Endorsing Caring for Our Children: National Health and Safety Performance Standards: Guidelines for Early Care and Education Programs, Third Edition

Related APHA Policies,

APHA Policy Statement 9109 – Standards for Child Care Health and Safety
APHA Policy Statement 2002-2 – Endorsing Caring for Our Children National Health and Safety Performance Standards: Guidelines for Out-of-Home Child Care Programs 

Abstract

Of the 21 million children in the United States under the age of 5 years, nearly half are enrolled in non-parental center-based child care or family child care homes. Since 1992, the American Public Health Association, the American Academy of Pediatrics, and the National Resource Center for Health and Safety in Child Care and Early Education, with support from the Maternal and Child Health Bureau of the Health Resources and Services, have collaborated on the document Caring for Our Children: National Health and Safety Performance Standards: Guidelines for Early Care and Education Programs. Caring for Our Children is recognized as the leading authoritative tool regarding health and safety guidelines for out-of-home child care and early education, and it serves as the national standard for out-of-home child care providers, parents, health professionals, and state officials. Previous APHA policies supported Caring for Our Children’s first and second editions. This policy statement extends the endorsement of APHA to the third edition, published in 2011.

Problem Statement

Scientific issues: Of the 21 million children under the age of 5 years in the United States³ nearly half are enrolled in non-parental center-based child care or family child care homes, including 29% of infants and toddlers age 2 or less.^4–6 Among working mothers, enrollment in non-family care jumps to 35% of infants under age 1 and 47% of infants/toddlers age 2 and below.⁶

Kindergarten surveys indicate that approximately 20% of children entering kindergarten have a health or developmental condition that potentially interferes with their readiness to learn,⁷ yet fewer than 30% of these children are identified as at risk before the age of 5 years.⁸ During the first 5 years of life, the child’s body, brain, mind, and personality rapidly develop under the influence of everyday learning, healthy and safe environments, and nurturing experiences provided by parents and other caregivers.⁹ There is substantial evidence that high-quality early childhood development programs can have a positive effect on preventing cognitive delays and increasing school readiness.¹⁰

The Institute of Medicine and the National Academy of Sciences have documented the powerful effects that appropriately timed early intervention and health promotion services can have on lifelong health and developmental outcomes.⁹ However, the quality of child care can affect a child’s early learning experiences and subsequent outcomes, and child care quality in our country varies greatly.¹¹ Because a child’s school readiness includes cognition and general knowledge, social-emotional development, physical health and good nutrition, motor development, and language development, the National Association for the Education of Young Children promotes developmentally appropriate practices in early care and education programs to reduce learning gaps and increase the achievement of all children through improved school readiness.¹² Furthermore, the National Governors Association (NGA) encourages working toward a seamless early care and education system that provides a safe, nurturing, and developmentally sound environment for all children and is linked to health care and education systems. The NGA position on early care and education policies identifies options for federal government roles and responsibilities that include promotion and dissemination of research on existing high-quality early care and education programs and support for state efforts to enforce state licensing and accreditation.¹³

The publication Caring for Our Children: National Health and Safety Performance Standards: Guidelines for Early Care and Education Programs addresses the need for guidelines for health promotion and disease prevention in out-of-home child care based on current research. Now in its third edition, Caring for Our Children is the product of a collaborative project among the American Academy of Pediatrics, the American Public Health Association, and the National Resource Center for Health and Safety in Child Care and Early Education, with support from the Maternal and Child Health Bureau of the Health Resources and Services Administration.¹⁴ Caring for Our Children is recognized as the leading authoritative tool regarding health and safety recommendations for out-of-home child care and serves as the national standard for out-of-home child care providers, parents, health professionals, and state officials.

Political/resource issues: Licensed child care centers and family child care homes already must satisfy state regulations. Unfortunately, state regulations tend to be less rigorous than the standards recommended in Caring for Our Children. In addition, standards, regulation, and funding levels vary across jurisdictions.^11,15,16 Providers’ training and education are closely associated with the quality of both center-based and home-based care.^11,17 Providers of out-of-home child care may need support from public health professionals such as child care health consultants (whose training is based on Caring for Our Children) should they wish to achieve higher quality rating scores or national accreditation. Such health consultation services are not without cost.¹⁸ However, the costs are reasonable considering the benefits, which include improvements in the development and use of standards-based health and safety policies; promotion of specific health and safety practices, up-to-date immunizations, and access to medical care homes; and availability of specialty consultations in mental health, nutrition, and oral health.^18,19

Child care centers and family child care homes that invest in upgrading their health and safety standards may also benefit from higher quality rating scores, which would justify charging higher fees.²⁰ The ability to charge higher fees could help offset the increased costs of enhancing these standards. In addition, grant funding through government programs and local initiatives helps cover changes required to achieve greater adherence to health and safety guidelines.²¹ For example, the US Department of Agriculture (USDA) offers child care wellness programs to help advance nutrition efforts.²² The USDA also awards grants through its Community Facilities Grant Program to rural areas; these grants can be used to expand and renovate essential facilities, such as child care centers, used for community, public safety, health care, and public services.²³ There is also funding available through the US Department of Health and Human Services and other possible small grants through local agencies.^21,23 An enterprising center might consider fundraising efforts (e.g., community car washes, raffles, bake sales) to apply toward the increased costs of meeting improved child safety standards. Although greater adherence to recommended health and safety standards may equate to increased costs, it is not cost prohibitive.

Ethical issues: Seemingly, there are no ethical issues attached to dissemination of research-based standards for health promotion and disease prevention in out-of-home child care. However, there are inequities in access to high-quality child care, which is more expensive than routine child care. Therefore, children from more advantaged families may be more likely to benefit from exposure to centers that incorporate the Caring for Our Children standards into their policies and practices. Conversely, if consultation and technical assistance in the implementation of these standards were more widely available, low-income children in out-of-home child care would benefit disproportionately given that they may be more in need of nutrition, oral health, social-emotional, and immunization support as well as referral to a medical home.

Proposed Recommendations Statement

APHA endorses the third edition of Caring for Our Children: National Health and Safety Performance Standards: Guidelines for Early Care and Education Programs because it demonstrates both leadership and commitment in prioritizing the health, safety, and well-being of young children at a national scale. The publication encourages out-of-home child care providers, child care health consultants, state health and child care administrators, and child care licensing bodies and regulators to adopt the Caring for Our Children guidelines as their standard of care. In addition, it urges states to develop publicly funded, high-quality early childhood education, child care, and prekindergarten programs and encourages the federal government to support states in their efforts to improve the quality of early care and education by helping them encourage child care programs in their implementation of the Caring for Our Children standards.

The health and safety of all children enrolled in early care and education programs is critical. Finding high-quality inclusive child care for children with disabilities is an ongoing challenge for parents.²⁴ Early care and education providers can greatly enhance their capacity and skills to meet the needs of all children by incorporating training and consultation with clear standards for inclusive care.^24,25 The child care setting can also be used as a platform for discussing and applying practical health and safety learning behaviors in daily activities. Health education and promotion of wellness activities among children can lead to healthier children and well-adjusted adults. Health and safety can focus on a number of issues, including overweight and obesity, nutrition and healthy eating habits, environmental safety, and chronic disease prevention and/or control.^26–28 All of these health and safety issues can be effectively enhanced and addressed through the use of the Caring for Our Children national health and safety performance standards. For instance, child care staff can model effective safety practices and health habits (e.g., appropriate eating and regular physical activity) in both indoor and outdoor environments. 

Opposing Arguments/Evidence 

It could be argued that a plethora of child care standards already exist in each state^29,30 and that child care licensing standards already provide the baseline of quality required. State licensing agencies must be sensitive to the implications of new regulations in terms of the cost and availability of child care. However, the fact that minimum licensing standards vary among states³¹ demonstrates that there is not complete agreement on the most appropriate child care standards. This can be disadvantageous to children and families in instances in which regulations may not be up to date or may not represent best practices. 

Action Steps

Therefore, APHA:

1. Endorses the third edition of Caring for Our Children: National Health and Safety Performance Standards: Guidelines for Early Care and Education Programs;
2. Encourages out-of-home child care providers, child care health consultants, state health and child care administrators, and child care licensing bodies and regulators to adopt Caring for Our Children as their standard of care; and
3. Encourages the federal government to support states in their efforts to improve the quality of early care and education by helping them encourage child care programs in their implementation of Caring for Our Children.

References

1. American Public Health Association. Policy No. 9109. Available at: http://www.apha.org/advocacy/policy/policysearch/default.htm?id=16. Accessed December 14, 2013.
2. American Public Health Association. Policy No. 2002-2. Available at: http://www.apha.org/advocacy/policy/policysearch/default.htm?id=276. Accessed December 14, 2013.
3. Children’s Defense Fund. State of America’s children. Available at: http://www.childrensdefense.org/child-research-data-publications/state-of-americas-children-2011/pdfs/poverty.pdf. Accessed December 14, 2013.
4. Federal Interagency Forum on Child and Family Statistics. America’s children: key national indicators of well-being, 2011. Available at: http://www.childstats.gov/americaschildren/glance.asp. Accessed December 14, 2013.
5. US Census Bureau. Who’s minding the kids? Child care arrangements: spring 2010—detailed tables. Available at: http://www.census.gov/hhes/childcare/data/sipp/2010/tables.html. Accessed December 14, 2013.
6. Capizzano J, Adams G, Sonenstein F. Child care arrangements for children under five: variations across states. Available at: http://www.urban.org/UploadedPDF/anf_b7.pdf. Accessed December 14, 2013.
7. High PC, Committee on Early Childhood, Adoption, and Dependent Care, and Council on School Health. Technical report: school readiness. Pediatrics. 2008;121(4):e1008–e1015. 
8. Glascoe FP. Screening for developmental and behavioral problems. Ment Retard Dev Disabil Res Rev. 2005;11:173–179. 
9. Shonkoff JP, Phillips D. From Neurons to Neighborhoods: The Science of Early Child Development. Washington, DC: National Academy Press; 2000.
10. Anderson LM, Shinn C, Fulilove MT, et al. The effectiveness of early childhood development programs: a systematic review. Am J Prev Med. 2003;24:32–46.
11. Fuller B, Kagan S, Loeb S, Chang Y. Child care quality: centers and home settings that serve poor families. Early Childhood Res Q. 2004;19(4):505–527.
12. National Association for the Education of the Young Child. Position statement: developmentally appropriate practice in early childhood programs serving children from birth through age 8. Available at: http://www.naeyc.org/files/naeyc/file/positions/position%20statement%20Web.pdf. Accessed December 14, 2013.
13. National Governors Association. Building ready states: a governor’s guide to supporting a comprehensive, high-quality early childhood state system: 2010. Available at: http://www.nga.org/files/live/sites/NGA/files/pdf/1010GOVSGUIDEEARLYCHILD.PDF. Accessed December 14, 2013.
14. American Academy of Pediatrics, American Public Health Association, National Resource Center for Health and Safety in Child Care and Early Education. Caring for Our Children: National Health and Safety Performance Standards: Guidelines for Early Care and Education Programs. 3rd ed. Elk Grove Village, IL: American Academy of Pediatrics; Washington, DC: American Public Health Association; 2011.
15. Fuller B, Kagan S, Loeb S, Chang Y. Child care quality: centers and home settings that serve poor families. Early Childhood Res Q. 2004;19(4):505–527. 
16. Perez A, Peterson S. Meeting the needs of the youngest infants in child care. Zero Three. 2009;29(3):13–17.
17. Burchinal M, Howes C, Kontos S. Structural predictors of child care quality in child care homes. Early Childhood Res Q. 2002;17(1):87–105.
18. Healthy Child Care Consultant Network Support Center. The influence of child care health consultants in promoting children’s health and well-being: a report on selected resources. Available at: http://www.mchlibrary.info/documents/34010.pdf. Accessed December 14, 2013
19. Isbell P, Kotch JB, Savage E, Gunn E, Lu LS, Weber DJ. Improvement of child care programs’ policies, practices, and children’s access to health care linked to child care health consultation. NHSA Dialog. 2013;16(2):34–52.
20. Zellman GL, Perlman M. Child-care quality rating and improvement systems in five pioneer states: implementation issues and lessons learned. Available at: http://www.rand.org/pubs/monographs/MG795. Accessed December 14, 2013.
21. Howell R. Government daycare center grants. Available at: http://smallbusiness.chron.com/government-daycare-center-grants-12723.html. Accessed December 14, 2013.
22. Texas Department of Food and Agriculture. Funding/grants. Available at: http://www.squaremeals.org/FampNResources/FundingGrants.aspx. Accessed December 14, 2013. 
23. US Department of Agriculture, Food and Nutrition Service. Child and Adult Care Food Program. Available at: http://www.fns.usda.gov/cacfp/child-and-adult-care-food-program. Accessed December 14, 2013.
24. Odom SL, Buysse V, Soukakou E. Inclusion for young children with disabilities: a quarter century of research perspectives. J Early Intervention. 2011;33:344–356. 
25. Erwin EJ, Puig, VI, Evenson YL, Beresford M. Community and connection in inclusive early-childhood education: a participatory action research investigation. Young Exceptional Child. 2012 ;15(4):17–28. 
26. Mayer LM, Thursby E. Adolescent parents and their children: a multifaceted approach to prevention of adverse childhood experiences (ACE). J Prev Intervention Community. 2012;40(4):304–312. 
27. Reynolds AJ, Temple JA, Ou SR, Robertson DL, Mersky JP, Topitzes JW, Niles MD. Effects of a school-based, early childhood intervention on adult health and well-being: a 19-year follow-up of low-income families. Arch Pediatr Adolesc Med. 2007;161(8):730–739. 
28. Reynolds AJ, Temple JA, Robertson DL, Mann EA. Long-term effects of an early childhood intervention on educational achievement and juvenile arrest: a 15-year follow-up of low-income children in public schools. JAMA. 2001;285(18):2339–2346. 
29. Tennessee State Board of Education, Office of the Commissioner. Standards for child care centers and school-age child care programs. Available at: http://www.tn.gov/sos/rules/0520/0520-12/0520-12-01.pdf. Accessed December 14, 2013.
30. Vermont Department of Children and Families, Agency for Human Services. Vermont statutes online, title 33: human services, chapter 35: child care. Available at: http://www.leg.state.vt.us/statutes/fullsection.cfm?Title=33&Chapter=035&Section=03502. Accessed December 14, 2013.
31. Benjamin SE, Copeland KA, Cradock A, Neelon B, Walker E, Slining M, Gillman M. Menus in child care: a comparison of state regulations with national standards. J Am Diet Assoc. 2009;109(1):109–115. 

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