fire safety at https://www.usfa.dhs.gov/applications/publications/display.cfm?id=208/.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. National Fire Protection Association (NFPA). 2009. NFPA 101: Life Safety Code. 2009 ed. Quincy, MA: NFPA.

STANDARD 5.2.5.2: Portable Fire Extinguishers

Portable fire extinguisher(s) should be installed and maintained and staff should be trained on their proper use as stated in Standard 3.4.3.2. The fire extinguisher should be of the A-B-C type. Size/number of fire extinguishers should be determined after a survey by the fire marshal or by an insurance company fire loss prevention representative. Instructions for the use of the fire extinguisher should be posted on or near the fire extinguisher. Fire extinguishers should not be accessible to children. Fire extinguishers should be inspected and maintained annually or more frequently as recommended by the manufacturer’s instructions.

RATIONALE: All fire extinguishers are labeled, using standard symbols, for the classes of fires on which they can be used. A red slash through any of the symbols tells you the extinguisher cannot be used on that class of fire. Class A designates ordinary combustibles such as wood, cloth, and paper. Class B designates flammable liquids such as gasoline, oil, and oil-based paint. Class C designates energized electrical equipment, including wiring, fuse boxes, circuit breakers, machinery, and appliances.

COMMENTS: Staff should be trained that the first priority is to remove the children from the facility safely and quickly. Fighting a fire is secondary to the safe exit of the children and staff.

For information on automatic fire extinguishers, see the National Fire Protection Association’s NFPA 101: Life Safety Code (1).

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. National Fire Protection Association (NFPA). 2009. NFPA 101: Life Safety Code. 2009 ed. Quincy, MA: NFPA.

5.2.6 Water Supply and Plumbing

STANDARD 5.2.6.1: Water Supply

Every facility should be supplied with piped running water under pressure, from a source approved by the Environmental Protection Agency (EPA) and/or the regulatory health authority, to provide an adequate water supply to every fixture connected to the water supply and drainage system. The water should be sufficient in quantity and pressure to supply water for cooking, cleaning, drinking, toilets, and outside uses.

Water supplied by a well or other private source should meet all applicable health and safety federal, state, and local public health standards and should be approved by the local regulatory health authority. Well water should be tested annually for bacterial and chemical content (nitrates or other run-off chemicals) or according to local regulatory health authority (2). Any facility not served by a public water supply should keep on file documentation of approval, from the local regulatory health authority, of the water supply.

RATIONALE: A water supply that is safe and does not spread disease or filth or contain dangerous substances is essential to life and health (1).

COMMENTS: For more information on water supply standards, contact the local health authority or the EPA.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

STANDARD 5.2.6.2: Testing of Drinking Water Not From Public System

If the facility’s drinking water does not come from a public water system, or the facility gets the drinking water from a household well, programs should test the water every year or as required by the local health department, for bacteriological quality, nitrates, total dissolved solids, pH levels, and other water quality indicators as required by the local health department. Testing for nitrate is especially important if there are infants under six months of age in care.

RATIONALE: Drinking water sources should be approved by the local health department. If a child care facility does not receive drinking water from a public water system, the child care operator should ensure that the drinking water is safe. Unsafe water supplies may cause illness or other problems (1) and contain bacteria and parasites. Infants below the age of six months who drink water containing nitrate in excess of the maximum concentration limit of ten milligrams per liter could become seriously ill and, if untreated, may die. Symptoms include shortness of breath and blue-baby syndrome (methemoglobinia) (2). Even if a private water supply is safe, regular testing is valuable because it establishes a record of water quality.

COMMENTS: Public water systems are responsible for complying with all regulations, including monitoring, reporting, and performing treatment techniques. Testing of private water supplies should be completed by a state certified laboratory (1). Most testing laboratories or services supply their own sample containers. Samples for bacteriological testing must be collected in sterile containers and under sterile conditions. Laboratories may sometimes send a trained technician to collect the sample. For further information, contact the local health authority or the U.S. Environmental Protection Agency (EPA).

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. U.S. Environmental Protection Agency (EPA). 2005. Home water testing. Washington, DC: EPA, Office of Water. http://www.epa.gov/ogwdw000/faq/pdfs/fs_homewatertesting.pdf.

2. American Academy of Pediatrics. Policy statement: Drinking water from private wells and risks to children. Pediatrics 123:1599-1605.

STANDARD 5.2.6.3: Testing for Lead and Copper Levels in Drinking Water

Drinking water, including water in drinking fountains, should be tested and evaluated in accordance with the assistance of the local health authority or state drinking water program to determine whether lead and copper levels are safe.

RATIONALE: Lead and copper in pipes can leach into water in harmful amounts and present a potential serious exposure. Lead exposure can cause: lower IQ levels, hearing loss, reduced attention span, learning disabilities, hyperactivity, aggressive behavior, coma, convulsion, and even death (2,3). Copper exposure can cause stomach and intestinal distress, liver or kidney damage, and complications of Wilson’s disease. Children’s bodies absorb more lead and copper than the average adult because of their rapid development (2,3).

It is especially important to test and have safe water at child care facilities because of the amount of time children spend in these facilities.

Caregivers/teachers should always run cold water for fifteen to thirty seconds before using for drinking, cooking, and making infant formula (3). Cold water is less likely to leach lead from the plumbing.

COMMENTS: Lead is not usually found in water that comes from wells or public drinking water supply systems. More commonly, lead can enter the drinking water when the water comes into contact with plumbing materials that contain lead (2,4).

Child care facilities that have their own water supply and are considered non-transient, non-community water systems (NTNCWS) are subject to the Environmental Protection Agency’s (EPA) Lead and Copper Rule (LCR) requirements, which include taking water samples for testing (1,2).

Contact your local health department or state drinking water program for information on how to collect samples and for advice on frequency of testing. See also the EPA references below.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. U.S. Environmental Protection Agency (EPA). 2009. Drinking water in schools and child care facilities. http://water.epa.gov/infrastructure/drinkingwater/schools/index.cfm.

2. U.S. Environmental Protection Agency (EPA). 2005. Lead and copper rule: A quick reference guide for schools and child care facilities that are regulated under the safe Drinking Water Act. Washington, DC: EPA, Office of Water. http://www.epa.gov/safewater/schools/pdfs/lead/qrg_lcr_schools.pdf.

3. U.S. Environmental Protection Agency (EPA). 2005. 3Ts for reducing lead in drinking water in child care facilities: Revised guidance. Washington, DC: EPA, Office of Water. http://www.epa
.gov/safewater/schools/pdfs/lead/toolkit_leadschools_guide_3ts_childcare.pdf.

4. Zhang, Y., A. Griffin, M. Edwards. 2008. Nitrification in premise plumbing: Role of phosphate, pH and pipe corrosion. Environ Sci Tech 42:4280-84.

STANDARD 5.2.6.4: Water Test Results

All water test results should be in written form and kept with other required reports and documents in one central location in the facility, ready for immediate viewing by consumers and regulatory personnel. Early care and education programs should maintain photocopies of all water-testing results if the business is required to submit reports to the regulatory authority.

RATIONALE: Consumers and regulatory personnel can determine that testing has been done through written documentation (1).

COMMENTS: Some regulatory authorities prefer to review copies of water test results available for inspection on site; others that do not provide on-site inspections may prefer to have the reports submitted to them.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. U.S. Environmental Protection Agency (EPA). 2005. 3Ts for reducing lead in drinking water in child care facilities: Revised guidance. Washington, DC: EPA, Office of Water. http://www.epa
.gov/safewater/schools/pdfs/lead/toolkit_leadschools_guide_3ts_childcare.pdf.

STANDARD 5.2.6.5: Emergency Safe Drinking Water and Bottled Water

Emergency safe drinking water should be supplied during interruption of the regular approved water supply. Bottled water should be certified as chemically and bacteriologically potable by the Food and Drug Administration (FDA), local health department or its designee.

RATIONALE: Children must have constant access to fresh, potable water if the regular approved supply of drinking water is temporarily interrupted.

COMMENTS: The FDA regulates commercially bottled water and has established specific regulations for bottled water in Title 21 of the Code of Federal Regulations (21 CFR) (1). In addition to the FDA, state and local governments also regulate bottled water. Commercially-bottled water is considered to have an indefinite safety shelf life if it is produced in accordance with current good manufacturing practices (CGMP) and quality standard regulations and is stored in an unopened, properly sealed container. Therefore, FDA does not require an expiration date for bottled water. However, long-term storage of bottled water may result in aesthetic defects, such as off-odor and taste. Bottlers may voluntarily put expiration dates on their labels. The materials used to produce plastic containers for bottled water are regulated by the FDA as food contact substances. Food contact substances must be approved under FDA’s food additive regulations. Commercial bottled water containers should not be used for any purpose other than to hold drinking water. Other liquids should not be stored in bottled-water containers. All drinking water containers must be thoroughly washed and sanitized prior to being refilled with drinking water. For information on safe plastics, see Standard 5.2.9.9.

Under FDA labeling rules, bottled water includes products labeled: bottled water, drinking water, artesian water, mineral water, sparkling bottled water, spring water, purified water, distilled, de-mineralized, de-ionized, or reverse osmosis water. Waters with added carbonation, soda water (or club soda), tonic water, and seltzer historically are regulated by FDA as soft drinks (1).

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. Posnick, L. M., H. Kim. 2002. Bottled water regulation and the FDA. Food Safety Mag (Aug/Sept).

STANDARD 5.2.6.6: Water Handling and Treatment Equipment

Newly installed water handling, treatment, filtering, or softening equipment should meet applicable National Sanitation Foundation (NSF) standards and should be approved by the local regulatory health authority.

RATIONALE: Adherence to NSF standards will help ensure a safe water supply. State and local codes vary, but they generally protect against toxins or sewage entering the water supply.

COMMENTS: Model codes are available from the NSF.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. NSF International. 2004. Home water treatment devices. http://www.nsf.org/consumer/drinking_water/dw_treatment.asp.

STANDARD 5.2.6.7: Cross-Connections

The facility should have no cross-connections that could permit contamination of the potable water supply:

Backflow preventers, vacuum breakers, or strategic air gaps should be provided for all boiler units in which chemicals are used. Backflow preventers should be tested annually;
Vacuum breakers should be installed on all threaded janitorial sink faucets and outdoor/indoor hose bibs;
Non-submersible, antisiphon ballcocks should be provided on all flush tank-type toilets.

RATIONALE: Pressure differentials may allow contamination of drinking water if cross-connections or submerged inlets exist. Water must be protected from cross-connections with possible sources of contamination (1).

COMMENTS: Short hoses are often attached to the faucets of janitorial sinks (and laundry sinks) and often extend below the top edge of the basin. The ends of a hose in a janitorial sink and a garden hose attached to an outside hose bibs are often found in a pool of potentially contaminated water. If the water faucet is not completely closed, a loss of pressure in the water system could result in the contaminated water being drawn up the hose like dirt is drawn into a vacuum cleaner, thus contaminating the drinking water supply.

Vacuum breakers may be installed as part of the plumbing fixture or are available to attach to the end of a faucet of hose bib.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. International Code Council (ICC). 2009. 2009 international plumbing code. Washington, DC: ICC.

STANDARD 5.2.6.8: Installation of Pipes and Plumbing Fixtures

Each gas pipe, water pipe, gas-burning fixture, plumbing fixture and apparatus, or any other similar fixture and all connections to water, sewer, or gas lines should be installed and free from defects, leaks, and obstructions in accordance with the requirements of the state and/or local regulatory agency for buildings.

RATIONALE: This standard prevents injuries and hazardous and unsanitary conditions.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

STANDARD 5.2.6.9: Handwashing Sink Using Portable Water Supply

When plumbing is unavailable to provide a handwashing sink, the facility should provide a handwashing sink using a portable water supply and a sanitary catch system approved by a local public health department. A mechanism should be in place to prevent children from gaining access to soiled water or more than one child from washing in the same water.

RATIONALE: The best way to clean hands is to wash with soap and running water or use a hand sanitizer, with supervision. Ideally, properly equipped handwashing sinks should be provided (see Standard 5.4.1.10). However, in emergency situations when a supply of running water or hand sanitizer may not be realistically available, sinks with a portable water supply can be used.

COMMENTS: A variety of portable hand sinks are available for purchase. Before purchasing, facilities should consult with their local health department on what types of portable sinks are allowed or approved for use.

The handling of waste water poses sanitation hazards for children and staff. Portable systems often require staff to lift the water containers. Such lifting may pose an occupational health risk.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

STANDARD 5.2.6.10: Drinking Fountains

Drinking fountains should have an angled jet and orifice guard above the rim of the fountain. The pressure should be regulated so the water stream does not contact the orifice guard or splash on the floor, but should rise at least two inches above the orifice guard.

Drinking fountains should be cleaned and disinfected at least daily and whenever visibly dirty.

At least eighteen inches of space should be provided between a drinking fountain and any kind of towel dispenser.

RATIONALE: Access to water provides for fluid maintenance essential to body health. The water must be protected from contamination to avoid the spread of disease. Space between a drinking fountain and sink or towel dispenser helps prevent contamination of the drinking fountain by organisms being splashed or deposited during use.

Moist surfaces such as drinking fountains in child care centers can be sources of rotavirus contamination during an outbreak (1).

TYPE OF FACILITY: Center

REFERENCES:

1. Butz, A. M., P. Fosarelli, J. Dick, T. Cusack, R. Yolken. 1993. Prevalence of rotavirus on high risk fomites in day-care facilities. Pediatrics 92:202-5.

5.2.7 Sewage and Garbage

STANDARD 5.2.7.1: On-Site Sewage Systems

A sewage system should be provided and inspected in accordance with state and local regulations. Whenever a public sewer is available, the facility should be connected to it. Where public sewers are not available, an on-site sewage system or other method approved by the local public health department should be installed. Raw or treated wastes should not be discharged on the surface of the ground.

The wastewater or septic system drainage field should not be located within the outdoor play area of a child care program, unless the drainage field has been designed by a sanitation engineer with the presence of an outdoor play area in mind and meets the approval of the local health authority.

The exhaust vent from a wastewater or septic system and drainage field should not be located within the children’s outdoor play area.

RATIONALE: Sewage must not be allowed to contaminate drinking water or ground water. It must be carried from the facility to a place where sanitary treatment equipment is available. Raw sewage is a health hazard and usually has an offensive odor.

The weight of children or the combined weight of children and playground equipment may cause the drainage field to become compacted, resulting in failure of the system. Some structures are anchored in concrete, which adds weight. The legs of some equipment, such as swing sets, can puncture the surface of drainage fields. In areas where frequent rains are coupled with high water tables, poor drainage, and flooding, the surface of drainage fields often becomes contaminated with untreated sewage.

COMMENTS: Whether the presence of an outdoor play area would adversely affect the operation of an on-site sewage system will depend on the type of playground equipment and method of anchoring, the type of resilient surface placed beneath playground equipment to reduce injury from falls, the soil type where the field would be placed (some soils are more compactable than others), the type of ground cover present (a cover of good grass underlain by a good sandy layer is much better than packed clay or some impermeable or slowly impermeable surface layer), and the design of the drainage field itself. Septic systems are now most commonly called “on-site sewage systems” or “on-site systems” because they treat and dispose of household wastewater on the household’s own property (1).

Staff should consult with the local public health department regarding sewage storage and disposal. The national/international organization representing on-site wastewater/sewage interests is the National On-Site Wastewater Recycling Association, Inc. (NOWRA).

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. National Onsite Wastewater Recycling Association (NOWRA). Homeowner’s onsite system guide and record keeping folder. http://www.nowra.org/documents/HomeownerOnsiteSystemGuide.pdf.

STANDARD 5.2.7.2: Removal of Garbage

Garbage and rubbish should be removed from rooms occupied by children, staff, parents/guardians, or volunteers on a daily basis and removed from the premises at least twice weekly or at other frequencies required by the regulatory health authority.

RATIONALE: This practice provides proper sanitation and protection of health, prevents infestations by rodents, insects, and other pests, and prevents odors and injuries.

COMMENTS: Compliance can be tested by checking for evidence of infestation and odors.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

STANDARD 5.2.7.3: Containment of Garbage

Garbage should be kept in containers approved by the regulatory health authority. Such containers should be constructed of durable metal or other types of material, designed and used so wild and domesticated animals and pests do not have access to the contents, and so they do not leak or absorb liquids. Waste containers should be kept covered with tight-fitting lids or covers when stored.

The facility should have a sufficient number of waste and diaper containers to hold all of the garbage and diapers that accumulate between periods of removal from the premises. Plastic garbage bag liners should be used in such containers. Exterior garbage containers should be stored on an easily cleanable surface. Garbage areas should be free of litter and waste that is not contained. Children should not be allowed access to garbage, waste, and refuse storage areas.

If a compactor is used, the surface should be graded to a suitable drain, as approved by the regulatory health authority.

RATIONALE: Containers for garbage attract animals and insects. When trash contains organic material, decomposition creates unpleasant odors. Therefore, child care facilities must choose and use garbage containers that control sanitation risks, pests, and offensive odors. Lining the containers with plastic bags reduces the contamination of the container itself and the need to wash the containers, which hold a concomitant risk of spreading the contamination into the environment.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

STANDARD 5.2.7.4: Containment of Soiled Diapers

Soiled diapers should be stored inside the facility in containers separate from other waste. Washable, plastic-lined, tightly covered receptacles, with a firmly fitting cover that does not require touching with contaminated hands or objects, should be provided, within arm’s reach of diaper changing tables, to store soiled diapers. The container for soiled diapers should be designed to prevent the user from contaminating any exterior surfaces of the container or the user when inserting the soiled diaper. Soiled diapers do not have to be individually bagged before placing them in the container for soiled diapers. Soiled cloth diapers and soiled clothing that are to be sent home with a parent/guardian, however, should be individually bagged.

The following types of diaper containers should not be used;

Those that require the user’s hand to push the diaper through a narrow opening;
Those with exterior surfaces that must be touched with the hand;
Those with exterior surfaces that are likely to be touched with the soiled diaper while the user is discarding the soiled diaper;
Those that have lids with handles.

Separate containers should be used for disposable diapers, cloth diapers (if used), and soiled clothes and linens. All containers should be inaccessible to children and should be tall enough to prevent children reaching into the receptacle or from falling headfirst into containers. The containers should be placed in an area that children cannot enter without close adult supervision.

RATIONALE: Separate, plastic-lined waste receptacles that do not require touching with contaminated hands or objects and that children cannot access enclose odors within, and prevent children from coming into contact with body fluids. Anything that increases handling increases potential for contamination (1). Step cans or other hands-free cans with tightly fitted lids provide protection against odor and hand contamination.

COMMENTS: Fecal material and urine should not be mixed with regular trash and garbage. Where possible, soiled disposable diapers should be disposed of as biological waste rather than in the local landfill. In some areas, recycling depots for disposable diapers may be available. The facility should not use the short, poorly made domestic step cans that require caregivers/teachers to use their hands to open the lids because the foot pedals don’t work. Caregivers/teachers will find it worthwhile to invest in commercial-grade step cans of sufficient size to hold the number of soiled diapers the facility collects before someone can remove the contents to an outside trash receptacle. These are the types used by doctor’s offices, hospitals, and restaurants. A variety of sizes and types are available from restaurant and medical wholesale suppliers. Other types of hands-free containers can be used as long as the user can place the soiled diaper into the receptacle without increasing contact of the user’s hands and the exterior of the container with the soiled diaper.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. Pickering, L. K., C. J. Baker, D. W. Kimberlin, S. S. Long, eds. 2009. Red book: 2009 report of the Committee on Infectious Diseases. Elk Grove Village, IL: American Academy of Pediatrics.

STANDARD 5.2.7.5: Labeling, Cleaning, and Disposal of Waste and Diaper Containers

Each waste and diaper container should be labeled to show its intended contents. These containers should be cleaned daily to keep them free from build-up of soil and odor. Wastewater from these cleaning operations should be disposed of by pouring it down a toilet or floor drain. Wastewater should not be poured onto the ground, into handwashing sinks, laundry sinks, kitchen sinks, or bathtubs.

RATIONALE: This standard prevents noxious odors and spread of disease.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

STANDARD 5.2.7.6: Storage and Disposal of Infectious and Toxic Wastes

Infectious and toxic wastes should be stored separately from other wastes, and should be disposed of in a manner approved by the regulatory health authority.

RATIONALE: This practice provides for safe storage and disposal of infectious and toxic wastes.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

5.2.8 Integrated Pest Management

STANDARD 5.2.8.1: Integrated Pest Management

Facilities should adopt an integrated pest management program (IPM) to ensure long-term, environmentally sound pest suppression through a range of practices including pest exclusion, sanitation and clutter control, and elimination of conditions that are conducive to pest infestations. IPM is a simple, common-sense approach to pest management that eliminates the root causes of pest problems, providing safe and effective control of insects, weeds, rodents, and other pests while minimizing risks to human health and the environment (2,4).

Pest Prevention: Facilities should prevent pest infestations by ensuring sanitary conditions. This can be done by eliminating pest breeding areas, filling in cracks and crevices; holes in walls, floors, ceilings and water leads; repairing water damage; and removing clutter and rubbish on the premises (5).

Pest Monitoring: Facilities should establish a program for regular pest population monitoring and should keep records of pest sightings and sightings of indicators of the presence of pests (e.g., gnaw marks, frass, rub marks).

Pesticide Use: If physical intervention fails to prevent pest infestations, facility managers should ensure that targeted, rather than broadcast applications of pesticides are made, beginning with the products that pose least exposure hazard first, and always using a pesticide applicator who has the licenses or certifications required by state and local laws.

Facility managers should follow all instructions on pesticide product labels and should not apply any pesticide in a manner inconsistent with label instructions. Material Safety Data Sheets (MSDS) are available from the product manufacturer or a licensed exterminator and should be on file at the facility Facilities should ensure that pesticides are never applied when children are present and that re-entry periods are adhered to.

Records of all pesticides applications (including type and amount of pesticide used), timing and location of treatment, and results should be maintained either on-line or in a manner that permits access by facility managers and staff, state inspectors and regulatory personnel, parents/guardians, and others who may inquire about pesticide usage at the facility.

Facilities should avoid the use of sprays and other volatilizing pesticide formulations. Pesticides should be applied in a manner that prevents skin contact and any other exposure to children or staff members and minimizes odors in occupied areas. Care should be taken to ensure that pesticide applications do not result in pesticide residues accumulating on tables, toys, and items mouthed or handled by children, or on soft surfaces such as carpets, upholstered furniture, or stuffed animals with which children may come in direct contact (3).

Following the use of pesticides, herbicides, fungicides, or other potentially toxic chemicals, the treated area should be ventilated for the period recommended on the product label.

Notification: Notification should be given to parents/guardians and staff before using pesticides, to determine if any child or staff member is sensitive to the product. A member of the child care staff should directly observe the application to be sure that toxic chemicals are not applied on surfaces with which children or staff may come in contact.

Registry: Child care facilities should provide the opportunity for interested staff and parents/guardians to register with the facility if they want to be notified about individual pesticide applications before they occur.

Warning Signs: Child care facilities must post warning signs at each area where pesticides will be applied. These signs must be posted forty-eight hours before and seventy-two hours after applications and should be sufficient to restrict uninformed access to treated areas.

Record Keeping: Child care facilities should keep records of pesticide use at the facility and make the records available to anyone who asks. Record retention requirements vary by state, but federal law requires records to be kept for two years (7). It is a good idea to retain records for a minimum of three years.

Pesticide Storage: Pesticides should be stored in their original containers and in a locked room or cabinet accessible only to authorized staff. No restricted-use pesticides should be stored or used on the premises except by properly licensed persons. Banned, illegal, and unregistered pesticides should not be used.

RATIONALE: Children must be protected from exposure to pesticides (1). To prevent contamination and poisoning, child care staff must be sure that these chemicals are applied by individuals who are licensed and certified to do so. Direct observation of pesticide application by child care staff is essential to guide the pest management professional away from surfaces that children can touch or mouth and to monitor for drifting of pesticides into these areas. The time of toxic risk exposure is a function of skin contact, the efficiency of the ventilating system, and the volatility of the toxic substance. Spraying the grounds of a child care facility exposes children to toxic chemicals. Studies and a recent consensus statement address the risk of neurodevelopmental effects from exposure to pesticides (6). Exposure to pesticides has been linked to learning and developmental disorders. Children are more vulnerable as their metabolic, enzymatic, and immunological systems are immature. Pesticides should only be used as an emergency application to eliminate threats to human health (6).

COMMENTS: Manufacturers of pesticides usually provide product warnings that exposure to these chemicals can be poisonous.

Child care staff should ask to see the license of the pest management professional and should be certain that the individual who applies the toxic chemicals has personally been trained and preferably, individually licensed, i.e., not working in the capacity of a technician being supervised by a licensed pest management professional. In some states only the owner of a pest management company is required to have this training, and s/he may then employ unskilled workers. Child care staff should ensure that the pest management professional is familiar with the pesticide s/he is applying.

Child care staff should contact their state pesticide office and request that their child care facility be added to the state pesticide sensitivity list, in states where such a list exists. When a child care facility is placed on the state pesticide sensitivity list, the child care staff will be notified if there are plans for general pesticide application occurring near the child care facility.

For further information about pest control, contact the state pesticide regulatory agency, the Environmental Protection Agency (EPA), or the National Pesticide Information Center. For possible poison exposure, contact the local poison center at 1-800-222-1222.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. Tulve, N. S., P. A. Jones, M. G. Nishioka, R. C. Fortmann, C. W. Croghan, J. Y. Zhou, A. Fraser, C. Cave, W. Friedman. 2006. Pesticide measurements from the First National Environmental Health Survey of Child Care Centers using a multi-residue GC/MS analysis method. Environ Sci Tech 40:6269-74.

2. U.S. Environmental Protection Agency. Integrated pest management (IPM) in schools. http://www.epa.gov/pesticides/ipm/index.htm.

3. U.S. Environmental Protection Agency. Integrated pest management (IPM) in child care.

http://www.epa.gov/pesticides/controlling/childcare-ipm.htm.

4. The IPM Institute of North America. IPM standards for schools. http://ipminstitute.org/school.htm.

5. University of California, Agriculture and Natural Resources. UC IPM online: Statewide integrated pest management program. How to manage pests. http://www.ipm.ucdavis.edu.

6. Gilbert, S. G. 2007. Scientific consensus statement on environmental agents associated with neurodevelopmental disorders. Bolinas, CA: Collaborative on Health and the Environment (CHE). http://www.neep.org/uploads/NEEPResources/id27/lddistatement.pdf.

7. South Dakota State University, Department of Plant Science. Restricted use pesticide record keeping: Pesticide recordkeeping is more than just a good idea -- it’s the law! http://www.sdstate.edu/ps/extension/pat/pesticide-record.cfm.

STANDARD 5.2.8.2: Insect Breeding Hazard

No facility should maintain or permit to be maintained any receptacle or pool, whether natural or artificial, containing water in such condition that insects breeding therein may become a public health issue.

RATIONALE: Collection of water in tin cans, children’s toys, flower pots, rain gutters, discarded tires and other refuse, and natural pools of water can provide breeding sites for mosquitoes. Elimination of mosquito breeding sites is one of the basic environmental control methods.

Mosquitoes are responsible for transmitting a variety of diseases. Mosquito-borne viruses such as West Nile virus, eastern equine encephalitis, western equine encephalitis, and St. Louis encephalitis have occurred in the United States and Canada (1). Children can develop allergic reactions to mosquito and fire ant bites and bee and wasp stings.

COMMENTS: Regular surveillance for stinging insect nests is important.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. Heymann, D. L. 2008. Control of communicable diseases manual. 19th ed. Washington, DC: American Public Health Association.

5.2.9 Prevention and Management of Toxic Substances

STANDARD 5.2.9.1: Use and Storage of Toxic Substances

The following items should be used as recommended by the manufacturer and should be stored in the original labeled containers:

Cleaning materials;
Detergents;
Automatic dishwasher detergents;
Aerosol cans;
Pesticides;
Health and beauty aids;
Medications;
Lawn care chemicals;
Other toxic materials.

Material Safety Data Sheets (MSDS) must be available onsite for each hazardous chemical that is on the premises.

These substances should be used only in a manner that will not contaminate play surfaces, food, or food preparation areas, and that will not constitute a hazard to the children or staff. When not in active use, all chemicals used inside or outside should be stored in a safe and secure manner in a locked room or cabinet, fitted with a child-resistive opening device, inaccessible to children, and separate from stored medications and food.

Chemicals used in lawn care treatments should be limited to those listed for use in areas that can be occupied by children.

Medications can be toxic if taken by the wrong person or in the wrong dose. Medications should be stored safely (see Standard 3.6.3.1) and disposed of properly (see Standard 3.6.3.2).

The telephone number for the poison center should be posted in a location where it is readily available in emergency situations (e.g., next to the telephone). Poison centers are open twenty-four hours a day, seven days a week, and can be reached at 1-800-222-1222.

RATIONALE: There are over two million human poison exposures reported to poison centers every year. Children under six years of age account for over half of those potential poisonings. The substances most commonly involved in poison exposures of children are cosmetics and personal care products, cleaning substances, and medications (1).

The MSDS explains the risk of exposure to products so that appropriate precautions may be taken.

COMMENTS: Many child-resistant types of closing devices can be installed on doors to prevent young children from accessing poisonous substances. Many of these devices are self-engaging when the door is closed and require an adult hand size or skill to open the door. A locked cabinet or room where children cannot gain access is best but must be used consistently. Child-resistant containers provide another level of protection.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. Bronstein, A. C., D. A. Spyker, L. R. Cantilena, Jr., J. L. Green, B. H. Rumack, S. E. Heard. 2008. 2007 annual report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 25th annual report. Clin Toxicol 46:927-1057.

STANDARD 5.2.9.2: Use of a Poison Center

The poison center should be called for advice about any exposure to toxic substances, or any potential poisoning emergency. The national help line for the poison center is 1-800-222-1222, and specialists will link the caregiver/teacher with their local poison center. The advice should be followed and documented in the facility’s files. The caregiver/teacher should be prepared for the call by having the following information for the poison center specialist:

The child’s age and sex;
The substance involved;
The estimated amount;
The child’s condition;
The time elapsed since ingestion or exposure.

The caregiver/teacher should not induce vomiting unless instructed by the poison center.

RATIONALE: Toxic substances, when ingested, inhaled, or in contact with skin, may react immediately or slowly, with serious symptoms occurring much later (1). It is important for the caregiver/teacher to call the poison center after the exposure and not “wait and see.” Symptoms vary with the type of substance involved. Some common poisoning symptoms include dermatitis, nausea, vomiting, diarrhea, and congestion.

COMMENTS: Any question on possible risks for exposure should be referred to poison center professionals for proper first aid and treatment. Regional poison centers have access to the latest information on emergency care of the poisoning victim.

Caregivers/teachers can go to http://www.aapcc.org to find their local poison center or for additional information on poisoning and poison safety. They can also access a variety of services that poison centers have: poison prevention, poison control, information about toxic substances including lead and chemicals that may be found in consumer products, and even assistance with disaster planning. Caregivers/teachers should feel comfortable calling the poison center about medication dosing errors. Poison centers provide free, confidential advice on how to handle the situation.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. American Academy of Pediatrics, Committee on Injury, Violence, and Poison Prevention. 2007. Policy statement: Poison treatment in the home. Pediatrics 119:1031.

STANDARD 5.2.9.3: Informing Staff Regarding Presence of Toxic Substances

Employers should provide staff with hazard information, including access to and review of the Material Safety Data Sheets (MSDS) as required by the Occupational Safety and Health Administration (OSHA), about the presence of toxic substances such as formaldehyde, cleaning and sanitizing supplies, insecticides, herbicides, and other hazardous chemicals in use in the facility. Staff should always read the label prior to use to determine safety in use. For example, toxic products regulated by the Environmental Protection Agency (EPA) will have an EPA signal word of CAUTION, WARNING, or DANGER. Where nontoxic substitutes are available, these nontoxic substitutes should be used instead of toxic chemicals. If a nontoxic product is not available, caregivers/teachers should use the least toxic product for the job. A CAUTION label is safer than a WARNING label, which is safer than a DANGER label.

RATIONALE: These precautions are essential to the health and well-being of the staff and the children alike. Many cleaning products and art materials contain ingredients that may be toxic. Regulations require employers to make the complete identity of these materials known to users. Because nontoxic substitutes are available for virtually all necessary products, exchanging them for toxic products is required.

COMMENTS: The U.S. Department of Labor, which oversees OSHA, is responsible for protection of workers and is listed in the phone books of all large cities. Because standards change frequently, the facility should seek the latest standards from the EPA. Information on toxic substances in the environment is available from the EPA. For information on consumer products contact the U.S. Consumer Product Safety Commission (CPSC). For information on art and craft materials, contact the Art and Creative Materials Institute (ACMI). The local health jurisdiction can also be a resource for information on hazardous chemicals in child care.

The MSDS explains the risk of exposure to products so that appropriate precautions may be taken.

TYPE OF FACILITY: Center; Large Family Child Care Home

REFERENCES:

1. Wargo, J. 2004. The physical school environment: An essential component of a health-promoting school. WHO Information series on School Health, document 2. Geneva: WHO. http://www.who.int/school_youth_health/media/en/physical_sch_environment.pdf.

2. Fiene, R. 2002. 13 indicators of quality child care: Research update. Washington, DC: U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation. http://aspe.hhs.gov/hsp/ccquality-ind02/.

STANDARD 5.2.9.4: Radon Concentrations

Radon concentrations inside a home or building used for child care must be less than four picocuries per liter of air. All facilities must be tested for the presence of radon, according to U.S. Environmental Protection Agency (EPA) testing protocols for long-term testing (i.e., greater than ninety days in duration using alpha-track or electret test devices).

RATIONALE: Radon is a colorless, odorless, radioactive gas that occurs naturally. It can be found in soil, water, building materials, and natural gas. Radon from the soil is the main cause of radon problems. Radon typically moves up through the ground to the air above and into a home or building through cracks and other holes in the foundation. Radon can get trapped inside the home or building where it can build up. In a small number of homes, the building materials can give off radon but the materials themselves rarely cause problems by themselves. If radon is present in the water supply, most of the risk is related to radon released into the air when water is used for showering or other household purposes (1). When radon gas is inhaled, it can damage lung tissue and lead to lung cancer. Radon levels can be easily measured to determine if acceptable levels have been exceeded. There is no known safe level of radon so there can always be some risk. The risk can be reduced by lowering the levels of radon in the home or building. Fixing buildings to reduce radon exposure may entail sealing cracks in the foundation or ventilating the area under the foundation.

COMMENTS: The average indoor radon level is estimated to be about 1.3 picocuries per liter of air, and about 0.4 picocuries per liter is normally found in the outside air. Most homes today can be reduced to two picocuries per liter or below (1).

Common test kits include: charcoal canisters, e-perm, alpha track detectors, and charcoal liquid scintillation devices. For more information on EPA and American Association of Radon Scientists and Technologists’ (AARST) testing protocols, see http://www.aarst.org. For material and information on radon, contact the EPA.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. U.S. Environmental Protection Agency (EPA). 2009. A citizen’s guide to radon: The guide to protecting yourself and your family from radon. http://www.epa.gov/radon/pdfs/citizensguide.pdf.

STANDARD 5.2.9.5: Carbon Monoxide Detectors

Carbon monoxide detector(s) should be installed in child care settings if one of the following guidelines is met:

The child care program uses any sources of coal, wood, charcoal, oil, kerosene, propane, natural gas, or any other product that can produce carbon monoxide indoors or in an attached garage;
If detectors are required by state/local law or state licensing agency.

Facilities must meet state or local laws regarding carbon monoxide detectors. Detectors should be tested monthly. Batteries should be changed at least yearly. Detectors should be replaced at least every five years.

RATIONALE: Carbon monoxide (CO) is a deadly, colorless, odorless, poisonous gas. It is produced by the incomplete burning of various fuels, including coal, wood, charcoal, oil, kerosene, propane, and natural gas. Products and equipment powered by internal combustion engine-powered equipment such as portable generators, cars, lawn mowers, and power washers also produce carbon monoxide. Carbon monoxide detectors are the only way to detect this substance.

Carbon monoxide poisoning causes symptoms that mimic the flu; mild symptoms are typically headache, dizziness, fatigue, nausea, and diarrhea. Prolonged exposure can cause confusion, shortness of breath, unconsciousness, and even death.

On average, about 170 people in the United States die every year from carbon monoxide produced by non-automotive consumer products (1). These products include malfunctioning fuel-burning appliances such as furnaces, ranges, water heaters, and room heaters; engine-powered equipment such as portable generators; fireplaces; and charcoal that is burned in homes and other enclosed areas. In 2005 alone, the U.S. Consumer Product Safety Commission (CPSC) staff was aware of at least ninety-four generator-related carbon monoxide poisoning deaths (1). Still others die from carbon monoxide produced by non-consumer products, such as cars left running in attached garages. The Centers for Disease Control and Prevention (CDC) estimate that several thousand people go to hospital emergency rooms every year to be treated for carbon monoxide poisoning (1).

COMMENTS: Carbon monoxide detectors should be installed according to the manufacturer’s instructions. One carbon monoxide detector should be installed in the hallway outside the bedrooms in each separate sleeping area. Carbon monoxide detectors may be installed into a plug-in receptacle or high on the wall. Hard-wired or plug-in carbon monoxide detectors should have battery backup. Installing carbon monoxide detectors near heating vents, locations that can be covered by furniture or draperies, above fuel-burning appliances or in kitchens should be avoided (1).

There are a number of safety steps that child care programs can do to help prevent carbon monoxide exposure (1-3):

Make sure major appliances are professionally installed and inspected according to local building codes and have older appliances checked for malfunctions and leaks;
Choose vented appliances when possible;
Have heating systems inspected and cleaned by a qualified technician annually and make sure the chimney is clean and with a proper draft control to ensure a proper vent for flue gases;
Check the color of the flame in the burner and pilot light (a yellow-colored flame indicates the fuel is not burning efficiently and could be releasing more carbon monoxide) (4);
Never use a gas oven to heat your facility;
Do not burn charcoal indoors;
Never operate gasoline-powered engines or generators in confined areas in or near the building;
Never leave a vehicle running in a garage or closed area. Even if the garage door is open, normal circulation will not supply enough fresh air to prevent a buildup of CO gas;
If the CO alarm goes off or if you have symptoms of CO poisoning, exit the building and call 9-1-1.

For other questions on CO poisoning call the poison center.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. U.S. Consumer Product Safety Commission (CPSC). 2008. Carbon monoxide questions and answers. Document #466. Bethesda, MD: CPSC. http://www.cpsc.gov/CPSCPUB/PUBS/
466.html.

2. Cowling, T. 2007. Safety first: Carbon monoxide poisoning. Healthy Child Care 10(5): 6-7. http://www.healthychild.net/SafetyFirst.php?article_id=402/.

3. Safe Kids USA. Carbon monoxide fact sheet. http://www.safekids.org/our-work/research/fact-sheets/
carbon-monoxide-fact-sheet.html.

4. Tremblay, K. R., Jr. 2006. Preventing carbon monoxide problems. Colorado State University Extension. http://www.ext.colostate.edu/pubs/consumer/09939.html.

STANDARD 5.2.9.6: Preventing Exposure to Asbestos or Other Friable Materials

Any asbestos, fiberglass, or other friable material or any material that is in a dangerous condition found within a facility or on the grounds of the facility should be repaired or removed. Repair usually involves either sealing (encapsulating) or covering asbestos material. Any repair or removal of asbestos should be done by a contractor certified to do in accordance with existing regulations of the U.S. Environmental Protection Agency (EPA). No children or staff should be present until the removal and cleanup of the hazardous condition have been completed.

Pipe and boiler insulation should be sampled and examined in an accredited laboratory for the presence of asbestos in a friable or potentially dangerous condition.

Non-friable asbestos should be identified to prevent disturbance and/or exposure during remodeling or future activities.

RATIONALE: Removal of significant hazards will protect the staff, children, and families who use the facility. Asbestos dust and fibers that are inhaled and reach the lungs can cause lung disease (1,2).

COMMENTS: The mere presence of asbestos in a child care facility, home, or a building is not hazardous. The danger is that asbestos materials may become damaged over time. Damaged asbestos may release asbestos fibers and become a health hazard (2,3). The best thing to do with asbestos material that is in good condition is to leave it alone. Disturbing it may create a health hazard where none existed before (1).

Asbestos that is in a friable condition means that it is easily crumbled (2).

The National Asbestos School Hazard Abatement Act of 1984 specifies requirements for removal of asbestos. Contact your local health department for additional information on asbestos regulations in your area. For more information regarding asbestos and applicable EPA regulations, contact regional offices of the EPA.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. U.S. Consumer Product Safety Commission (CPSC). Asbestos in the home. http://www.cpsc.gov/cpscpub/pubs/453.html.

2. U.S. Department of Health and Human Services, Agency for Toxic Substances and Disease Registry. 2001. Toxicological profile for asbestos.

http://www.atsdr.cdc.gov/ToxProfiles/tp61-p.pdf.

3. Fiene, R. 2002. 13 indicators of quality child care: Research update. Washington, DC: U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation. http://aspe.hhs.gov/hsp/ccquality-ind02/.

STANDARD 5.2.9.7: Proper Use of Art and Craft Materials

Only art and craft materials that are approved by the Art and Creative Materials Institute (ACMI) should be used in the child care facility. Art and craft materials should conform to all applicable ACMI safety standards. Materials should be labeled in accordance with the chronic hazard labeling standard, ASTM D4236.

The facility should prohibit use of unlabeled, improperly labeled old, or donated materials with potentially harmful ingredients.

Caregivers/teachers should closely supervise all children using art and craft materials and should make sure art and craft materials are properly used, cleaned up, and stored in original containers that are fully labeled. Materials should be age-appropriate. Children should not eat or drink while using art and craft materials.

Caregivers/teachers should have emergency protocols in place in the event of an injury, poisoning, or allergic reaction. If caregivers/teachers suspect a poisoning may have occurred they should call their poison center at 1-800-222-1222. Rooms should be well ventilated while using art and craft materials.

Only ACMI-approved unscented water-based markers should be used for children’s art projects and work.

RATIONALE: Contamination and injury may occur if art and craft materials are improperly used or labeled. Labels are required on art supplies to identify any hazardous ingredients, risks associated with their use, precautions, first aid, and sources of further information (1).

Art material, approved by the ACMI, has been tested for both chronic and acute health hazards. The ACMI AP (Approved Product) Seal, with or without Performance Certification, identifies art materials that are safe and that are certified in a toxicological evaluation by a medical expert to contain no materials in sufficient quantities to be toxic or injurious to humans, including children, or to cause acute or chronic health problems. This seal is currently replacing the previous non-toxic seals: CP (Certified Product), AP (Approved Product), and HL Health Label (Non-Toxic) over a ten-year phase-in period. Such products are certified by ACMI to be labeled in accordance with the chronic hazard labeling standard, ASTM D4236, and the U.S. Labeling of Hazardous Art Materials Act (LHAMA). Additionally, products bearing the AP Seal with Performance Certification or the CP Seal are certified to meet specific requirements of material, workmanship, working qualities, and color developed by ACMI and others through recognized standards organizations, such as the American National Standards Institute (ANSI) and ASTM International. Some products cannot attain this performance certification because no quality standard currently exists for certain types of products (1).

Children have been known to try and eat fruit-scented markers. Solvent-based/permanent markers can trigger headaches and/or asthma (3).

COMMENTS: Non-toxic art and craft supplies intended for children are readily available.

Some products labeled “non-toxic” are not necessarily a safer alternative; thus the need to check for the proper labeling.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. Art and Creative Materials Institute. 2010. Safety - what you need to know. http://www.acminet.org/Safety.htm.

3. U.S. Consumer Product Safety Commission (CPSC). Art and craft safety guide. Bethesda, MD: CPSC. http://www.cpsc.gov/cpscpub/pubs/5015.pdf.

STANDARD 5.2.9.8: Use of Play Dough and Other Manipulative Art or Sensory Materials

The child care program should have the following procedures on the use and life span of manipulative art or sensory materials such as clay, play dough, etc:

If handmade, these materials should be made fresh each week, labeled, dated and stored in airtight containers;
If purchased, these products should be stored in their original packaging;
Products that are labeled as toxic are prohibited;
The surface upon which they are used and the tools used with these materials should be cleaned and sanitized before and after use;
Children should practice hand hygiene before and after each use;
Material should be discarded if it is sneezed upon, put into a child’s mouth, or in any other way possibly contaminated;
Children with latex or gluten allergies should be given their own portion of the material and that individual portion should be stored separately if for repeat use.
Children with cuts, sores, scratches and colds with sneezing and runny noses should be given their own portion of the material and that individual portion should be stored separately if for repeat use.

RATIONALE: Hand hygiene, supervision of children, and discarding material that is contaminated are appropriate hygienic practices when using these materials. Providing children with their own portion of modeling material helps prevent cross-contamination (1).

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. Life Tips. Cutting down on playdough germs. http://parent
.lifetips.com/tip/43479/day-care-and-babysitters/concerns-and
-coping/cutting-down-on-playdough-germs.html.

STANDARD 5.2.9.9: Plastic Containers and Toys

The facility should use infant bottles, plastic containers, and toys that do not contain Polyvinyl chloride (PVC), Bisphenol A (BPA), or phthalates. When possible, caregivers/teachers should substitute materials such as paper, ceramic, glass, and stainless steel for plastics.

RATIONALE: Plastics can contain chemicals and metals, which are used as additives and stabilizers. Some of these additives and stabilizers can be toxic, such as lead (e.g., toys, vinyl lunchboxes). Plastics can release chemicals into food and drink; some types of plastics are more likely to do so than others (polycarbonate, PVC, polystyrene). Effects are not fully studied or understood, but in animal studies, some plastics have been tied to a wide range of negative health effects including endocrine (hormone) disruption and cancer (1,11).

PVC, also known as vinyl, is one of the most commonly used types of plastics today. PVC is present in many things used daily, from water bottles and containers, to wallpaper, wall paneling, credit cards, and children’s toys. Some of the substances added to PVC are among the hormone-disrupting chemicals that may pose hazards to human health and child development. PVC products, including certain toys, may have chemicals such as lead, cadmium, and phthalates, which can flake, leach, or off-gas, causing the release of these chemicals into the surroundings (2).

Phthalates is a class of chemicals used to make plastics flexible (3,4,11). Phthalates are used in many products: vinyl flooring, plastic clothing (e.g., raincoats), detergents, adhesives, personal-care products (fragrances, nail polish, soap), and is commonly found in vinyl (PVC) plastic products (toys, plastic bags) (13). In a national study, some phthalates have been found in 97% (5) of the people tested with generally higher concentrations found in children (6). In animal studies, health effects range from developmental and reproductive toxicity to damage to the liver (7,8).

Bisphenol A (BPA) is used when making polycarbonate and other plastic products. BPA is widely used in consumer products (infant bottles, protective coating in food cans, toys, containers, and personal care products) (13). It can leach from these products and potentially cause harm to those in contact with them. It can also have estrogen (female hormone)-like effects, which may impact biological systems at very low doses. Children may be exposed via: ingestion (diet and sucking/mouthing plastics), inhalation (of dust), and dermal contact. A national study found BPA in the urine of over 90% of people tested; children were found to have higher levels than adults (9). BPA has been found in pregnant women, umbilical cord blood, and placentas at levels demonstrated in animals to alter development (10).

COMMENTS: The Consumer Product Safety Improvement Act (CPSIA) empowers the U.S. Consumer Product Safety Commission (CPSC) to set regulations protecting consumers of these products with testing and labeling. As of this writing new CPSC requirements are under development. Consumers of products for children should look for products that state “phthalate-free” or “BPA-free” or certification by Toy Safety Certification Program (TSCP) or American National Standards Institute (ANSI).

Following are guidelines by which caregivers/teachers may reduce exposure to phthalates and BPA:

When possible, opt for glass, porcelain or stainless steel containers, particularly for hot food or liquids (12);
If using plastic, do not use plastic or plastic wrap for heating in microwave (try substituting a paper towel or waxpaper for covering foods) (12);
Check the symbol on the bottom of the plastic items including toys before buying. The plastics industry has developed identification codes to label different types of plastic. The identification system divides plastic into seven distinct types and uses a number code generally found on the bottom of containers. For a table that explains the seven code system, go to http://www.natureworksllc.com/the-ingeo-journey/end-of-life-options/recycling/plastic-codes.aspx. Contact the manufacturer if there is a question about the chemical content of a plastic item;
Best plastic choices are 1 (PETE), 2 (HDPE), 4 (LDPE), 5 (PP) and plastics labeled “phthalate-free” or “BPA-free”;
Avoid plastics labeled 3 (V), 6 (PS), and 7 (PC). Polycarbonate containers that contain BPA usually have a number 7 on the bottom;
Use alternatives to polycarbonate “7” infant bottles. Alternatives include glass infant bottles, BPA free, and products made of safer plastics such as polyethylene and polypropylene that are less likely to release harmful plasticizers (12) (safer non-polycarbonate bottles are usually cloudy and squeezable);
Do not use latex rubber nipples or plastic bottle liners;
Avoid canned foods when possible;
If infant formula is used, it is best to use powdered formula in a can;
Do not place plastics in the dishwasher;
If using hard polycarbonate plastics (PC) such as water bottles/infant bottles, do not use for warm/hot liquids;
Dispose of plastic bottles when they are old and scratched;
Toys should be certified by the Toy Safety Certification Program (TSCP) or American National Standards Institute (ANSI).

For more tips on safer food use of plastics, see the Institute for Agriculture and Trade Policy (IATP) Website: Smart Plastics Guide: Healthier Food Uses of Plastics, available at http://www.iatp.org/foodandhealth/.

For more tips on safer alternatives to PVC plastics, see the Center for Health, Environment, and Justice (CHEJ) Website: The Campaign for Safe Healthy Consumer Products, available at http://www.besafenet.com/pvc/.

For general information on plastics and on how to recycle them, see the U.S. Environmental Protection Agency (EPA) Website: Common Wastes and Materials: Plastics, at http://www.epa.gov/osw/conserve/materials/plastics.htm.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. Eco-Healthy Child Care. 2010. Plastics and plastic toys. Children’s Environmental Health Network. http://www.cehn.org/files/Plastics_Plastic_Toys_Dec2010.pdf.

2. Healthy Building Network. PVC plastic: PVC facts. http://www
.healthybuilding.net/pvc/facts.html.

3. Huff, J. 1982. Di(2-ethylhexyl) adipate: Condensation of the carcinogenesis bioassay, technical report. Environ Health Perspectives 45:205-7.

4. Kluwe, W. M. 1986. Carcinogenic potential of phthalic acid esters and related compounds: Structure-activity relationships. Environ Health Perspectives 65:271-78.

5. Silva, M. J., D. B. Barr, J. A. Reidy, et al. 2004. Urinary levels of seven phthalate metabolites in the U.S. population from the National Health and Nutrition Examination Survey (NHANES), 1999-2000. Environ Health Perspectives 112:331-38.

6. Kolarik, B., K. Naydenov, M. Larsson, et al. 2008. The association between phthalates in dust and allergic diseases among Bulgarian children. Environ Health Perspectives 116:98-103.

7. Centers for Disease Control and Prevention (CDC). 2009. Fourth national report on human exposure to environmental chemicals. Atlanta, GA: CDC. http://www.cdc.gov/exposurereport/pdf/FourthReport.pdf.

8. Blount, B. C., M. Silva, S. Caudill, et al. 2000. Levels of seven urinary phthalate metabolites in a human reference population. Environ Health Perspectives 108:979-82.

9. Calafat, A. M., X. Ye, L. Wong, et al. 2008. Exposure of the U.S. population to bisphenol A and 4-tertiary-octylphenol: 2003-2004. Environ Health Perspectives 116:39-44.

10. Ikezuki, Y., O. Tsutsumi, Y. Takai, Y. Kamei, Y. Taketani. 2002. Determination of bisphenol A concentrations in human biological fluids reveals significant early prenatal exposure. Human Reproduction 17:2839-41.

11. American Academy of Pediatrics. 2007. Technical report: Pediatric exposure and potential toxicity of phthalate plasticizers. Pediatrics 119:1031.

12. California Childcare Health Program (CCHP). 2008. Banning chemicals called phthalates in childhood products. Berkeley, CA: CCHP. http://www.ucsfchildcarehealth.org/pdfs/factsheets/BannedChem_0308.pdf.

13. U.S. Consumer Product Safety Commission. 2009. Prohibition on the sale of certain products containing specified phthalates. http://www.cpsc.gov/about/cpsia/108rfc.pdf.

STANDARD 5.2.9.10: Prohibition of Poisonous Plants

Poisonous or potentially harmful plants are prohibited in any part of a child care facility that is accessible to children. All plants not known to be nontoxic should be identified and checked by name with the local poison center (1-800-222-1222) to determine safe use.

RATIONALE: Plants are important to our health and well-being and are a great lesson in learning to understand and respect our environment. However, some plants can be harmful when eaten or touched (1,2). Plants are among the most common household substances that children ingest. Determining the toxicity of every commercially available household plant is difficult. A more reasonable approach is to keep any unknown plant out of the environment that children use. All outdoor plants and their leaves, fruit, and stems should be considered potentially toxic (1).

COMMENTS: Cuttings, trimmings, and leaves from potentially harmful plants must be disposed of safely so children do not have access to them.

For toxic, frequently ingested products and plants, see the American Academy of Pediatrics’ (AAP) Handbook of Common Poisonings in Children, available at http://www.aap.org.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. American Academy of Pediatrics. 2011. Handbook of common poisonings in children. 4th ed. Elk Grove Village, IL: AAP.

STANDARD 5.2.9.11: Chemicals Used to Control Odors

The use of the following should be prohibited:

Incense;
Moth crystals or moth balls;
Chemical air fresheners; and
Toilet/urinal deodorizer blocks.

RATIONALE: Many chemicals are sold to cover up noxious odors or ward off pests. Many of these chemicals are hazardous (1). As an alternative, caregivers/teachers should remove the source of noxious odors to the extent possible by dissipating noxious odors through cleaning and ventilation (e.g., opening windows) and controlling pests using nontoxic methods.

Toilet/urinal deodorizer blocks commonly contain para-dichlorobenzene (PDCB), a toxic chemical, designated as a possible human carcinogen (2), that has no cleaning function. These deodorizers only serves to mask odors that should be eliminated by proper cleaning.

COMMENTS: Contact the poison center at 1-800-222-1222 or the U.S. Environmental Protection Agency (EPA) Regional offices listed in the federal agency section of the telephone directory for assistance in identifying hazardous products.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. Fiene, R. 2002. 13 indicators of quality child care: Research update. Washington, DC: U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation. http://aspe.hhs.gov/hsp/ccquality-ind02/.

2. Suhua, W., L. Rongzhu, Y. Changqing, X. Guangwei, H. Fangan, J. Junjie, X. Wenrong, M. Aschner. 2010. Lipid peroxidation and changes of trace elements in mice treated with paradichlorobenzene. Biol Trace Elem Res 136:320-36.

STANDARD 5.2.9.12: Treatment of CCA Pressure-Treated Wood

A penetrating coating (e.g., oil-based, semi-transparent stain) should be applied every six months to all chromated copper arsenate (CCA)-treated surfaces to which a child may have access.

RATIONALE: The Consumer Product Safety Commission advises that arsenic exposure in children from contact with CCA-treated wood playground structures is estimated to be about 3.5 micrograms each day that includes a playground visit (1).The health effects related to arsenic include irritation of the stomach and intestines, birth or developmental effects, cancer, and infertility and miscarriages in women (1,2,3). Children can be exposed to the arsenic in CCA-treated wood by touching surfaces made from this material (1). Based on limited data, applying certain penetrating coatings may reduce the amount of arsenic that comes out of the wood (1).

COMMENTS: CCA-treated wood is found extensively in outdoor structures, furniture, and play equipment built prior to December 31, 2003 when manufacturers of CCA reached a voluntary agreement with the Environmental Protection Agency (EPA) to end the manufacture of CCA-treated wood for most consumer applications. EPA has indicated that some stocks of wood treated with CCA before this date might have been found on shelves until mid-2004. If a wooden structure was built prior to December 31, 2003 and is not of a rot-resistant type of wood (e.g., redwood, cedar) it is safe to assume it does contain arsenic. If the date the equipment was built is unknown or was built shortly after December 31, 2003, test kits are available from many common retailers.

Caregivers/teachers should be aware that children are exposed to arsenic through their hand-to-mouth activity while and after playing on CCA-treated wood playsets. To minimize the risk of exposure to arsenic from CCA-treated playsets, caregivers/teachers and children should thoroughly wash their hands with soap and water immediately after outdoor play, especially before eating (4). Children should also be discouraged from eating while on CCA-treated playsets. These precautions should be followed even if a protective coating has been applied to CCA-treated wood.

While available data are very limited, some studies suggest that applying certain penetrating coatings (e.g., oil-based, semi-transparent stains) on a regular basis may reduce the migration of wood preservative chemicals from CCA-treated wood (2). In selecting a finish, caregivers/teachers should be aware that, in some cases, “film-forming” or non-penetrating stains on outdoor surfaces such as decks and fences are not recommended, as subsequent peeling and flaking may ultimately have an impact on durability as well as exposure to the preservatives in the wood.

To eliminate the risk of children’s exposure to arsenic from CCA-treated wood it is recommended it be replaced. If this is not feasible, replacing the components children come in contact with the most (e.g., handrails, retaining walls) will limit their exposure.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. U.S. Consumer Product Safety Commission (CPSC). Fact sheet: Chromated copper arsenate (CCA)-treated wood used in playground equipment. http://www.cpsc.gov/phth/ccafact.html.

2. U.S. Environmental Protection Agency. 2008. Chromated copper arsenate (CCA): Consumer advice related to CCA-treated wood. http://www.epa.gov/oppad001/reregistration/cca/cca_consumer
_doc.htm.

3. U.S. Environmental Protection Agency. 2008. Chromated Copper Arsenate (CCA): Final probabilistic risk assessment for children who contact CCA-treated playsets and decks. http://www.epa.gov/oppad001/reregistration/cca/final_cca_factsheet.htm.

4. Gray, S., J. Houlihan. 2002. All hands on deck: Nationwide consumer testing of backyard decks and playsets shows high levels of arsenic on old wood. Washington, DC: Environmental Working Group. http://www.ewg.org/files/allhandsondeck.pdf.

STANDARD 5.2.9.13: Testing for Lead

In all centers, both exterior and interior surfaces covered by paint with lead levels of 0.06% and above, or equal to or greater than 1.0 milligram per square centimeter and accessible to children, should be removed by a safe chemical or physical means or made inaccessible to children, regardless of the condition of the surface.

In large and small family child care homes, flaking or deteriorating lead-based paint on any surface accessible to children should be removed or abated according to health department regulations. Where lead paint is removed, the surface should be refinished with lead-free paint or nontoxic material. Sanding, scraping, or burning of lead-based paint surfaces should be prohibited. Children and pregnant women should not be present during lead renovation or lead abatement activities.

Any surface and the grounds around and under surfaces that children use at a child care facility, including dirt and grassy areas should be tested for excessive lead in a location designated by the health department. Caregivers/teachers should check the U.S. Consumer Product Safety Commission’s Website, http://www.cpsc.gov, for warnings of potential lead exposure to children and recalls of play equipment, toys, jewelry used for play, imported vinyl mini-blinds and food contact products. If they are found to have toxic levels, corrective action should be taken to prevent exposure to lead at the facility. Only nontoxic paints should be used.

RATIONALE: Ingestion of lead paint can result in high levels of lead in the blood, which affects the central nervous system and can cause mental retardation (2,3). Paint and other surface coating materials should comply with lead content provisions of the Code of Federal Regulations, Title 16, Part 1303.

Some imported vinyl mini-blinds contain lead and can deteriorate from exposure to sunlight and heat and form lead dust on the surface of the blinds (1). The U.S. Consumer Product Safety Commission (CPSC) recommends that consumers with children six years of age and younger remove old vinyl mini-blinds and replace them with new mini-blinds made without added lead or with alternative window coverings. See Comments for resources.

Lead is a neurotoxin. Even at low levels of exposure, lead can cause reduction in a child’s IQ and attention span, and result in reading and learning disabilities, hyperactivity, and behavioral difficulties. Lead poisoning has no “cure.” These effects cannot be reversed once the damage is done, affecting a child’s ability to learn, succeed in school, and function later in life. Other symptoms of low levels of lead in a child’s body are subtle behavioral changes, irritability, low appetite, weight loss, sleep disturbances, and shortened attention span (2,3).

COMMENTS: House paints made before 1978 may contain lead. If there is any doubt about the presence of lead in existing paint, contact the health department for information regarding testing. Lead is used to make paint last longer. The amount of lead in paint was reduced in 1950 and further reduced again in 1978. Houses built before 1950 likely contain lead paint, and houses built after 1950 have less lead in the paint. House paint sold today has little or no lead. Lead is prohibited in contemporary paints. Lead-based paint is the most common source of lead poisoning in children (3).

In buildings where lead has been removed from the surfaces, lead paint may have contaminated surrounding soil. Therefore, the soil in play areas around these buildings should be tested. Outdoor play equipment was commonly painted with lead-based paints, too. These structures and the soil around them should be checked if they are not known to be lead-free.

The danger from lead paint depends on:

Amount of lead in the painted surface;
Condition of the paint;
Amount of lead (from paint, chips, soil, or dust) that gets into the child.

Children nine months through five years of age are at the greatest risk for lead poisoning. Most children with lead poisoning do not look or act sick. A blood lead test is the only way to know if children are being lead poisoned. Children should have a test result below 10 ug/dL (2,4).

A booklet called Protect Your Family from Lead in Your Home is available from the U.S. Environmental Protection Agency (EPA), the CPSC, and U.S. Department of Housing and Urban Development (HUD). The EPA also has a pamphlet called Finding a Qualified Lead Professional for Your Home, which provides information on how to identify qualified lead inspectors and risk assessors. Before starting a renovation project on a facility built before 1978, the contractor or property owner is required to have parents/guardians sign a pre-renovation disclosure form, which indicates that the parents/guardians received Renovate Right: Important Lead Hazard Information for Families, Child Care Providers, and Schools, available at http://www.epa.gov/lead/pubs/renovaterightbrochure.pdf. The contractor must also make renovation information available to the parents/guardians of children under age six that attend child care centers or homes, and provide to owners and administrators of pre-1978 child care facilities to be renovated a copy of Renovate Right: Important Lead Hazard Information for Families, Child Care Providers, and Schools (5).

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. U.S. Consumer Product Safety Commission (CPSC). 1996. CPSC finds lead poisoning hazard for young children in imported vinyl miniblinds. http://www.cpsc.gov/CPSCPUB/PREREL/PRHTML96/96150.html.

2. Centers for Disease Control and Prevention (CDC). 2005. Preventing lead poisoning in young children. Atlanta, GA: CDC. http://www.cdc.gov/nceh/lead/publications/PrevLeadPoisoning.pdf.

3. U.S. Environmental Protection Agency (EPA). 2010. The lead-safe certified guide to renovate right. Washington, DC: EPA. http://www
.epa.gov/lead/pubs/renovaterightbrochure.pdf.

4. Binns, H. J., C. Campbell, M. J. Brown. 2007. Interpreting and managing blood lead levels of less than 10 mg/dL in children and reducing childhood exposure to lead: Recommendations of the Centers for Disease Control and Prevention Advisory Committee on Childhood Lead Poisoning Prevention. Pediatrics 120: e1285-98.

5. U.S. Environmental Protection Agency. 2010. Lead in paint, dust, and soil: Renovation, repair and painting (RRP). http://www.epa
.gov/lead/pubs/renovation.htm.

STANDARD 5.2.9.14: Shoes in Infant Play Areas

Adults and children should remove or cover shoes before entering a play area used by a specific group of infants. These individuals, as well as the infants playing in that area, may wear shoes, shoe covers, or socks that are used only in the play area for that group of infants.

RATIONALE: When infants play, they touch the surfaces on which they play with their hands, and then put their hands in their mouths. Lead and other toxins in soil around a facility can be a hazard when tracked into a facility on shoes (1).

COMMENTS: Facilities can meet this standard in several ways. The facility can designate contained play surfaces for infant play on which no one walks with shoes. Individuals can wear shoes or slippers that are worn only to walk in the infant play area or they can wear clean cloth or disposable shoe covers over shoes that have been used to walk outside the infant play area.

This standard applies to shoes that have been worn outdoors, in the play areas of other groups of children, and in toilet and diaper changing areas. All of these locations are potential sources of contamination.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. U.S. Environmental Protection Agency. 2009. Lead in paint, dust and soil: Basic information. http://www.epa.gov/lead/pubs/
leadinfo.htm.

STANDARD 5.2.9.15: Construction and Remodeling During Hours of Operation

Construction, remodeling, painting, or alterations of structures during child care operations should be isolated from areas where children are present and done in a manner that will prevent hazards or unsafe conditions (such as fumes, dust, safety, and fire hazards).

Low volatile organic compounds (VOC) paints should be used in child care areas. Painted areas should be ventilated until they are fully dry and odor-free before children are permitted to occupy them.

RATIONALE: Children should be protected from activities and equipment associated with construction and renovation of the facility that may cause injury or illness.

Volatile organic compounds (VOCs) are emitted as gases from certain solids or liquids. VOCs include a variety of chemicals, some of which may have short- and long-term adverse health effects. Some organic compounds can cause cancer in animals; some are suspected or known to cause cancer in humans. Key signs or symptoms associated with exposure to VOCs include conjunctival irritation, nose and throat discomfort, headache, allergic skin reaction, dyspnea, declines in serum cholinesterase levels, nausea, emesis, epistaxis, fatigue, and dizziness (2).

COMMENTS: Ideally, construction and renovation work should be done when the facility is not in operation and when there are no children present. Many facilities arrange to schedule such work on weekends. If this is not possible, temporary barriers can be constructed to restrict access of children to those areas under construction. A plastic vapor barrier sheet could be temporarily hung to prevent dust and fumes from drifting into those areas where children are present. However, the minimum number of egress/escape paths should be maintained without compromise during the rehabilitation work.

Common renovation activities like sanding, cutting, and demolition can create hazardous lead dust and chips by disturbing lead-based paint, which can be harmful to adults and children. U.S. Environmental Protection Agency (EPA) regulations require persons performing renovation, repair, and painting activities in homes, child care facilities, and schools built before 1978 to give a renovation-specific lead hazard information pamphlet to the owners and occupants of the building. Persons performing these activities in child care facilities and schools must also provide general information about the renovation to the parents/guardians of children using the facility. The renovation-specific pamphlet, called Renovate Right: Important Lead Hazard Information for Families, Child Care Providers, and Schools, is available at http://www.epa.gov/lead/pubs/
renovaterightbrochure.pdf (1).

EPA regulations require training and certification of renovation contractors and building maintenance personnel performing renovation, repair and painting projects that disturb lead-based paint in homes, child care facilities, and schools built before 1978. They are required to follow specific work practices to prevent lead contamination. The EPA recommends that anyone performing renovation, repair, and painting projects in pre-1978 homes, child care facilities and schools follow lead-safe work practices, which include containing the work area to keep dust and debris inside the area, minimizing the creation of dust, and cleaning the work area thoroughly after the project has been completed.

The two most effective counter-measures against VOCs are to avoid VOC-emitting products and to ventilate areas when using VOC-emitting products. Caregivers/teachers can choose from many high quality latex-based paints that emit low levels of VOCs. Some major paint manufacturers offer special odorless VOC-free products (3).

When planning or beginning new construction, consideration should be given to using the least toxic or non-toxic materials.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. U.S. Environmental Protection Agency (EPA). 2010. The lead-safe certified guide to renovate right. Washington, DC: EPA. http://
www.epa.gov/lead/pubs/renovaterightbrochure.pdf.

2. U.S. Environmental Protection Agency. 2010. An introduction to indoor air quality: Volatile organic compounds (VOCs). http://
www.epa.gov/iaq/voc.html.

3. American Academy of Pediatrics Pennsylvania Chapter, Health Child Care Pennsylvania. Indoor air pollution. Health Link Online 21:3. http://www.ecels-healthychildcarepa.org/content/9-4-09%20v8vol%2021%20fall%20%202009%20HL%20ONLINE.pdf.

5.3 General Furnishings and Equipment

Note to Reader: See Chapter 6 for Play Area/Playground Equipment Requirements

5.3.1 General Furnishings and Equipment Requirements

STANDARD 5.3.1.1: Safety of Equipment, Materials, and Furnishings

Equipment, materials, furnishings, and play areas should be sturdy, safe, and in good repair and should meet the recommendations of the U.S. Consumer Product Safety Commission (CPSC) for control of the following safety hazards:

Openings that could entrap a child’s head or limbs;
Elevated surfaces that are inadequately guarded;
Lack of specified surfacing and fall zones under and around climbable equipment;
Mismatched size and design of equipment for the intended users;
Insufficient spacing between equipment;
Tripping hazards;
Components that can pinch, sheer, or crush body tissues;
Equipment that is known to be of a hazardous type;
Sharp points or corners;
Splinters;
Protruding nails, bolts, or other components that could entangle clothing or snag skin;
Loose, rusty parts;
Hazardous small parts that may become detached during normal use or reasonably foreseeable abuse of the equipment and that present a choking, aspiration, or ingestion hazard to a child;
Strangulation hazards (e.g., straps, strings, etc.);
Flaking paint;
Paint that contains lead or other hazardous materials;
Tip-over hazards, such as chests, bookshelves, and televisions.

RATIONALE: The hazards listed in this standard are those found by CPSC to be most commonly associated with injury (1).

A study conducted by the Center for Injury Research and Policy of The Research Institute at Nationwide Children’s Hospital found that from 1990-2007 an average of nearly 15,000 children younger than eighteen years of age visited emergency departments annually for injuries received from furniture tip-overs (2).

COMMENTS: Equipment and furnishings that are not sturdy, safe, or in good repair, may cause falls, entrap a child’s head or limbs, or contribute to other injuries. Disrepair may expose objects that are hazardous to children. Freedom from sharp points, corners, or edges should be judged according to the Code of Federal Regulations, Title 16, Section 1500.48, and Section 1500.49. Freedom from small parts should be judged according to the Code of Federal Regulations, Title 16, Part 1501. To obtain these publications, contact the Superintendent of Documents of the U.S. Government Printing Office. For assistance in interpreting the federal regulations, contact the CPSC; the CPSC also has regional offices.

Used equipment and furnishings should be closely inspected to determine whether they meet this standard before allowing them to be placed in a child care facility. If equipment and furnishings have deteriorated to a state of disrepair, where they are no longer sturdy or safe, they should be removed from all areas of a child care facility to which children have access. Staff should check on a regular basis to ensure that toys and equipment used by children have not been recalled. A list of recalls can be accessed at http://www.cpsc.gov, or facilities can subscribe to an email notification list from the CPSC (see also, RELATED STANDARDS).

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. U.S. Consumer Product Safety Commission (CPSC). 2008. Public playground safety handbook. Bethesda, MD: CPSC. http://
www.cpsc.gov/cpscpub/pubs/325.pdf.

2. Gottesman, B. L., L. B. McKenzie, K. A. Conner, G. A. Smith. 2009. Injuries from furniture tip-overs among children and adolescents in the United States, 1990-2007. Clin Pediatrics 48:851.

STANDARD 5.3.1.2: Product Recall Monitoring

Staff should, on a monthly basis, seek information on recalls of juvenile products that may be in use at the facility. Of particular importance are recalls related to cribs, bassinets, and portable play yards that may be used for infant sleep. Additionally, caregivers/teachers should be aware of recalls of toys, playground equipment, strollers, and any other product routinely used by children in the child care facility.

RATIONALE: Product recalls are often ineffective at removing hazardous products from use because the owners/users are not aware of the recall. Children have died in child care settings from injury related to sleep equipment that had been recalled.

COMMENTS: The U.S. Consumer Product Safety Commission (CPSC) offers a free subscription email service for product recall notices at http://www.cpsc.gov/cpsclist.aspx. Subscribers can note that they only want to receive recalls related to juvenile products.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

STANDARD 5.3.1.3: Size of Furniture

Furniture should be durable and child-sized or adapted for children’s use. Tables should be between waist and mid-chest level of the intended child-user and allow the child’s feet to rest on a firm surface while seated for eating.

RATIONALE: Children cannot safely or comfortably use furnishings that are not sized for their use. When children eat or work at tables that are above mid-chest level, they must reach up to get their food or do their work instead of bringing the food from a lower level to their mouth and having a comfortable arrangement when working to develop their fine-motor skills. When eating, this leads to scooping food into the mouth instead of eating more appropriately. When working, this leads to difficulty succeeding with hand-eye coordination. When children do not have a firm surface on which to rest their feet, they cannot reposition themselves easily if they slip down. This can lead to poor posture and increased risk of choking. When children use chairs that are too high for them, they are at risk for falling.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

STANDARD 5.3.1.4: Surfaces of Equipment, Furniture, Toys, and Play Materials

Equipment, furnishings, toys, and play materials should have smooth, nonporous surfaces or washable fabric surfaces that are easy to clean and sanitize, or be disposable.

Walls, ceilings, floors, furnishings, equipment, and other surfaces should be suitable to the location and the users. They should be maintained in good repair, free from visible soil and in a clean condition. Programs should choose materials with the least probability of containing materials that off-gas toxic elements such as volatile organic compounds (VOCs), formaldehyde, or toxic flame retardants (polybrominated diphenylethers [PBDE]). Carpets, porous fabrics, and other surfaces that trap soil and potentially contaminated materials should not be used in toilet rooms, diaper change areas, and areas where food handling occurs (1).

Areas used by staff or children who have allergies to dust mites or components of furnishings or supplies should be maintained according to the recommendations of primary care providers.

RATIONALE: Few young children practice good hygiene. Messy play is developmentally appropriate in all age groups, and especially among very young children, the same group that is most susceptible to infectious disease. These factors lead to soiling and contamination of equipment, furnishings, toys, and play materials. To avoid transmission of disease within the group, these materials must be easy to clean and sanitize.

Formaldehyde and toxic flame retardants are the toxins of most concern in household furnishings, as they are both commonly found in furniture and carpets. Formaldehyde is a flammable, colorless gas that has a pungent odor. It is a human carcinogen, an asthma trigger, and a suspected neurological, reproductive, and liver toxin. People are exposed by breathing contaminated air from pressed wood furniture, flooring, and after application of certain paints, fabrics, and household cleaners. Toxic Flame Retardants (PBDEs) are widely used in furniture foam, carpet padding, back coatings for draperies and upholstery, plastics, building materials, and electrical appliances. It is believed that more than 80% of PBDE exposure is from house dust. PBDEs persist in the environment and accumulate in living things. Health concerns associated with PBDE exposure include liver, thyroid, and neurodevelopmental toxicity.

Carpets and porous fabrics are not appropriate for some areas because they are difficult to clean and sanitize. Disease-causing microorganisms have been isolated from carpets. Caregivers/teachers must remove illness-causing materials. Many allergic children have allergies to dust mites, which are microscopic insects that ingest the tiny particles of skin that people shed normally every day. Dust mites live in carpeting and fabric but can be killed by frequent washing and use of a clothes dryer or mechanical, heated dryer. Restricting the use of carpeting and furnishings to types that can be laundered regularly helps. Other children may have allergies to animal products such as those with feathers, fur, or wool, while some may be allergic to latex.

COMMENTS: Toys that can be washed in a mechanical dishwasher that meets the standard for cleaning and sanitizing dishes can save labor, if the facility has a dishwasher. Otherwise, after the children have used them, these toys can be placed in a tub of detergent water to soak until the staff has time to scrub, rinse, and sanitize the surfaces of these items. Except for fabric surfaces, nonporous surfaces are best because porous surfaces can trap organic material and soil. Fabric surfaces that can be laundered provide the softness required in a developmentally appropriate environment for young children. If these fabrics are laundered when soiled, the facility can achieve cleanliness and sanitation. When a material cannot be cleaned and sanitized it should be discarded.

One way to measure compliance with the standard for cleanliness is to wipe the surface with a clean mop or clean rag, and then insert the mop or rag in cold rinse water. If the surface is clean, no residue will appear in the rinse water.

Disposable gloves are commonly made of latex or vinyl. If latex-sensitive individuals are present in the facility, only vinyl or nitrile disposable gloves should be used.

Tips for Reducing Exposure to Formaldehyde and PBDEs:

Avoid wall-to-wall carpets;
Limit use of pressed wood products that are made with adhesives that contain urea-formaldehyde (UF) resins; choose solid-wood furniture;
Do not leave foam exposed (this includes furniture and toys, such as stuffed animals);
Keep dust levels down;
Vacuum often – use a high efficiency particulate air (HEPA) filter vacuum cleaner;
Ventilate while cleaning;
Except in emergency situations, remove shoes prior to going indoors;
Clean area rugs with biodegradable cleaners;
Choose floor coverings that are made with natural fibers (cotton, hemp, and wool) that are naturally fire-resistant and contain fewer chemicals (2).

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. U.S. Environmental Protection Agency. Polybrominated diphenylethers (PBDEs). http://www.epa.gov/oppt/pbde/.

2. Eco-Healthy Child Care (EHCC). Furniture and carpets. Washington, DC: EHCC. http://www.oeconline.org/resources/publications/factsheetarchive/Furniture and carpets.pdf.

STANDARD 5.3.1.5: Placement of Equipment and Furnishings

Equipment and furnishings should be placed to help prevent collisions and injuries, ensure proper supervision while meeting the objectives of the curriculum, and permit freedom of movement by the children. Televisions should be anchored or mounted to prevent tipping over.

RATIONALE: The placement of furnishings plays a significant role in the way space is used. If the staff places furnishings in such a way that they create large runways, children will run in this area. If the staff places furnishings that children can climb in locations where climbing is unsafe, this adds risk to the environment. Placement of furnishings should address the needs of the children for stimulation and development and at the same time help to prevent collisions and injury. Equipment and furnishings should be arranged so that a caregiver/teacher can easily view the children from different positions in the room.

From 2000 through 2006, the U.S. Consumer Product Safety Commission (CPSC) reported 134 tip-over related deaths involving children five years old or younger (1). Additionally, CPSC estimates that in 2006 at least 16,300 children five years old and younger were treated in U.S. hospital emergency rooms because of injuries associated with TV, furniture, and appliance tip-overs (1).

Industry standards require that TV stands, chests, bureaus, and dressers pass a stability test. If a piece of furniture violates these standards, the product can be subject to a safety recall.

COMMENTS: To prevent children from falling out of windows, the safest place for chairs and other furniture is away from windows. Chairs and other furnishings that children can easily climb should be kept away from cabinets and shelves to discourage children from climbing to a dangerous height or reaching for something hazardous.

To help prevent tip-over hazards, CPSC offers the following safety tips:

Verify that furniture is stable on its own (for added security, anchor to the floor or attach to the wall all entertainment units, TV stands, bookcases, shelving, and bureaus using appropriate hardware, such as brackets, screws, or toggle bolts);
Place televisions on sturdy furniture appropriate for the size of the TV or on a low-rise base;
Push the TV as far back as possible from the front of its stand;
Place electrical cords out of a child’s reach, and teach children not to play with the cords;
Remove items that might tempt kids to climb, such as toys and remote controls, from the top of the TV and furniture (1).

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. U.S. Consumer Product Safety Commission (CPSC). The tipping point: Preventing TV, furniture, and appliance tip-over deaths and injuries. http://www.cpsc.gov/cpscpub/pubs/5004.pdf.

STANDARD 5.3.1.6: Floors, Walls, and Ceilings

Floors, walls, and ceilings should be in good repair, and easy to clean when soiled. Only smooth, nonporous surfaces should be permitted in areas that are likely to be contaminated by body fluids or in areas used for activities involving food. The hand contact and splash areas of doors and walls should be covered with a finish that is at least as cleanable as an epoxy finish or enamel paint.

Floors should be free from cracks, bare concrete, dampness, splinters, sliding rugs, and uncovered telephone jacks or electrical outlets.

Carpeting should be clean, in good repair, nonflammable, and nontoxic.

Each bathroom, toilet room, and shower room floor and wall should be impervious to water up to a height of five feet and capable of being kept in a clean and sanitary condition.

All public bathrooms should be constructed of materials that are impervious to moisture, bacteria, mold, or fungus growth. The floor-to-wall joints should be constructed to provide a sanitary cove with a minimum radius of three-eighths inch. Flooring material should be appropriate for bathroom use (e.g., vinyl sheet, ceramic tile, fiber-reinforced plastic, epoxy products). All wall surfaces within twenty-four inches of a water closet or urinal should be ceramic tile to a height of forty-eight inches (1).

RATIONALE: Messy play and activities that lead to soiling of floors and walls is developmentally appropriate in all age groups, but especially among very young children, the same group that is most susceptible to infectious disease. These factors lead to soiling and contamination of floors and walls. A smooth, nonporous surface prevents deterioration and mold and is easier to clean and sanitize; therefore, helps prevent the spread of infectious diseases. To avoid transmission of disease within the group, and to maintain an environment that supports learning cleanliness as a value, all surfaces should be kept clean.

Cracked or porous floors cannot be kept clean and sanitary. Dampness promotes the growth of mold. Rugs without friction backing or underlayment and uncovered telephone jacks or electrical outlets in floors are tripping hazards. Damaged floors, walls or ceilings can expose underlying hazardous structural elements and materials. Surface materials must not pose health, safety, or fire hazards.

COMMENTS: Carpeted floors are not smooth, and therefore, carpeting is not consistent with this standard, except for area carpets for activities that do not involve food or contact with body fluids. Many family child care homes and indoor playrooms of centers use wall-to-wall carpeting on the floor. Although carpeted floors may be more comfortable to walk and play on, smooth floor surfaces provide a better environment for children with allergies (2).

Washable rugs can be placed on smooth floor surfaces. By using friction backings or underlayment, removable and washable carpeting can be used on smooth floor surfaces safely.

When facilities use carpeting or sound-absorbing materials on walls and ceilings, these materials must not be used in areas where contamination with body fluids or food is likely because they are difficult to clean. Thus, carpeted walls should not be present around the diaper change areas, in toilet rooms, in food preparation areas, or where food is served.

Obtain ASTM D2859-06 Standard Test Method for Flammability of Finished Textile Floor Covering Materials, for flammability of finished materials from ASTM International. Ask the local fire marshal for fire safety code requirements.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. City of Edina, MN. 2000. City Code § 455. http://www.ci.edina
.mn.us/CityCode/L5-01_CityCodeSect0455.htm.

2. Davis, J. L. Breathe easy: 5 ways to improve indoor air quality. http://www.webmd.com/health-ehome-9/indoor-air-quality.

STANDARD 5.3.1.7: Facility Arrangements to Minimize Back Injuries

The child care setting should be organized to reduce the risk of back injuries for adults provided that such measures do not pose hazards for children or affect the implementation of developmentally appropriate practice. Furnishings and equipment should enable caregivers/teachers to hold and comfort children and enable their activities while minimizing the need for bending and for lifting and carrying heavy children and objects. Caregivers/teachers should not routinely be required to use child-sized chairs, tables, or desks.

RATIONALE: Back strain can arise from adult use of child-sized furniture. Analysis of worker compensation claims shows that employees in the service industries, including child care, have an injury rate as great as or greater than that of workers employed in factories. Back injuries are the leading type of injury (1). Appropriate design of work activities and training of workers can prevent most back injuries. The principles to support these recommendations (see Comments) are standard principles of ergonomics, in which jobs and workplaces are designed to eliminate biomechanical hazards.

In a statewide (Wisconsin) survey of health status, behaviors, and concerns, 446 randomly selected early childhood professionals, directors, center teachers, and family providers, reported dramatic changes in frequency of backache and fatigue symptoms since working in child care (2).

COMMENTS: Some approaches to reduce risk are:

Adult-height changing tables;
Small, stable stepladders, stairs, and similar equipment to enable children to climb to the changing table or other places to which they would otherwise be lifted, without creating a fall hazard;
Convenient equipment for moving children, reducing the necessity of carrying them;
Adult furniture that eliminates awkward sitting or working positions in all areas where adults work.

This standard is not intended to interfere with child-adult interactions or to create hazards for children. Modifications can be made in the environment to minimize hazards and injuries for both children and adults. Adult furniture has to be available at least for break times, staff meetings, etc.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. Brown, M. Z., S. G. Gerberich. 1993. Disabling injuries to childcare workers in Minnesota, 1985 to 1990: An analysis of potential risk factors. J Occup Med 1993 35:1236-43.

2. Grantz, R. R., A. Claffey. 1996. Adult health in child care: Health status, behaviors, and concerns of teachers, directors, and family child care providers. Early Child Res Q. 11:243-67.

STANDARD 5.3.1.8: High Chair Requirements

High chairs, if used, should have a wide base and a securely locking tray, along with a crotch bar/guard to prevent a child from slipping down and becoming entrapped between the tray and the seat. High chairs should also be equipped with a safety strap to prevent a child from climbing out of the chair. The safety strap should be fastened with every use. Caps or plugs on tubing should be firmly attached. Folding high chairs should have a locking device that prevents the high chair from collapsing. High chairs should be labeled or warranted by the manufacturer in documents provided at the time of purchase or verified thereafter by the manufacturer as meeting the ASTM International current Standard F404-08 Consumer Safety Specification for High Chairs. High chairs should be used in accordance with manufacturer’s instructions including following restrictions based on age and minimum/maximum weight of children.

Highchairs should be kept far enough away from a table, counter, wall or other surface so that the child can’t use them to push off or to grab potentially dangerous cords or objects.

RATIONALE: High chairs offer potential for entrapment, falls and other injuries. Current ASTM Standard F404-08 Consumer Safety Specifications for High Chairs covers:

Sharp edges;
Locking devices;
Drop tests of the tray;
Disengagement of the tray;
Load and stability of the chair;
Protection from coil springs and scissoring;
Maximum size of holes;
Restraining system tests;
Labeling;
Instructional literature.

COMMENTS: The general age of high chair users is about six-months- to three-years-old (1). Caregivers/teachers should transition children from high chairs to small tables and chairs as soon as they are capable of using them.

Manufacturers and vendors also may indicate a weight restriction for use by children who do not exceed thirty-seven pounds (2). The Juvenile Products Manufacturers Association (JPMA) has a testing and certification program for highchairs, play yards, carriages, strollers, walkers, gates, and expandable enclosures. When purchasing such equipment, consumers can look for labeling that certifies that these products meet the standards. ASTM also maintains a Website at http://www.astm.org with the latest standards on high chair specifications.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. U.S. Consumer Product Safety Commission (CPSC). Tips for your baby’s safety. http://www.cpsc.gov/cpscpub/pubs/200.html.

2. Lerner, N. D., R. W. Huey, B. M. Kotwal. 2001. Product profile report, 19. Rockville, MD: Westat.

STANDARD 5.3.1.9: Carriage, Stroller, Gate, Enclosure, and Play Yard Requirements

Each carriage, stroller, gate, enclosure, and play yard used should meet the corresponding ASTM International standard and should be so labeled on the equipment.

Carriages/strollers: ASTM F833-10 Standard Consumer Safety Performance Specification for Carriages and Strollers;
Gates/enclosures: ASTM F1004-10 Consumer Safety Specification for Expansion Gates and Expandable Enclosures;
Play yards: ASTM F406-10 Consumer Safety Specification for Non-Full-Size Baby Cribs/Play Yards.

RATIONALE: The presence of a Juvenile Products Manufacturers Association (JPMA) certification seal on products that are made for children ensures that the product is in compliance with the requirements of the current safety standard for that product at the time of manufacture.

COMMENTS: ASTM also maintains a website at http://www.astm.org with the latest standards on high chair specifications. For more information, contact the JPMA or the ASTM.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

STANDARD 5.3.1.10: Restrictive Infant Equipment Requirements

Restrictive infant equipment such as swings, stationary activity centers (e.g., exersaucers), infant seats (e.g., bouncers), molded seats, etc., if used, should only be used for short periods of time (a maximum of fifteen minutes twice a day) (1). Infants should not be placed in equipment until they are developmentally ready. Infants should be supervised when using equipment. Safety straps should be used if provided by the manufacturer of the equipment. Equipment should not be placed on elevated surfaces, uneven surfaces, near the top of stairs, or within reach of safety hazards. Stationary activity centers should be used with the stabilizing legs down in a locked position. Infants should not be allowed to sleep in equipment that was not manufactured as infant rest/sleep equipment. The use of jumpers (attached to a door frame or ceiling) and infant walkers is prohibited.

RATIONALE: Keeping an infant confined in a piece of infant equipment prevents an infant from active movement. Infants need the opportunity to play on the floor in a safe open area to develop their gross motor skills. If infants are not given the opportunity for floor time, their development can be hindered or delayed (2). The shape of an infant’s head can be affected if pressure is applied often and for long periods of time. This molding of the skull is called plagiocephaly. Due to the recommendation for back sleeping, an infant’s skull already experiences a great amount of time with pressure on the back of the head. When an infant is kept in a piece of infant equipment such as an infant seat or a swing, the pressure again is applied to the back of an infant’s head; thus, increasing the likelihood of plagiocephaly. To prevent plagiocephaly and to promote normal development, infants should spend time on their tummies when awake and supervised (3).

Infants are not well-protected in restrictive infant equipment and can be injured by animals or other children. Other children or animals can hang, climb, or jump on or into the equipment; therefore, supervision is required during use. Safety straps must be used to prevent injuries and deaths of infants; infants have fallen out of equipment or have been strangled when safety straps have not been used (10).

Equipment must always be placed on the floor and away from the top of stairs to prevent falls; infants have been injured when equipment has been pushed or pulled off an elevated surface or the top of stairs. The surface or floor under the equipment needs to be level to prevent the risk of the equipment tipping over. It is imperative for equipment to be placed out of the reach of potential safety hazards such as furniture, dangling appliance cords, curtain pulls, blind cords, hot surfaces, etc., so infants cannot reach them. The guideline of twenty minutes twice a day was designated so that use could be clearly measured and monitored (1).

Infants should not be placed in equipment, such as stationary activity centers, that require them to support their heads on their own unless they have mastered this skill. Allowing infants to sleep in infant equipment is not recommended due to the documented decrease in an infant’s oxygen saturation caused by the downward flexion of an infant’s head and neck due to an infant’s underdeveloped head and neck muscles (8,9). If an infant falls asleep in a piece of equipment, the infant should be promptly removed and placed flat on the infant’s back in a safety approved crib.

If the stabilizing legs on stationary activity centers are not down and locked in place, this puts an infant at risk of tipping over in the equipment as well as creates an unstable piece of equipment for a mobile infant to use to pull himself up.

Infant walkers are dangerous because they move children around too fast and to hazardous areas, such as stairs. The upright position also can cause children in walkers to “tip over” or can bring children close to objects that they can pull down onto themselves. In addition, walkers can run over or run into others, causing pain or injury. Many injuries, some fatal, have been associated with infant walkers (4-7). There have been several reports of spring/clamp breaking on various models of jumpers (jump-up seats) according to the CPSC (7).

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. National Association for Family Child Care, The Family Child Care Accreditation Project, Wheelock College. 2005. Quality standards for NAFCC accreditation, standard 4.5. 4th ed. Salt Lake City, UT: NAFCC. http://www.nafcc.org/documents/QualStd.pdf.

2. American Physical Therapy Association (APTA). 2008. Lack of time on tummy shown to hinder achievement of developmental milestones, say physical therapists. Press release.

3. American Academy of Pediatrics (AAP), Healthy Child Care America. 2008. Back to sleep, tummy to play. Elk Grove Village, IL: AAP. http://www.healthychildcare.org/pdf/SIDStummytime.pdf.

4. American Academy of Pediatrics, Committee on Injury and Poison Prevention. 2008. Policy statement: Injuries associated with infant walkers. Pediatrics 122:450.

5. DiLillo, D., A. Damashek, L. Peterson. 2001. Maternal use of baby walkers with young children: Recent trends and possible alternatives. Injury Prevention 7:223-27.

6. Shields, B. J., G. A. Smith. 2006. Success in the prevention of infant walker-related injuries: An analysis of national data, 1990-2001. Pediatrics 117: e452-59.

7. Chowdhury, R. T. 2009. Nursery product-related injuries and deaths among children under age five. Washington, DC: U.S. Consumer Product Safety Commission. http://www.cpsc.gov/library/nursery07.pdf.

8. Kinane, T. B., J. Murphy, J. L. Bass, M. J. Corwin. 2006. Comparison of respiratory physiologic features when infants are placed in car safety seats or car beds. Pediatrics 118:522-27.
9. Kornhauser, C. L., C. V. Scirica, I. S. Gantar, D. Osredkar, D. Neubauer, T. B. Kinane. 2009. A comparison of respiratory patterns in healthy term infants placed in car safety seats and beds. Pediatrics 124: e396-e402.

10. Warda, L., G. Griggs. 2006. Childhood Falls in Manitoba: CHIRPP Report: An assessment of injury severity and fall events by age group. Winnipeg: The Injury Prevention Centre of Children’s Hospital. http://www.mpeta.ca/documents/IOI/Falls.pdf.

STANDARD 5.3.1.11: Exercise Equipment

Children should not be permitted to have access to equipment intended for adult exercise.

RATIONALE: Exercise equipment can be potentially hazardous to young children especially if unsupervised. The U.S. Consumer Product Safety Commission (CPSC) estimates that each year about 8,700 children under five years of age are injured with exercise equipment. There are an additional 16,500 injuries per year to children ages five to fourteen. Types of equipment identified in these cases include stationary bicycles, treadmills, and stair climbers. Fractures and even amputations were reported in about 20% of exercise equipment-related injuries (1,2). These types of equipment may be attractive to young children because of their size and the inability to store after use (3). Equipment should be placed or stored in rooms that can be secured from children’s access.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. U.S. Consumer Product Safety Commission (CPSC). Prevent injuries to children from exercise equipment. Document #5028. Washington, DC: CPSC. http://www.cpsc.gov/CPSCPUB/PUBS/5028.html.

2. U.S. Consumer Product Safety Commission (CPSC). 2000. National electronic injury surveillance system: Exercise equipment estimate report, 1999. Washington, DC: CPSC.

3. Jones, C. S., J. Freeman, T. M. Penhollow. 2006. Epidemiology of exercise equipment-related injuries to young children. Pediatr Emergency Care 22:160-63.

STANDARD 5.3.1.12: Availability and Use of a Telephone or Wireless Communication Device

The facility should provide at all times at least one working non-pay telephone or wireless communication device for general and emergency use:

On the premises of the child care facility;
In each vehicle used when transporting children;
On field trips.

Drivers, while transporting children should not operate a motor vehicle while using a mobile telephone or wireless communications device when the vehicle is in motion or a part of traffic, with the exception of use of a navigational system or global positioning system device.

RATIONALE: A telephone must be available to all caregivers/teachers in an emergency (1).

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. Walsh, E. 2004. Health and safety notes: Field trip safety tips. Berkeley, CA: California Childcare Health Program. http://www.ucsfchildcarehealth.org/pdfs/healthandsafety/fieldtripsen070604_adr.pdf.

5.3.2 Additional Equipment Requirements for Facilities Serving Children with Special Health Care Needs

Note to Reader: See Standard 3.6.3.2 for medication storage.

STANDARD 5.3.2.1: Therapeutic and Recreational Equipment

The facility should have therapeutic and recreational equipment to enhance the educational and developmental progress of children with special health care needs, to the extent that they can be safely and reasonably furnished. Some therapeutic equipment such as trampolines will need to have proper supervision for safety. Such equipment must be securely stored and inaccessible to children when not being used.

RATIONALE: Children with special health care needs may require special equipment of various types. For the individual child, the equipment should be available to meet the goals and methods outlined in the service plan. This equipment, if accessible, may pose a hazard to children in the facility.

COMMENTS: Devices and assisted technology that individual children require is unique to them, based on their own specific needs.

The Americans with Disabilities Act (ADA) does not require personal equipment (e.g., eyeglasses, wheelchairs, etc.) to be furnished by the child care program.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

STANDARD 5.3.2.2: Special Adaptive Equipment

Special adaptive equipment (such as toys, augmentative communication devices, and wheelchairs) for children with special health care needs should be available in and correctly utilized by the facility as part of their reasonable accommodations for the child.

Staff should be instructed and trained in use of communication devices and other adaptive equipment.

RATIONALE: If a facility serves one or more children with special health care needs, adaptive equipment necessary for the child’s participation in all activities is needed.

COMMENTS: Most adaptive equipment can be created by making simple adaptation of typically used items such as eating utensils, cups, plates, etc.

Caregivers/teachers are not responsible for providing personal equipment (such as hearing aids, eyeglasses, braces, and wheelchairs), but should be aware of how they should be used and if repairs are necessary.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

STANDARD 5.3.2.3: Storage for Adaptive Equipment

The facility should provide storage space for all adaptive equipment (such as equipment for physical therapy, occupational therapy, or adaptive physical education) separate and apart from classroom floor space. The storage space should be easily accessible to the staff. Equipment should be stored safely and in an organized way.

RATIONALE: Frequently, storing adaptive equipment is a problem in centers. This equipment should be stored outside of classroom space to maximize floor space and minimize distracting clutter.

TYPE OF FACILITY: Center

STANDARD 5.3.2.4: Orthotic and Prosthetic Devices

A trained, designated staff member should check prosthetic devices (upper and lower extremity), including hearing aids, processors for cochlear implants, eyeglasses, braces, and wheelchairs, daily to ensure that these appliances are in good working order, cleaned correctly, and have been applied properly.

RATIONALE: Battery-driven devices such as hearing aids require close monitoring because the batteries have a short life and young children require adult assistance to replace them. Eyeglasses scratch and break, as do other assistive appliances. Staff members should be adequately trained to perform orthotic and prosthetic device monitoring.

COMMENTS: The facility should have parents/guardians supply extra batteries for hearing aids. Facilities should store and discard the batteries in such a manner that children cannot ingest them. With the parents’/guardians’ permission, the staff may perform minor repairs on equipment if they are trained but should not attempt major repairs.

Upper extremity and lower extremity orthotics and/or eyeglasses are not effective if they are not applied correctly to the child. Instruction from parents/guardians or professionals may be necessary to ensure proper application of devices.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

5.4 Space and Equipment in Designated Areas

5.4.1 Toilet and Handwashing Areas

STANDARD 5.4.1.1: General Requirements for Toilet and Handwashing Areas

Clean toilet and handwashing facilities should be located in the best place to meet the developmental needs of children.

For infant areas, toilets and handwashing facilities are for adult rather than child use. They should be located within the infant area to reduce staff absence.

For toddler areas, toilet and handwashing facilities should be located in or adjacent to the toddler rooms.

For preschool and school-age children, toilet and handwashing facilities should be located near the entrance to the group room and near the entrance to the playground. If both entrances are close to each other, then only one set of toilet and handwashing facilities is needed.

RATIONALE: Young children have poor bowel and bladder control and cannot wait long when they have to use the toilet (1). Young children must be able to get to toilet facilities quickly. Staff must have easy access to hand washing facilities to wash their hands at the times when it is appropriate and still maintain supervision of the children.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. Olds, A. R. 2001. Child care design guide. New York: McGraw-Hill.

STANDARD 5.4.1.2: Location of Toilets and Privacy Issues

Toilets should be located in rooms separate from those used for cooking or eating. If toilets are not on the same floor as the child care area and not within sight or hearing of a caregiver/teacher, an adult should accompany children younger than five years of age to and from the toilet area. In centers, males and females who are six years of age and older should have separate and private toilet facilities. Younger children who request privacy and have shown capability to use toilet facilities properly should be given permission to use separate and private toilet facilities.

RATIONALE: It is important to prevent contamination of food and to eliminate unpleasant odors from the food areas.

Supervision and assistance are necessary for young children. Although cultures differ in privacy needs, sex-separated toileting among people who are not relatives is the norm for adults. Children should be allowed the opportunity to practice modesty when independent toileting behavior is well-established in the majority of the group. By six years of age, most children can use the toilet by themselves (1).

COMMENTS: Compliance is monitored by observation.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. Shelov, S. P., R. E. Hannemann, eds. 1998. Caring for your baby and young child: Birth to age 5. 2nd ed. Elk Grove Village, IL: American Academy of Pediatrics.

STANDARD 5.4.1.3: Ability to Open Toilet Room Doors

Children should be able to easily open every toilet room door from the inside, and caregivers/teachers should be able to easily open toilet room doors from the outside if adult assistance is required.

RATIONALE: Doors that can be opened easily will prevent entrapment.

COMMENTS: Inside latches that children can easily manage will allow the child to ensure privacy when using the toilet. The latch or lock available for use, must be of a type that the staff can easily open from the outside in case a child requires adult assistance.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

STANDARD 5.4.1.4: Preventing Entry to Toilet Rooms by Infants and Toddlers

Toilet rooms should have barriers that prevent entry by infants and toddlers who are unattended. Infants and toddlers should be supervised by sight and sound at all times.

RATIONALE: Infants and toddlers can drown in toilet bowls, play in the toilet, have contact with contaminated items or surfaces, or otherwise engage in potentially injurious behavior if they are not supervised in toilet rooms.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

STANDARD 5.4.1.5: Chemical Toilets

Chemical toilets should not be used in child care facilities unless they are provided as a temporary measure in the event that the facility’s normal plumbed toilets are not functioning. Constant supervision should be required for young children using a chemical toilet. In the event that chemical toilets may be required on a temporary basis, the caregiver/teacher should seek approval for use from the regulatory health agency.

RATIONALE: Chemical toilets can pose a safety hazard to young children. Young children climbing on the toilet seat could fall through the opening and into the chemical that is contained in the waste receptacle.

COMMENTS: A chemical toilet is a toilet consisting of a seat or bowl attached to a container holding a chemical solution that changes waste into sludge (1).

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. Dictionary.com. 2000. Chemical toilets. The American heritage dictionary of the English language. 4th ed. http://dictionary.reference.com/browse/chemical toilets.

STANDARD 5.4.1.6: Ratios of Toilets, Urinals, and Hand Sinks to Children

Toilets and hand sinks should be easily accessible to children and facilitate adult supervision. The number of toilets and hand sinks should be subject to the following minimums:

Toddlers:
1. If each group size is less than ten children, provide one sink and one toilet per group.
Preschool-age children:
1. If each group size is less than ten children, provide one sink and one toilet per group;
2. If each group size is between ten to sixteen children, provide two sinks and two flush toilets for each group.
School-age children:
1. If each group size is less than ten children, provide one sink and one toilet per group;
2. If each group size is between ten to twenty children, provide two sinks and two toilets per group. Provide separation of male and female toilets.

For toddlers and preschoolers, the maximum toilet height should be eleven inches, and maximum height for hand sinks should be twenty-two inches. Urinals should not exceed 30% of the total required toilet fixtures and should be used by one child at a time. For school-age children, standard height toilet, urinal, and hand sink fixtures are appropriate.

Non-flushing equipment in toilet learning/training should not be counted as toilets in the toilet:child ratio.

RATIONALE: The environment can become contaminated more easily with multiple simultaneous users of urinals, because at least one of the children must assume an off-center position in relationship to the fixture during voiding.

Young children use the toilet frequently and cannot wait long when they have to use the toilet. The ratio of 1:10 is based on best professional experience of early childhood educators who are facility operators (1). This ratio also limits the group that will be sharing facilities (and infections).

COMMENTS: The ratios of toilets and hand sinks to children provided above takes into consideration the maximum group size specified under Standard 1.1.1.2. Local building codes also dictate toilet and sink requirements based on number of children utilizing them.

State licensing regulations have often applied a ratio of 1:10 for toddlers and preschool children, and 1:15 for school-age children. The ratios used in this standard correspond to the maximum group sizes for each age group specified in Standard 1.1.1.2.

A ratio of one toilet to every ten children may not be sufficient if only one toilet is accessible to each group of ten, so a minimum of two toilets per group is preferable when the group size approaches ten. However, a large toilet room with many toilets used by several groups is less desirable than several small toilet rooms assigned to specific groups, because of the opportunities such a large room offers for transmitting infectious disease agents.

When providing bathroom fixtures for a mixed group of preschool and school-age children, requiring a school-age child to use bathroom fixtures designed for preschoolers may negatively impact the self-esteem of the school-age child.

TYPE OF FACILITY: Center; Large Family Child Care Home

REFERENCES:

1. Olds, A. R. 2001. Child care design guide. New York: McGraw-Hill.

STANDARD 5.4.1.7: Toilet Learning/Training Equipment

Equipment used for toilet learning/training should be provided for children who are learning to use the toilet. Child-sized toilets or safe and cleanable step aids and modified toilet seats (where adult-sized toilets are present) should be used in facilities. Non-flushing toilets (i.e., potty chairs) should be strongly discouraged.

If child-sized toilets, step aids, or modified toilet seats cannot be used, non-flushing toilets (potty chairs) meeting the following criteria should be provided for toddlers, preschoolers, and children with disabilities who require them. Potty chairs should be:

Easily cleaned and disinfected;
Used only in a bathroom area;
Used over a surface that is impervious to moisture;
Out of reach of toilets or other potty chairs;
Cleaned and disinfected after each use in a sink used only for cleaning and disinfecting potty chairs.

Equipment used for toilet learning/training should be accessible to children only under direct supervision.

The sink used to clean and disinfect the potty chair should also be cleaned and disinfected after each use.

RATIONALE: Child-sized toilets that are flushable, steps, and modified toilet seats provide for easier use and maintenance. Sanitary handling of potty chairs is difficult. Flushable toilets are superior to any type of device that exposes the staff to contact with feces or urine. Many infectious diseases can be prevented through appropriate hygiene and disinfection methods. Surveys of environmental surfaces in child care settings have demonstrated evidence of fecal contamination (1). Fecal contamination has been used to gauge the adequacy of disinfection and hygiene.

COMMENTS: If potty chairs are used, they should be constructed of plastic or similar nonporous synthetic products. Wooden potty chairs should not be used, even if the surface is coated with a finish. The finished surface of wooden potty chairs is not durable and, therefore, may become difficult to wash and disinfect effectively.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. Gorski, P. A. 1999. Toilet training guidelines: Day care providers-the role of the day care provider in toilet training. Pediatrics 103:1367-68.

STANDARD 5.4.1.8: Cleaning and Disinfecting Toileting Equipment

Utility gloves and equipment designated for cleaning and disinfecting toilet learning/training equipment and flush toilets should be used for each cleaning and should not be used for other cleaning purposes. Utility gloves should be washed with soapy water and dried after each use.

RATIONALE: Contamination of hands and equipment in a child care room has played a role in the transmission of disease (1,2).

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. Churchill, R. B., L. K. Pickering. 1997. Infection control challenges in child-care centers. Infect Dis Clin North Am 11:347-65.

2. Van, R., A. L. Morrow, R. R. Reves, L. K. Pickering. 1991. Environmental contamination in child day-care centers. Am J Epidemiol 133:460-70.

STANDARD 5.4.1.9: Waste Receptacles in the Child Care Facility and in Child Care Facility Toilet Room(s)

Waste receptacles in the facility should be kept clean, in good repair, and emptied daily. Toilet rooms should have at least one plastic-lined waste receptacle with a foot-pedal operated lid.

RATIONALE: This practice prevents the spread of disease and filth. In toilet rooms, users may need to dispose of waste that is contaminated with body fluids. Sanitary disposal of this material requires a lidded container that does not have to be handled to be opened.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

STANDARD 5.4.1.10: Handwashing Sinks

A handwashing sink should be accessible without barriers (such as doors) to each child care area. In areas for infants, toddlers, and preschoolers, the sink should be located so the caregiver/teacher may visually supervise the group of children while carrying out routine handwashing or having children wash their hands. Sinks should be placed at the child’s height or be equipped with a stable step platform to make the sink available to children. If a platform is used, it should have slip-proof steps and platform surface. Also, each sink should be equipped so that the user has access to:

Water, at a temperature at least 60°F and no hotter than 120°F;
A foot-pedal operated, electric-eye operated, open, self-closing, slow-closing, or metering faucet that provides a flow of water for at least thirty seconds without the need to reactivate the faucet;
A supply of hand-cleansing non-antibacterial, unscented liquid soap;
Disposable single-use cloth or paper towels or a heated-air hand-drying device with heat guards to prevent contact with surfaces that get hotter than 120°F.

A steam tap or a water tap that provides hot water that is hotter than 120°F may not be used at a handwashing sink.

RATIONALE: Transmission of many infectious diseases can be prevented through handwashing (1). To facilitate routine handwashing at the many appropriate times, sinks must be close at hand and permit caregivers/teachers to provide continuous supervision while they wash their hands. The location, access, and supporting supplies to enable adequate handwashing are important to the successful integration of this key routine. Foot-pedaled operated or electric-eye operated handwashing sinks and liquid soap dispensers are preferable because they minimize hand contamination during and after handwashing. The flow of water must continue long enough for the user to wet the skin surface, get soap, lather for at least twenty seconds, and rinse completely.

Comfortably warm water helps to release soil from hand surfaces and provides comfort for the person who is washing the hands. When the water is too cold or too hot for comfort, the person is less likely to wet and rinse long enough to lather and wash off soil. Having a steam tap or a super-heated hot water tap available at a handwashing sink poses a significant risk of scald burns.

COMMENTS: Shared access to soap and disposable towels at more than one sink is acceptable if the location of these is fully accessible to each person. There is no evidence that antibacterial soap reduces the incidence of illness among children in child care.

TYPE OF FACILITY: Center

REFERENCES:

1. Centers for Disease Control and Prevention (CDC). Wash your hands. http://www.cdc.gov/features/handwashing/.

STANDARD 5.4.1.11: Prohibited Uses of Handwashing Sinks

Handwashing sinks should not be used for rinsing soiled clothing, for cleaning equipment that is used for toileting, or for the disposal of any waste water used in cleaning the facility.

RATIONALE: The sink used to wash/rinse soiled clothing or equipment used for toileting becomes contaminated during this process and can be a source of transmission of disease to those who wash their hands in that sink (1).

TYPE OF FACILITY: Center; Large Family Child Care Home

REFERENCES:

1. Laborde, D. J., K. A. Weigle, D. J. Weber, J. B. Kotch. 1993. Effect of fecal contamination on the diarrheal illness rates in day-care centers. Am J Epidemiol 138:243-55.

STANDARD 5.4.1.12: Mop Sinks

Centers with more than thirty children should have a mop sink. Large and small family child care homes should have a means of obtaining clean water for mopping and disposing of it in a toilet or in a sink used only for such purposes.

RATIONALE: Handwashing and food preparation sinks must not be contaminated by wastewater. Contamination of hands, toys, and equipment in the room plays a role in the transmission of diseases in child care settings (1,2).

COMMENTS: Mop sinks are installed on the floor, similar to a shower pan, and are usually located in janitor’s closets or laundry facilities.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. Churchill, R. B., L. K. Pickering. 1997. Infection control challenges in child-care centers. Infect Dis Clin North Am 11:347-65.

2. Van, R., A. L. Morrow, R. R. Reves, L. K. Pickering. 1991. Environmental contamination in child day-care centers. Am J Epidemiol 133:460-70.

5.4.2 Diaper Changing Areas

STANDARD 5.4.2.1: Diaper Changing Tables

The facility should have at least one diaper changing table per infant group or toddler group to allow sufficient time for changing diapers and for cleaning and sanitizing between children. Diaper changing tables and sinks should be used only by the children in the group whose routine care is provided together throughout their time in child care. The facility should not permit shared use of diaper changing tables and sinks by more than one group.

RATIONALE: Diaper changing requires time, as does cleaning the changing surfaces. When caregivers/teachers from different groups use the same diaper changing surface, disease spreads more easily from group to group. Child care facilities should not put the diaper changing tables and sinks in a buffer zone between two classrooms, because doing so effectively joins the groups from the perspective of cross-contamination.

TYPE OF FACILITY: Center; Large Family Child Care Home

STANDARD 5.4.2.2: Handwashing Sinks for Diaper Changing Areas in Centers

Handwashing sinks in centers should be provided within arm’s reach of the caregiver/teacher to diaper changing tables and toilets. A minimum of one handwashing sink should be available for every two changing tables. Where infants and toddlers are in care, sinks and diaper changing tables should be assigned for use to a specific group of children and used only by children and adults who are in the assigned group as defined by Standard 5.4.2.1. Handwashing sinks should not be used for bathing or removing smeared fecal material.

RATIONALE: Sinks must be close to where the diapering takes place to avoid transfer of contaminants to other surfaces en route to washing the hands of staff and children. Having sinks close by will help prevent the spread of contaminants and disease.

When sinks are shared by multiple groups, cross-contamination occurs. Many child care centers put the diaper changing tables and sinks in a buffer zone between two classrooms, effectively joining the groups through cross-contamination.

COMMENTS: Shared access to soap and disposable towels at more than one sink is acceptable if the location of these is fully accessible to each person.

TYPE OF FACILITY: Center

REFERENCES:

STANDARD 5.4.2.3: Handwashing Sinks for Diaper Changing Areas in Homes

Handwashing sinks in large and small family child care homes should be supplied for diaper changing, as specified in Standard 5.4.2.2, except that they should be within ten feet of the changing table if the diapering area cannot be set up so the sink is adjacent to the changing table. If diapered toddlers and preschool-age children are in care, a stepstool should be available at the handwashing sink, as specified in Standard 5.4.1.10, so smaller children can stand at the sink to wash their hands. Handwashing sinks should not be used for bathing or removing smeared fecal material.

RATIONALE: When children from more than one family are in care, the diaper changing area should be arranged to be as close as possible to a non-food sink to avoid fecal-oral transmission of infection.

Sinks must be close to where the diapering takes place to avoid transfer of contaminants to other surfaces en route to washing the hands of staff and children. Having sinks close by will help prevent the spread of contaminants and disease.

TYPE OF FACILITY: Large Family Child Care Home; Small Family Child Care Home

STANDARD 5.4.2.4: Use, Location, and Setup of Diaper Changing Areas

Infants and toddlers should be diapered only in the diaper changing area. Children should be discouraged from remaining in or entering the diaper changing area. The contaminated surfaces of waste containers should not be accessible to children.

Diaper changing areas and food preparation areas should be physically separated. Diaper changing should not be conducted in food preparation areas or on surfaces used for other purposes. Food and drinking utensils should not be washed in sinks located in diaper changing areas.

The diaper changing area should be set up so that no other surface or supply container is contaminated during diaper changing. Bulk supplies should not be stored on or brought to the diaper changing surface. Instead, the diapers, wipes, gloves, a thick layer of diaper cream on a piece of disposable paper, a plastic bag for soiled clothes, and disposable paper to cover the table in the amount needed for a specific diaper change will be removed from the bulk container or storage location and placed on or near the diaper changing surface before bringing the child to the diaper changing area.

Conveniently located, washable, plastic-lined, tightly covered, hands-free receptacles, should be provided for soiled cloths and linen containing body fluids.

Where only one staff member is available to supervise a group of children, the diaper changing table should be positioned to allow the staff member to maintain constant sight and sound supervision of children.

RATIONALE: The use of a separate area for diaper changing or changing of soiled underwear reduces contamination of other parts of the child care environment (1-2). Children cannot be expected to avoid contact with contaminated surfaces in the diaper changing area. They should be in this area only for diaper changing and be protected as much as possible from contact with contaminated surfaces. The separation of diaper changing areas and food preparation areas prevents transmission of disease. Using diaper changing surfaces for any other purpose increases the likelihood of contamination and spreading of infectious disease agents.

Bringing storage containers for bulk supplies to the diaper changing table is likely to result in their contamination during the diaper changing process. When these containers stay on the table or are replaced in a storage location, they become conduits for transmitting disease agents. Bringing to the table only the amount of each supply that will be consumed in that specific diaper changing will prevent contamination of diapering supplies and the environment.

Hands-free receptacles prevent environmental contamination so the children do not come into contact with disease-bearing body fluids.

Often, only one staff person is supervising children when a child has to be changed. Orienting the diaper changing table so the staff member can maintain direct observation of all children in the room allows adequate supervision.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. Aronson, S. S. 1999. The ideal diaper changing station. Child Care Information Exchange 130:92.

STANDARD 5.4.2.5: Changing Table Requirements

Changing tables should meet the following requirements:

Have impervious, nonabsorbent, smooth surfaces that do not trap soil and are easily disinfected;
Be sturdy and stable to prevent tipping over;
Be at a convenient height for use by caregivers/teachers (between twenty-eight and thirty-two inches high);
Be equipped with railings or barriers that extend at least six inches above the change surface.

RATIONALE: This standard is designed to prevent disease transmission and falls and to provide safety measures during diapering. Commercial diaper change tables vary as much as ten inches in height. Many standard-height thirty-six inch counters are used as the diaper change area. When a railing or barrier is attached, shorter staff members cannot change diapers without standing on a step.

Back injury is a common occupational injury for caregivers/teachers (3,5). Using changing tables that are sized for caregiver/teacher comfort and convenience can help prevent back injury (1,3-4). Railings of two inches or less in height have been observed in some diaper change areas and when combined with a moisture-impervious diaper changing pad approximately one inch thick, render the railing ineffective. A change table height of twenty-eight inches to thirty-two inches (standard table height) plus a six-inch barrier will reduce back strain on staff members and provide a safe barrier to prevent children from falling off the changing table.

Data from the U.S. Consumer Product Safety Commission (CPSC) show that falls are a serious hazard associated with infant changing tables (2). Safety straps on changing tables are provided to prevent falls but they trap soil and they are not easily disinfected. Therefore, diaper changing tables should not have safety straps.

COMMENTS: An impervious surface is defined as a smooth surface that does not absorb liquid or retain soil. While changing a child, the adult must hold onto the child at all times.

The activity of diaper changing presents an opportunity for adult interaction with the child whose diaper is being changed.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. Aronson, S. S. 1999. The ideal diaper changing station. Child Care Info Exch 130:92.

2. U.S. Consumer Product Safety Commission (CPSC). 1997. The safe nursery. Washington, DC: CPSC. http://www.cpsc.gov/cpscpub/pubs/202.pdf.

3. ASTM International. 2008. ASTM F2388-08. Baby changing tables for domestic use. West Conshohocken, PA: ASTM.

4. Gratz, R., A. Claffey, P. King, G. Scheuer. 2002. The physical demands and ergonomics of working with young children. Early Child Devel Care 172:531-37.

5. Fiene, R. 2002. 13 indicators of quality child care: Research update. Washington, DC: U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation. http://aspe.hhs.gov/hsp/ccquality-ind02/.

STANDARD 5.4.2.6: Maintenance of Changing Tables

Changing tables should be nonporous, kept in good repair, and cleaned and disinfected after each use to remove visible soil and germs.

RATIONALE: Many infectious diseases can be prevented through appropriate cleaning and disinfection procedures. It is difficult, if not impossible, to disinfect porous surfaces, broken edges, and surfaces that cannot be completely cleaned. Bacterial cultures of environmental surfaces in child care facilities have shown fecal contamination, which has been used to gauge the adequacy of sanitation and hygiene measures practiced at the facility (1).

One study has demonstrated that “diapering, handwashing, and food preparation equipment that is specifically designed to reduce the spread of infectious agents significantly reduced diarrheal illness among the children and absence as a result of illness among staff in out-of-home child care centers” (2).

COMMENTS: Caregivers/teachers should be reminded that many disinfectants leave residues that can cause skin irritation or other symptoms. Caregivers/teachers should always follow the manufacturer’s instructions for preparation and use.

A U.S. Environmental Protection Agency (EPA)-registered product labeled for use as a disinfectant suitable for the surface material should be used to disinfect the changing table after use. Some bleach products are EPA-registered disinfectants.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. Pickering, L. K., C. J. Baker, D. W. Kimberlin, S. S. Long, eds. 2009. Red Book: 2009 report of the Committee on Infectious Diseases. Elk Grove Village, IL: American Academy of Pediatrics.

2. Kotch, J. B., P. Isbell, D. J. Weber, V. Nguyen, E. Gunn, S. Fowlkes, J. Virk, J. Allen. 2007. Hand-washing and diapering equipment reduces disease among children in out-of-home child care centers. Pediatrics 120: e29-e36.

5.4.3 Bathtubs and Showers

STANDARD 5.4.3.1: Ratio and Location of Bathtubs and Showers

The facility should have one bathtub or shower for every six children receiving overnight care. If the facility is caring for infants, it should have age-appropriate bathing facilities for them. Bathtubs and showers, when required or used as part of the daily program, should be located within the facility or in an approved building immediately adjacent to it.

RATIONALE: A sufficient number of age-appropriate bathing tubs and showers must be available to permit separate bathing for every child.

COMMENTS: Assuming that each bath takes ten to fifteen minutes, a ratio of one tub to six children with time to wash the tub between children means that bathing would require about one and one-half hours.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

STANDARD 5.4.3.2: Safety of Bathtubs and Showers

All bathing facilities should have a conveniently located grab bar that is mounted at a height appropriate for a child to use. Nonskid surfaces should be provided in all tubs and showers. Bathtubs should be equipped with a mechanism to guarantee that drains are kept open at all times, except during supervised use. Water temperature should not exceed 120°F and anti-scald devices should be permanently installed in the faucet and shower head.

RATIONALE: Falls in tubs are a well-documented source of injury according to the National Electronic Injury Surveillance System (NEISS) data collected by the U.S. Consumer Product Safety Commission (CPSC) (2). Grab bars and nonslip surfaces reduce this risk (2). Drowning and falls in bathtubs are also a significant cause of injury for young children and children with disabilities (1,2). An open drain will prevent a pool of water from forming if a child turns on a water faucet and, therefore, will prevent a potential drowning situation. Bathtub water comprises the leading cause of scalds for young children (2). Water heated to temperatures greater than 120°F takes less than thirty seconds to burn the skin (2).

COMMENTS: Various inexpensive devices to check water temperature are available at stores and on the Internet.

TYPE OF FACILITY: Center

REFERENCES:

1. Gipson, K. 2009. Submersions related to non-pool and non-spa products, 2008 report. Washington, DC: CPSC. http://www.cpsc
.gov/library/FOIA/FOIA09/OS/nonpoolsub2008.pdf.

2. D’Souza, A. L., N. G. Nelson, L. B. McKenzie. 2009. Pediatric burn injuries treated in US emergency departments between 1990 and 2006. Pediatrics 124:1424-30.

5.4.4 Laundry Area

STANDARD 5.4.4.1: Laundry Service and Equipment

Centers should have a mechanical washing machine and dryer on site or should contract with a laundry service. Where laundry equipment is used in a large or small family child care home (or the large or small family home caregiver/teacher uses an off-site laundry facility), the equipment should comply with Standard 5.4.4.2.

RATIONALE: Bedding and towels that are not thoroughly cleaned pose a health threat to users of these items.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

STANDARD 5.4.4.2: Location of Laundry Equipment and Water Temperature for Laundering

Laundry equipment should be located in an area separate from the kitchen and child care areas and inaccessible to children. The water temperature for the laundry should be maintained above 140°F unless one of the following conditions exists:

The product labeled by the manufacturer as a sanitizer is applied according to the manufacturer’s instructions, in which case the temperature should be as specified by the manufacturer of the product;
A dryer is used that the manufacturer attests heats the clothes above 140°F;
The clothes are completely ironed (1).

Dryers should be vented to the outside. Dryer hoses and vent connections should be checked periodically for proper alignment and connection. Lint must be removed with each use and periodically cleaned from the hose to avoid fires. If a commercial laundry service is used, its performance should meet or exceed the requirements listed above.

RATIONALE: Chemical sanitizers are temperature-dependent. Ironing or heating the clothing above 140°F will sanitize. Bent dryer hoses can cause lint to catch in dryers, which is a potential fire hazard. Disconnected dryer hoses will vent lint, dust, and particles indoors, which may cause respiratory problems.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. Witt, C. S., J. Warden. 1971. Can home laundries stop the spread of bacteria in clothing? Textile Chemist Colorist 3:55-57.

5.4.5 Sleep and Rest Areas

STANDARD 5.4.5.1: Sleeping Equipment and Supplies

Facilities should have an individual crib, cot, sleeping bag, bed, mat, or pad that has not been recalled for each child who spends more than four hours a day at the facility. No child should simultaneously share a crib, bed, or bedding with another child. Facilities should ensure that toddler beds are in compliance with the current U.S. Consumer Product Safety Commission (CPSC) and ASTM safety standards (1). Clean linens should be provided for each child. Beds and bedding should be washed between uses if used by different children. Regardless of age group, bed linens should not be used as rest equipment in place of cots, beds, pads, or similar approved equipment. Bed linens used under children on cots, cribs, futons, and playpens should be tight-fitting. Sheets for an adult bed should not be used on a crib mattress. See Standard 5.4.5.2 for crib specifications.

When pads are used, they should be enclosed in washable covers and should be long enough so the child’s head or feet do not rest off the pad. Mats and cots should be made with a waterproof material that can be easily washed and sanitized. Plastic bags or loose plastic material should never be used as a covering.

No child should sleep on a bare, uncovered surface. Seasonally appropriate covering, such as sheets, sleep garments, or blankets that are sufficient to maintain adequate warmth, should be available and should be used by each child below school-age. Pillows, blankets, and sleep positioners should not be used with infants. If pillows are used by toddlers and older children, pillows should have removable cases that can be laundered, be assigned to a child, and used by that child only while s/he is enrolled in the facility. Each child’s pillow, blanket, sheet, and any special sleep item should be stored separately from those of other children.

Pads and sleeping bags should not be placed directly on any floor that is cooler than 65°F when children are resting. Cribs, cots, sleeping bags, beds, mats, or pads in/on which children are sleeping should be placed at least three feet apart. If the room used for sleeping cannot accommodate three feet of spacing between children, it is recommended for caregivers/teachers to space children as far as possible from one another and/or alternate children head to feet. Screens used to separate sleeping children are not recommended because screens can affect supervision, interfere with immediate access to a child, and could potentially injure a child if pushed over on a child. If unoccupied sleep equipment is used to separate sleeping children, the arrangement of such equipment should permit the staff to observe and have immediate access to each child. The ends of cribs do not suffice as screens to separate sleeping children.

The sleeping surfaces of one child’s rest equipment should not come in contact with the sleeping surfaces of another child’s rest equipment during storage.

Caregivers/teachers should never use strings to hang any object, such as a mobile, or a toy or a diaper bag, on or near the crib where a child could become caught in it and strangle.

Infant monitors and their cords and other electrical cords should never be placed in the crib or sleeping equipment.

Crib mattresses should fit snugly and be made specifically for the size crib in which they are placed. Infants should not be placed on an inflatable mattress due to potential of entrapment or suffocation.

RATIONALE: Separate sleeping and resting, even for siblings, reduces the spread of disease from one child to another.

Droplet transmission occurs when droplets containing microorganisms generated from an infected person, primarily during coughing, sneezing, or talking are propelled a short distance (three feet) and deposited on the conjunctivae, nasal mucosa, or mouth (2).

Because respiratory infections are transmitted by large droplets of respiratory secretions, a minimum distance of three feet should be maintained between cots, cribs, sleeping bags, beds, mats, or pads used for resting or sleeping (2). A space of three feet between cribs, cots, sleeping bags, beds, mats, or pads will also provide access by the staff to a child in case of emergency. If the facility uses screens to separate the children, their use must not hinder observation of children by staff or access to children in an emergency.

Lice infestation, scabies, and ringworm are among the most common infectious diseases in child care. These diseases are transmitted by direct person-to-person contact. Ringworm is transmitted by the sharing of personal articles such as combs, brushes, towels, clothing, and bedding. Prohibiting the sharing of personal articles helps prevent the spread of these diseases.

The use of tight-fitting bed linens prevents suffocation and strangling. Adult bed sheets can become loose and entangle an infant (3).

From time to time, children drool, spit up, or spread other body fluids on their sleeping surfaces. Using cleanable, waterproof, nonabsorbent rest equipment enables the staff to wash and sanitize the sleeping surfaces. Plastic bags may not be used to cover rest and sleep surfaces/equipment because they contribute to suffocation if the material clings to the child’s face.

Canvas cots are not recommended for infants and toddlers. The end caps require constant replacement and the cots are a cutting/pinching hazard when end caps are not in place. A variety of cots are made with washable sleeping surfaces that are designed to be safe for children.

COMMENTS: Although children freely interact and can contaminate each other while awake, reducing the transmission of infectious disease agents on large airborne droplets during sleep periods will reduce the dose of such agents to which the child is exposed overall. In small family child care homes, the caregiver/teacher should consider the home to be a business during child care hours and is expected to abide by regulatory expectations that may not apply outside of child care hours. Therefore, child siblings related to the caregiver/teacher may not sleep in the same bed during the hours of operation.

Caregivers/teachers may ask parents/guardians to provide bedding that will be sent home for washing at least weekly or sooner if soiled.

Pillows are not required for older children.

Many caregivers/teachers find that placing children in alternate positions so that one child’s head is across from the other’s feet reduces interaction and promotes settling during rest periods. This positioning may be beneficial in reducing transmission of infectious agents as well.

The use of solid crib ends as barriers between sleeping children can serve as a barrier if they are three feet away from each other (2).

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. U.S. Consumer Product Safety Commission (CPSC). 2011. CPSC approves new mandatory standard for toddler beds. http://
www.cpsc.gov/cpscpub/prerel/prhtml11/11199.html.

2. Pickering, L. K., C. J. Baker, D. W. Kimberlin, S. S. Long, eds. 2009. Red book: 2009 report of the Committee on Infectious Diseases, 153. Elk Grove Village, IL: American Academy of Pediatrics.

3. American Academy of Pediatrics. 2010. Ages and stages: A parent’s guide to safe sleep. Healthy Children. http://www.healthychildren.org/English/ages-stages/baby/sleep/Pages/A-Parents-Guide-to-Safe-Sleep.aspx.

STANDARD 5.4.5.2: Cribs

Facilities should check each crib before its purchase and use to ensure that it is in compliance with the current U.S. Consumer Product Safety Commission (CPSC) and ASTM safety standards.

Recalled or “second-hand” cribs should not be used or stored in the facility. When it is determined that a crib is no longer safe for use in the facility, it should be dismantled and disposed of appropriately.

Staff should only use cribs for sleep purposes and should ensure that each crib is a safe sleep environment. No child of any age should be placed in a crib for a time-out or for disciplinary reasons. When an infant becomes large enough or mobile enough to reach crib latches or potentially climb out of a crib, they should be transitioned to a different sleeping environment (such as a cot or sleeping mat).

Each crib should be identified by brand, type, and/or product number and relevant product information should be kept on file (with the same identification information) as long as the crib is used or stored in the facility.

Staff should inspect each crib before each use to ensure that hardware is tightened and that there are not any safety hazards. If a screw or bolt cannot be tightened securely, or there are missing or broken screws, bolts, or mattress support hangers, the crib should not be used.

Safety standards document that cribs used in facilities should be made of wood, metal, or plastic. Crib slats should be spaced no more than two and three-eighths inches apart, with a firm mattress that is fitted so that no more than two fingers can fit between the mattress and the crib side in the lowest position. The minimum height from the top of the mattress to the top of the crib rail should be twenty inches in the highest position. Cribs with drop sides should not be used. The crib should not have corner post extensions (over one-sixteenth inch). The crib should have no cutout openings in the head board or footboard structure in which a child’s head could become entrapped. The mattress support system should not be easily dislodged from any point of the crib by an upward force from underneath the crib. All cribs should meet the ASTM F1169-10a Standard Consumer Safety Specification for Full-Size Baby Cribs, F406-10b Standard Consumer Safety Specification for Non-Full-Size Baby Cribs/Play Yards, or the CPSC 16 CFR 1219, 1220, and 1500 – Safety Standards for Full-Size Baby Cribs and Non-Full-Size Baby Cribs; Final Rule.

Cribs should be placed away from window blinds or draperies.

As soon as a child can stand up, the mattress should be adjusted to its lowest position. Once a child can climb out of his/her crib, the child should be moved to a bed. Children should never be kept in their crib by placing, tying, or wedging various fabric, mesh, or other strong coverings over the top of the crib.

Cribs intended for evacuation purpose should be of a design and have wheels that are suitable for carrying up to five non-ambulatory children less than two years of age to a designated evacuation area. This crib should be used for evacuation in the event of fire or other emergency. The crib should be easily moveable and should be able to fit through the designated fire exit.

RATIONALE: Standards have been developed to define crib safety, and staff should make sure that cribs used in the facility meet these standards to protect children and prevent injuries or death (1-3). Significant changes to the ATSM and CPSC standards for cribs were published in December 2010. As of June 28, 2011 all cribs being manufactured, sold or leased must meet the new stringent requirements. Effective December 28, 2012 all cribs being used in early care and education facilities including family child care homes must also meet these standards. For the most current information about these new standards please go to http://www.cpsc.gov/info/cribs/index.html.

More infants die every year in incidents involving cribs than with any other nursery product (4). Children have become trapped or have strangled because their head or neck became caught in a gap between slats that was too wide or between the mattress and crib side.

An infant can suffocate if its head or body becomes wedged between the mattress and the crib sides (6).

Corner posts present a potential for clothing entanglement and strangulation (5). Asphyxial crib deaths from wedging the head or neck in parts of the crib and hanging by a necklace or clothing over a corner post have been well-documented (6).

Children who are thirty-five inches or taller in height have outgrown a crib and should not use a crib for sleeping (4). Turning a crib into a cage (covering over the crib) is not a safe solution for the problems caused by children climbing out. Children have died trying to escape their modified cribs by getting caught in the covering in various ways and firefighters trying to rescue children from burning homes have been slowed down by the crib covering (6).

CPSC has received numerous reports of strangulation deaths on window blind cords over the years (7).

COMMENTS: For more information on articles in cribs, see Standard 5.4.5.1: Sleeping Equipment and Supplies and Standard 6.4.1.3: Crib Toys.

A “safety-approved crib” is one that has been certified by the Juvenile Product Manufacturers Association (JPMA).

If portable cribs and those that are not full-size are substituted for regular full-sized cribs, they must be maintained in the condition that meets the ASTM F406-10b Standard Consumer Safety Specification for Non-Full-Size Baby Cribs/Play Yards. Portable cribs are designed so they may be folded or collapsed, with or without disassembly. Although portable cribs are not designed to withstand the wear and tear of normal full-sized cribs, they may provide more flexibility for programs that vary the number of infants in care from time to time.

Cribs designed to be used as evacuation cribs, can be used to evacuate infants, if rolling is possible on the evacuation route(s).

To keep window blind cords out of the reach of children, staff can use tie-down devices or take the cord loop and cut it in half to make two separate cords. Consumers can call 1-800-506-4636 or visit the Window Covering Safety Council Website at http://windowcoverings.org to receive a free repair kit for each set of blinds.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. ASTM International. 2010. ASTM F1169-10a: Standard consumer safety specification for full-size baby cribs. West Conshohocken, PA: ASTM.

2. ASTM International. 2010. ASTM F406-10b: Standard consumer safety specification for non-full-size baby cribs/play yards. West Conshohocken, PA: ASTM.

3. U.S. Consumer Product Safety Commission (CPSC). 2010. Safety standards for full-size baby cribs and non-full-size baby cribs; final rule. 16 CFR 1219, 1220, and 1500. http://www.cpsc
.gov/businfo/frnotices/fr11/cribfinal.pdf.

4. U.S. Consumer Product Safety Commission (CPSC). 1997. The safe nursery. Washington, DC: CPSC. http://www.cpsc.gov/cpscpub/pubs/202.pdf.

5. Juvenile Products Manufacturers Association. 2007. Safe and sound for baby: A guide to juvenile product safety, use, and selection. 9th ed. Moorestown, NJ: JPMA. http://www.jpma.org/content/retailers/safe-and-sound/.

6. U.S. Consumer Product Safety Commission (CPSC). 1996. CPSC warns parents about infant strangulations caused by failure of crib hardware. Document #5025. http://www.cpsc.gov/cpscpub/pubs/5025.html.

7. U.S. Consumer Product Safety Commission (CPSC). Are your window coverings safe? http://www.cpsc.gov/cpscpub/pubs/5009a.pdf.

STANDARD 5.4.5.3: Stackable Cribs

Use of stackable cribs (i.e., cribs that are built in a manner that there are two or three cribs above each other that do not touch the ground floor) in facilities is not advised. In older facilities, where these cribs are already built into the structure of the facility, staff should develop a plan for phasing out the use of these cribs.

If stackable cribs are used, they must meet the current Consumer Product Safety Commission’s (CPSC) federal standard for non-full-size cribs, 16 CFR 1220. In addition they should be three feet apart and staff placing or removing a child from a crib that cannot reach from standing on the floor, should use a stable climbing device such as a permanent ladder rather than climbing on a stool or chair. Infants who are able to sit, pull themselves up, etc. should not be placed in stackable cribs.

RATIONALE: Stackable cribs are designed to save space by having one crib built on top of another. Although they may be practical from the standpoint of saving space, infants on the top level of stackable cribs will be positioned at a height that will be several feet from the floor. Infants who fall from several feet or more can have an intracranial hemorrhage (i.e., serious bleed inside of the skull). While no injury reports have been filed, there is a potential for injury as a result of either latch malfunction or a caregiver/teacher who slips or falls while placing or removing a child from a crib. It is best practice to place an infant to sleep in a safe sleep environment (safety-approved crib with a firm mattress and a tight-fitting sheet) at a level that is close to the floor.

A minimum distance of three feet between cribs is required because respiratory infections are transmitted by large droplets of respiratory secretions, which usually are limited to a range of less than three feet from the infected person. (1).

Young children placed to sleep in stackable cribs may have difficulties falling asleep because they may not be used to sleeping in this type of equipment. In addition, requiring staff to use stackable cribs may cause them concern and fear regarding their liability if an injury occurs.

COMMENTS: Many state child care licensing regulations prohibit the use of stackable cribs (2). If stackable cribs are not prohibited in the caregiver’s/teacher’s state and they are used, parents/guardians should be informed and extreme care should be taken to ensure that no infant falls from the higher level cribs due to the potential for injury. Any injury that is suspected to be related to the use of stackable cribs should be reported to the U.S. Consumer Product Safety Commission (CPSC) at 1-800-638-2772 or http://www
.cpsc.gov.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. Pickering, L. K., C. J. Baker, D. W. Kimberlin, S. S. Long, eds. 2009. Red book: 2009 report of the Committee on Infectious Diseases, 153. Elk Grove Village, IL: American Academy of Pediatrics.

2. National Resource Center for Health and Safety in Child Care and Early Education (NRC). 2010. NRC Website. Individual states’ child care licensure regulations. http://nrckids.org/STATES/states.htm.

STANDARD 5.4.5.4: Futons

Child-sized futons should be used only if they meet the following requirements:

Not on a frame;
Easily cleanable;
Encased in a tight-fitting waterproof cover;
Meet all other standards on sleep and rest areas (Section 5.4.5).

RATIONALE: Frames pose an entrapment hazard. Futons that are easy to clean can be kept sanitary. Supervision is necessary to maintain adequate spacing of futons and ensure that bedding is not shared, thereby reducing transmission of infectious diseases and keeping children out of traffic areas.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

STANDARD 5.4.5.5: Bunk Beds

Children younger than six years of age should not use the upper levels of double-deck beds (or “bunk beds”). Bunk beds must conform to the U.S. Consumer Product Safety Commission (CPSC) Facts Document #071, Bunk Beds and the ASTM F1427-07 Standard Consumer Safety Specification for Bunk Beds (1).

RATIONALE: Falls and entrapment between mattress and guardrails, bed structure and wall, or between slats from bunk beds are a well-documented cause of injury in young children (1).

COMMENTS: Consult the CPSC, the manufacturer’s label, or the consumer safety information provided by the American Furniture Manufacturer’s Association (AFMA) for advice. Check the ASTM Website, http://www.astm.org, for up to date Standards.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. ASTM International. ASTM F1427-07: Standard consumer safety specification for bunk beds. West Conshohocken, PA: ASTM International.

5.4.6 Space for Children Who Are Ill, Injured, or Need Special Therapies

STANDARD 5.4.6.1: Space for Children Who Are Ill

Each facility should have a separate room or designated area within a room for the temporary or ongoing care of a child who needs to be separated from the group because of injury or illness. This room or area should be located so the child may be supervised and may be within the child’s usual child care room. Toilet and lavatory facilities should be readily accessible. If the child under care is suspected of having an infectious disease, all equipment the child uses should be cleaned and sanitized after use. This room or area may be used for other purposes when it is not needed for the separation and care of a child or if the uses do not conflict.

RATIONALE: Children who are injured or ill may need to be separated from other children to provide for rest and to minimize the spread of potential infectious disease (1). It is best practice for toilet and lavatory facilities to be readily available to permit frequent handwashing when children are well and even more so when they are ill. Proximity should provide rapid access in the event of vomiting or diarrhea to avoid contaminating the environment. Handwashing sinks should be stationed in each room not only to provide the opportunity to maintain cleanliness but also to permit the caregiver/teacher to maintain continuous supervision of the other children in care.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. Pickering, L. K., C. J. Baker, D. W. Kimberlin, S. S. Long, eds. 2009. Red book: 2009 report of the Committee on Infectious Diseases, 153. Elk Grove Village, IL: American Academy of Pediatrics.

STANDARD 5.4.6.2: Space for Therapy Services

In addition to accessible classrooms, in facilities where some but fewer than fifteen children need occupational or physical therapy and some but fewer than twenty children need individual speech therapy, centers should provide a quiet, private, accessible area within the child care facility for therapy. No other activities should take place in this area at the time therapy is being provided.

Family child care homes and facilities integrating children who need therapy services should receive these services in a space that is separate and private during the time the child is receiving therapy.

Additional space may be needed for equipment according to a child’s needs.

RATIONALE: Quiet, private space is necessary for physical, occupational, and speech therapies (1). Most caregivers/teachers also indicate that the other children in the facility are disrupted less if the therapies are provided in a separate area. For speech therapy, working with the child in a quiet location is especially important. Caregivers/teachers should attempt to incorporate therapeutic principles into the child’s general child care activities. Doing so will achieve maximum benefit for the child receiving therapy and promote understanding on the part of the child’s peers and caregivers/teachers about how to address the child’s disability when the therapist is not present.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. Olds, A. R. 2001. Zoning a group room. In Child care design guide, 137-165. New York: McGraw-Hill.

5.5 Storage Areas

Note to Reader: See Standard 3.6.3.2 for medication storage.

STANDARD 5.5.0.1: Storage and Labeling of Personal Articles

The facility should provide separate storage areas for each child’s and staff member’s personal articles and clothing. Personal effects and clothing should be labeled with the child’s name. Bedding should be labeled with the child’s full name, stored separately for each child, and not touching other children’s personal items.

If children use the following items at the child care facility, those items should be stored in separate, clean containers and should be labeled with the child’s full name:

Individual cloth towels for bathing purposes;
Toothbrushes;
Washcloths;
Combs and brushes.

Toothbrushes, towels, and washcloths should be allowed to dry when they are stored and not touching.

RATIONALE: This standard prevents the spread of organisms that cause disease and promotes organization of a child’s personal possessions. Lice infestation, scabies, and ringworm are common infectious diseases in child care. Providing space so personal items may be stored separately helps to prevent the spread of these diseases.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

STANDARD 5.5.0.2: Coat Hooks/Cubicles

Coat hooks should be spaced so coats will not touch each other, or individual cubicles or lockers of the child’s height should be provided for storing children’s clothing and personal possessions.

RATIONALE: Ringworm is a common infectious disease in child care and can be transmitted by sharing personal articles such as combs, towels, clothing, and bedding (1). Providing space so personal items may be stored separately helps prevent the spread of disease.

COMMENTS: Whenever possible, coat hooks should not be placed at children’s eye level because of potential risk of injury to eyes. Safety hooks should be used instead.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. Pickering, L. K., C. J. Baker, D. W. Kimberlin, S. S. Long, eds. 2009. Red book: 2009 report of the Committee on Infectious Diseases, 661-662. Elk Grove Village, IL: American Academy of Pediatrics.

STANDARD 5.5.0.3: Storage of Play and Teaching Equipment and Supplies

The facility should provide and use space to store play and teaching equipment, supplies, records and files, cots, mats, and bedding. Children should not have unsupervised access to storage areas.

RATIONALE: This practice enhances safety and provides a good example of an orderly environment.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

STANDARD 5.5.0.4: Storage for Soiled and Clean Linens

Child care facilities should provide separate storage areas for soiled linen and clean linen. Children should not have unsupervised access to storage areas.

RATIONALE: This practice discourages contamination of clean areas and children from soiled and contaminated linen. Providing separate storage areas reduces fire load and helps contain fire, if spontaneous combustion occurs in soiled linens.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

STANDARD 5.5.0.5: Storage of Flammable Materials

Gasoline, hand sanitizers in volume, and other flammable materials should be stored in a separate building, in a locked area, away from high temperatures and ignition sources, and inaccessible to children.

RATIONALE: Flammable materials such as chemicals and cleaners account for the majority of burns to the head and face of children (1). These materials are also involved in unintentional ingestion by children.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. D’Souza, A. L., N. G. Nelson, L. B. McKenzie. 2009. Pediatric burn injuries treated in US emergency departments between 1990 and 2006. Pediatrics 124:1424-30.

STANDARD 5.5.0.6: Inaccessibility to Matches, Candles, and Lighters

Matches, candles, and lighters should not be accessible to children.

RATIONALE: The U.S. Consumer Product Safety Commission (CPSC) estimates that 150 deaths occur each year from fires started by children playing with lighters. Children under five-years-old account for most of these fatalities (1). A child playing with candles or near candles is one of the biggest contributors to candle fires (2). Matches have also been the source of some fire-related deaths. Children may hide in a closet or under a bed when faced with fire, leading to fatalities (2).

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. U.S. Consumer Product Safety Commission (CPSC). Child-resistant lighters protect young children. Document #5021. Bethesda, MD: CPSC. http://www.cpsc.gov/cpscpub/pubs/
5021.html.

2. Miller, D., R. Chowdhury, M. Greene. 2009. 2004-2006 residential fire loss estimates. Washington, DC: U.S. Consumer Product Safety Commission (CPSC). http://www.cpsc.gov/LIBRARY/fire06.pdf.

STANDARD 5.5.0.7: Storage of Plastic Bags

Plastic bags, whether intended for storage, trash, diaper disposal, or any other purpose, should be stored out of reach of children.

RATIONALE: Plastic bags have been recognized for many years as a cause of suffocation. Warnings regarding this risk are printed on diaper-pail bags, dry-cleaning bags, and so forth. The U.S. Consumer Product Safety Commission (CPSC) has received average annual reports of twenty-five deaths per year to children due to suffocation from plastic bags. Nearly 90% of the reported deaths were to children under the age of one (1).

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. U.S. Consumer Product Safety Commission (CPSC). Children still suffocating with plastic bags. Document #5064. Bethesda, MD: CPSC. http://www.cpsc.gov/CPSCPUB/PUBS/5064.html.

STANDARD 5.5.0.8: Firearms

Centers should not have any firearms, pellet or BB guns (loaded or unloaded), darts, bows and arrows, cap pistols, stun guns, paint ball guns, or objects manufactured for play as toy guns within the premises at any time. If present in a small or large family child care home, these items must be unloaded, equipped with child protective devices, and kept under lock and key with the ammunition locked separately in areas inaccessible to the children. Parents/guardians should be informed about this policy.

RATIONALE: The potential for injury to and death of young children due to firearms is apparent (1-5). These items should not be accessible to children in a facility (2,3).

COMMENTS: Compliance is monitored via inspection.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. American Academy of Pediatrics, Committee on Injury and Poison Prevention. 2004. Policy statement: Firearm-related injuries affecting the pediatric population. Pediatrics 114:1126.

2. DiScala, C., R. Sege. 2004. Outcomes in children and young adults who are hospitalized for firearms-related injuries. Pediatrics 113:1306-12.

3. Grossman, D. C., B. A. Mueller, C. Riedy, et al. 2005. Gun storage practices and risk of youth suicide and unintentional firearm injuries. JAMA 296:707-14.

4. Katcher, M. L., A. N. Meister., C. A. Sorkness, A. G. Staresinic, S. E. Pierce, B. M. Goodman, N. M. Peterson, P. M. Hatfield, J. A. Schirmer. 2006. Use of the modified Delphi technique to identify and rate home injury hazard risks and prevention methods for young children. Injury Prev 12:189-94.

5. Hemenway, D., D. Weil. 1990. Phasers on stun: The case for less lethal weapons. J Policy Analysis Management 9:94-98.

5.6 Supplies

STANDARD 5.6.0.1: First Aid and Emergency Supplies

The facility should maintain first aid and emergency supplies in each location where children are cared for. The first aid kit or supplies should be kept in a closed container, cabinet, or drawer that is labeled and stored in a location known to all staff, accessible to staff at all times, but locked or otherwise inaccessible to children. When children leave the facility for a walk or to be transported, a designated staff member should bring a transportable first aid kit. In addition, a transportable first aid kit should be in each vehicle that is used to transport children to and from a child care facility.

First aid kits or supplies should be restocked after use. An inventory of first aid supplies should be conducted at least monthly. A log should be kept that lists the date that each inventory was conducted, verification that expiration dates of supplies were checked, location of supplies (i.e., in the facility supply, transportable first aid kit(s), etc.), and the legal name/signature of the staff member who completed the inventory.

The first aid kit should contain at least the following items:

Disposable nonporous, latex-free or non-powdered latex gloves (latex-free recommended);
Scissors;
Tweezers;
Non-glass, non-mercury thermometer to measure a child’s temperature;
Bandage tape;
Sterile gauze pads;
Flexible roller gauze;
Triangular bandages;
Safety pins;
Eye patch or dressing;
Pen/pencil and note pad;
Cold pack;
Current American Academy of Pediatrics (AAP) standard first aid chart or equivalent first aid guide such as the AAP Pediatric First Aid For Caregivers and Teachers (PedFACTS) Manual;
Coins for use in a pay phone and cell phone;
Water (two liters of sterile water for cleaning wounds or eyes);
Liquid soap to wash injury and hand sanitizer, used with supervision, if hands are not visibly soiled or if no water is present;
Tissues;
Wipes;
Individually wrapped sanitary pads to contain bleeding of injuries;
Adhesive strip bandages, plastic bags for cloths, gauze, and other materials used in handling blood;
Flashlight;
Whistle;
Battery-powered radio (1).

When children walk or are transported to another location, the transportable first aid kit should include ALL items listed above AND the following emergency information/items:

List of children in attendance (organized by caregiver/teacher they are assigned to) and their emergency contact information (i.e., parents/guardian/emergency contact home, work, and cell phone numbers);
Special care plans for children who have them;
Emergency medications or supplies as specified in the special care plans;
List of emergency contacts (i.e., location information and phone numbers for the Poison Center, nearby hospitals or other emergency care clinics, and other community resource agencies);
Maps;
Written transportation policy and contingency plans.

RATIONALE: Facilities must place emphasis on safeguarding each child and ensuring that the staff members are able to handle emergencies (2).

COMMENTS: Many centers simply leave a first aid kit in all vehicles used to transport children, regardless of whether the vehicle is used to take a child to or from a center, or for outings. Maps are required in case transporting staff need to find an alternate way back to the facility or another route to emergency services when roads are closed and/or communication and power systems are inaccessible. Programs may want to have access to hand-held or stationary electronic/cellular, or satellite devices (e.g., GIS systems or phones that include relevant features) when transporting to help locate alternative routes during an emergency.

Syrup of Ipecac should not be used to induce vomiting and should not be included in first aid kits or available at a child care program (1). Contact the local poison center at 1-800-222-1222 for instructions if needed.

Hand sanitizers may be used under supervision as an alternative to washing hands with soap and water if wipes are used to remove visible soil before the hand sanitizer is applied.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. American Academy of Pediatrics. 2007. Pediatric first aid for caregivers and teachers. Rev ed. Elk Grove Village, IL: AAP. http://www.pedfactsonline.com/.

STANDARD 5.6.0.2: Single Service Cups

Single service cups should be dispensed by staff or in a cup dispenser approved by the regulatory health authority. Single service cups should not be reused.

RATIONALE: Reusing cups, even by the same person, allows growth of organisms in the cup between uses.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

STANDARD 5.6.0.3: Supplies for Bathrooms and Handwashing Sinks

Bathrooms and handwashing sinks should be supplied with:

Liquid soap, hand sanitizer, hand lotion, and paper towels or other hand-drying devices approved by the regulatory health authority, within arm’s reach of the user of each sink;
Toilet paper, within arm’s reach of the user of each toilet.

The facility should permit the use of only single-use cloth or disposable paper towels. The shared use of a towel should be prohibited. All tissues and disposable towels should be discarded into an appropriate waste container after use.

RATIONALE: Lack of supplies discourages necessary handwashing. Cracks in the skin and excessive dryness from frequent handwashing discourage the staff from complying with necessary hygiene and may lead to increased bacterial accumulation on hands. The availability of hand lotion to prevent dryness encourages staff members to wash their hands more often. Supplies must be within arm’s reach of the user to prevent contamination of the environment with waste, water, or excretion.

Shared cloth towels can transmit infectious disease. Even though a child may use a cloth towel that is solely for that child’s use, preventing shared use of towels is difficult. Disposable towels prevent this problem, but once used, must be discarded. Many infectious diseases can be prevented through appropriate hygiene and sanitation.

COMMENTS: Bar soap should not be used by children or staff. Liquid soap is widely available, economical, and easily used by staff and children. If anyone is sensitive to the type of product used, a substitute product that accommodates this special need should be used.

A disposable towel dispenser that dispenses the towel without having to touch the container or the fresh towel supply is better than towel dispensers in which the person must use a lever to get a towel, or handle the towel supply to remove one towel. Some roller devices dispense one towel at a time from a paper towel roll; some commercial dispensers hold either a large roll or a pile of folded towels inside the dispenser, with the towel intended for next use sticking out of the opening of the dispenser.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

STANDARD 5.6.0.4: Microfiber Cloths, Rags, and Disposable Towels and Mops Used for Cleaning

Microfiber cloths should be preferred for cleaning. They should be laundered between each use. If microfiber cloths are not appropriate for use, disposable towels should be preferred for cleaning. If clean reusable rags are used, they should be laundered separately between each one-time use for cleaning. Disposable towels should be sealed in a plastic bag and removed to outside garbage. Cloth rags should be placed in a closed, foot-operated, plastic-lined receptacle until laundering. When a mop is needed, microfiber mops should be considered as a preferred cleaning method over conventional loop mops. Use of sponges in child care facilities for cleaning purposes is not recommended.

RATIONALE: Microfiber cloths are superior at picking up bacteria and holding it in the fibers. The microfiber mopping system offers many health and safety benefits. The microfiber mopping system is as effective as using the traditional loop mop method, yet there is a reduction in the use of and exposure to harsh disinfectant chemicals (2). Additionally, the microfiber mops are lighter and easier to use than conventional mops thus lessening the potential for worker muscle sprains (1). The system leaves only a light film of water on the floor that dries quickly, thus lessening the potential for worker injury for slips and falls on a wet floor. Materials used for cleaning become contaminated in the process and must be handled so they do not spread potentially infectious material (3).

COMMENTS: Sponges generally are contaminated with bacteria and are difficult to clean.

For more detailed information on microfiber cloths and mopping, see Sustainable Hospitals Project EPA Best Practices Publication Using Microfiber Mops in Hospitals, available at http://www.epa.gov/region9/waste/p2/projects/hospital/mops.pdf.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. Sustainable Hospitals Project, University of Massachusetts–Lowell. 2003. 10 reasons to use microfiber mopping. http://www
.sustainablehospitals.org/PDF/tenreasonsmop.pdf.

2. Sustainable Hospitals Project, University of Massachusetts–Lowell. 2003. Are microfiber mops beneficial for hospitals? http://www.sustainablehospitals.org/PDF/MicrofiberMopCS.pdf.

3. Hoyle, M., B. Slezak. 2008. Understanding microfiber’s role in infection. Infection Control Today (May). http://www
.infectioncontroltoday.com/articles/2008/11/understanding
-microfiber-s-role-in-infection-prev.aspx.

5.7 Maintenance

STANDARD 5.7.0.1: Maintenance of Exterior Surfaces

Porches, steps, stairs, and walkways should:

Be maintained free from accumulations of water, ice, or snow;
Have a non-slip surface;
Be kept free of loose objects;
Be in good repair;
Be free of flaking paint.

RATIONALE: Trip surfaces lead to injury. Flaking lead-based paint can be ingested in sufficient quantities to cause lead poisoning (1,2,3).

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. U.S. Consumer Product Safety Commission (CPSC). What you should know about lead based paint in your home: Safety alert. http://www.cpsc.gov/cpscpub/pubs/5054.html.

2. Centers for Disease Control and Prevention (CDC). 2005. Preventing lead poisoning in young children. Atlanta, GA: CDC. http://www.cdc.gov/nceh/lead/publications/PrevLeadPoisoning.pdf.

3. U.S. Environmental Protection Agency (EPA). 2010. The lead-safe certified guide to renovate right. Washington, DC: EPA. http://www.epa.gov/lead/pubs/renovaterightbrochure.pdf.

STANDARD 5.7.0.2: Removal of Hazards From Outdoor Areas

All outdoor activity areas should be maintained in a clean and safe condition by removing:

Debris;
Dilapidated structures;
Broken or worn play equipment;
Building supplies and equipment;
Glass;
Sharp rocks;
Stumps and roots;
Branches;
Animal excrement;
Tobacco waste (cigarette butts);
Garbage;
Toxic plants;
Anthills;
Beehives and wasp nests;
Unprotected ditches;
Wells;
Holes;
Grease traps;
Cisterns;
Cesspools;
Unprotected utility equipment;
Other injurious material.

Holes or abandoned wells within the site should be properly filled or sealed. The area should be well-drained, with no standing water.

A maintenance policy for playgrounds and outdoor areas should be established and followed.

RATIONALE: Proper maintenance is a key factor when trying to ensure a safe play environment for children. Each playground is unique and requires a routine maintenance check program developed specifically for that setting.

TYPE OF FACILITY: Center; Large Family Child Care; Small Family Child Care Home

STANDARD 5.7.0.3: Removal of Allergen Triggering Materials From Outdoor Areas

Outdoor areas should be kept free of excessive dust, weeds, brush, high grass, and standing water.

RATIONALE: Dust, weeds, brush, and high grass are potential allergens (1). Standing water breeds insects.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. Asthma and Allergy Foundation of America. 2005. Allergy overview. http://www.aafa.org/display.cfm?id=9&cont=82/.

STANDARD 5.7.0.4: Inaccessibility of Hazardous Equipment

Any hazardous equipment should be made inaccessible to children by barriers, or removed until rendered safe or replaced. The barriers should not pose any hazard.

RATIONALE: Limiting access to hazardous equipment can prevent injuries to children and staff in child care.

COMMENTS: Examples of barriers to equipment that pose a safety hazard are structures (including fences) that children can climb, prickly bushes, and standing bodies of water. Barriers such as plastic orange construction site fencing could be used to block access. While not child proof, it is conspicuous and sends a message that it is there to prevent access to the equipment it surrounds.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

STANDARD 5.7.0.5: Cleaning Schedule for Exterior Areas

A cleaning schedule for exterior areas should be developed and assigned to appropriate staff members. Delegated staff members should actively look for flaking or peeling paint while cleaning the exterior areas. If flaking/peeling paint is found, it should be tested for lead. If the paint is found to contain lead, the area should be covered by latex-based paint to create a barrier between the lead-based paint and the children in care.

RATIONALE: Developing a cleaning schedule that delegates responsibility to specific staff members helps ensure that the child care facility is appropriately cleaned. Proper cleaning reduces the risk of injury and the transmission of disease.

Lead paint chips may be ingested by young children and lead to neurological and behavioral problems. Covering the lead paint with latex paint reduces toxic exposure (1-3).

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. U.S. Consumer Product Safety Commission (CPSC). What you should know about lead based paint in your home: Safety alert. http://www.cpsc.gov/cpscpub/pubs/5054.html.

2. Centers for Disease Control and Prevention (CDC). 2005. Preventing lead poisoning in young children. Atlanta, GA: CDC. http://www.cdc.gov/nceh/lead/publications/PrevLeadPoisoning.pdf.

3. U.S. Environmental Protection Agency (EPA). 2010. The lead-safe certified guide to renovate right. Washington, DC: EPA. http://www
.epa.gov/lead/pubs/renovaterightbrochure.pdf.

STANDARD 5.7.0.6: Storage Area Maintenance and Ventilation

Storage areas should have appropriate lighting and be kept clean. If the area is a storage room, the area should be mechanically ventilated to the outdoors when chemicals or a janitorial sink are present.

RATIONALE: Spilled items must be removed to promote health and safety. Spilled dry foods could attract rodent and insects. Chemicals and janitorial supplies can build up toxic fumes that can leak into occupied areas if they are not ventilated to the outdoors (1).

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. U.S. Environmental Protection Agency. An introduction to indoor air quality. http://www.epa.gov/iaq/voc.html.

STANDARD 5.7.0.7: Structure Maintenance

The structure should be kept in good repair and safe condition.

Each window, exterior door, and basement or cellar hatchway should be kept in sound condition and in good repair.

RATIONALE: Older preschool-age and younger school-age children readily engage in play and explore their environments. The physical structure where children spend each day can present caregivers/teachers with special safety concerns if the structure is not kept in good repair and maintained in a safe condition. For example, peeling paint in an older building may be ingested, floor surfaces in disrepair could cause falls and other injury, and broken glass windows could cause severe cuts or other glass injury (1).

Children’s environments must be protected from exposure to moisture, dust, and excessive temperatures.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. Whole Building Design Guide Secure/Safe Committee. 2010. Ensure occupant safety and health. National Institute of Building Sciences. http://www.wbdg.org/design/ensure_health.php.

STANDARD 5.7.0.8: Electrical Fixtures and Outlets Maintenance

Electrical fixtures and outlets should be maintained in safe condition and good repair.

RATIONALE: Unsafe or broken electrical fixtures and outlets could expose children to serious electrical shock or electrocution. Loose or frayed wires are also unsafe.

COMMENTS: Running an appliance or extension cord underneath a carpet or rug is not recommended because the cord could fray or become worn and cause a fire (1).

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. Greiner, D., D. Leduc, eds. 2008. Well beings: A guide to health in child care. 3rd ed. Ottawa, ON: Canadian Paediatric Society.

STANDARD 5.7.0.9: Plumbing and Gas Maintenance

Each gas pipe, water pipe, gas-burning fixture, plumbing fixture and apparatus, or any other similar fixture, and all connections to water, sewer, or gas lines should be maintained in good, sanitary working condition.

RATIONALE: Pipe maintenance prevents injuries from hazardous and unsanitary conditions.

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

STANDARD 5.7.0.10: Cleaning of Humidifiers and Related Equipment

Humidifiers, dehumidifiers, and air-handling equipment that involve water should be cleaned and disinfected according to manufacturers’ instructions.

RATIONALE: These appliances provide comfort by controlling the amount of moisture in the indoor air. To get the most benefit, the facility should follow all instructions. If the facility does not follow recommended care and maintenance guidelines, microorganisms may be able to grow in the water and become airborne, which may lead to respiratory problems (1).

COMMENTS: For additional information, contact the U.S. Consumer Product Safety Commission (CPSC) and the Association of Home Appliance Manufacturers (AHAM).

TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home

REFERENCES:

1. U.S. Consumer Product Safety Commission (CPSC). CPSC issues alert about care of room humidifiers: Safety alert. Dirty humidifiers may cause health problems. http://www.cpsc.gov/cpscpub/pubs/5046.html.