Children engage in active outdoor play every day. Sturdy shoes or sneakers help them run, climb, jump, and explore safely. The arrival of warm weather can encourage more vigorous play, but also the tendency to wear unsafe footwear.
Many children choose different footwear on warm days. Flip-flops, loose sandals, and rubber clogs are unsafe shoes. Avoid shoes that can fall off or catch on objects during active play. Unsafe shoes increase the risk of injury due to falls. Encourage parents/guardians to provide a pair of sneakers or other safe shoes to keep in the child’s cubby for use during active play.

In a June 2011 report, the Institute of Medicine (IOM) recommended obesity control measures for children in 5 areas:
1. Growth Monitoring
2. Physical Activity
3. Healthy Eating
4. Limiting Screen Time and Marketing Exposure for Children
5. Sufficient Sleep

 The national American Academy of Pediatrics has a FREE, online Spanish-language magazine. The articles are about common child health concerns such as immunizations, the importance of sleep, and how to manage stress.

The majority of early learning programs serve some children with special health needs. These are children with a special medical, behavioral, or developmental condition. They are children who require care that differs in some way from that of typically developing children. For example, children need individual care plans if they have asthma, a severe allergic reaction to a food, seizures or diabetes. Children who have challenging behavior require care plans too.

ECELS has developed many tools to help programs set up a care plan for a child with any type of special need. The ECELS website has forms, a checklist and a process guide to download and use to make effective care plans.

Did you know…
ECELS has valuable tools to help you meet the new STARS Standard LM 2.5 Program uses Caring for our Children to establish policies and practices regarding care plans for children with special medical needs as well as medication administration.

1. Use Model Child Care Health Policies5th Ed. form-field version to adapt a policy for your program. See Section 10-Health Plan, items E, F, and Appendix X - Medication Administration Packet. Model Child Care Health Policies, 5th Ed. is consistent with Caring for Our Children, 3rd Ed. online (CFOC3).
2. Use the ECELS Care Plan for Children with Special Needs and Process to Enroll documents.  
3. Unavailble- The online self-learning module is temporarily unavailable while ECELS updates the format. The ECELS Self-Learning Module, Children with Medical and Developmental Special Needs, Inclusive Practices educates staff about caring for children with special needs as well as medication administration. (2 hours credit)

If you have questions about these tools, please send an email with your contact information to This email address is being protected from spambots. You need JavaScript enabled to view it. Updated 6/22/2021

Participation in outdoor activities during colder weather is possible. Outdoor play is enjoyable when children and staff dress appropriately. This article addresses important information to remain safe outdoors in cold weather. Also included is cold weather guidance from the:

- PA Department of Human Services' (DHS) Regulations for operating a child care facility
- PA Position Statements ECERS-R

A link to Avoid Spot Treat Frostbite & Hypothermia infographic infographic is provided. The Weather Watch Chart helps early care and education (ECE) providers plan daily playtime with guidance on wind chill factor and humidity relative to temperature. 1/29/21

Stay Safe in Hot Weather

Extreme heat can make children sick in many ways, including dehydration, heat cramps, heat exhaustion, and heat stroke.

It is possible to safely participate in outdoor activities during the summer heat. To help protect kids from heat illness::

  • Stay hydrated
  • Dress lightly
  • Provide shade in play areas
  • Plan for extra rest time
  • Cool off
  • Prevent the effects of sun exposure

Weather monitoring resources:
Staff can use the Iowa Department of Public Health’s Child Care Weather Watch resource to help understand words used in weather forecast. This resource, along with local forecasts, can help staff monitor the temperature, humidity, and air quality. To stay up to date on current conditions:

Check the Air Quality Index at and subscribe to EnviroFlash. This service from the US Environmental Protection Agency and state/local environmental agencies provides daily emails with information about local air quality. Poor air quality can negatively affect children with asthma and other special health care needs.
Check the forecast for the UV Index at to limit exposure to the sun on days when the Index is high.

Sign up to receive hourly weather forecasts from the National Weather Service on a computer or mobile phone. The National Weather Service (NWS) provides up-to-date weather information on all advisories and warnings. It also provides safety tips for caregivers/teachers to use as a tool in determining when weather conditions are comfortable for outdoor play.

Stay hydrated

Encourage children to drink water regularly and have it readily available—even before they ask for it.

Infants: On hot days, infants receiving breast milk in a bottle can be given additional breast milk in a bottle, but they should not be given water—especially in the first six months of life. Infants receiving formula can be given additional formula in a bottle.
Toddlers and preschool children: Provide regularly scheduled water breaks to encourage all children to drink during active play, even if they don’t feel thirsty. Fluoridated water (bottled or from the faucet) can reduce the risk of early childhood caries and is the best drink choice for young children in between meals.


CFOC Standards:

National Center on Early Childhood Health and Wellness

Posted 8/10/2021

The skin of infants and toddlers is more sensitive to ultraviolet radiation. Their skin absorbs chemicals more easily than the skin of adults and older children. Sun exposure can cause unhealthy changes in the skin at any age. Of the three types of ultraviolet radiation, UVA and UVB damage skin. Children should spend a lot of time outdoors. Protecting their skin from sun damage is very important.

No matter what type or tone of skin a person has, from infancy to old age, everyone should have protection from sun exposure. Sunscreen products and sun protective clothing help prevent sunburn, skin cancer and early skin aging throughout life. The best protection is wearing light weight, tightly-woven sun-protective hats and clothing outside. Wearing sun protective clothing should be combined with wearing sun screen after 6 months of age.

Active supervision minimizes harm to children. All staff should review the fact sheet Active Supervision At-A-Glance Six Strategies To Keep Children Safe Active Supervision At-A-Glance Six Strategies To Keep Children Safe. The fact sheet is available in English and Spanish. Although written for Head Start, these key strategies apply to all types of care. They apply to all age groups, and all activities.

The key strategies are:
• Set up the environment – Keep furniture at waist height or shorter, avoid clutter, make all spaces fully observable.
• Position staff – Assign staff to locations where they can hear and see all the children. They should have a clear path to each child to take quick action. Caregivers/teachers should stay close to children who might need special help or support.
• Scan and count – Keep checking the location and activity of each child. Count the children frequently (e.g. at least every 10-15 minutes.) Count while moving from one location to another.
• Listen – Pay attention to the sounds in the environment. Specific sounds or the absence of them may signify reason for concern. Use sounds such as a bell attached to doors in the room, or equipment being moved to alert staff to provide closer supervision.
• Anticipate children’s behavior – Use knowledge both of typical behavior and possible unusual behavior. Be prepared to modify supervision, planned activities or other elements to help each child succeed and avoid harm.
• Engage and redirect – Give children opportunities to problem solve, using observation to intercede when the child needs support.
To learn more about active supervision, see The Early Childhood Learning & Knowledge Center of Head Start and search for “Active Supervision”.    Reviewed and reaffirmed 6/2021

Swaddling (wrapping tightly) in a blanket calms many young babies. However, improper use of this practice increases risk of harm. If the blanket is too loose, it can move up to cover the infant’s face. Loose blankets around the infant’s head are a risk factor for Sudden Infant Death Syndrome (SIDS.) Swaddling may cause overheating, another SIDS risk factor. If the blanket wraps the legs so they are not free to move, researchers find the baby is more likely to develop hip disease. 

Q: What is the guidance regarding embedded tick removal for ECE providers?
A: It is recommended that removal of a tick from a child should be completed by the parent/guardian or medical professional as soon as possibleAccording to Dr. Brittany Massare, ECELS Advisor and Pediatrician, “The more time a tick is attached to a child increases the risk of Lyme disease transmission. In general, the CDC says it takes at least 36-48 hours of the tick being attached before Lyme is spread to the person. If a parent did a thorough tick check before bed the night before and did not see a tick, this is reassuring. But because attached ticks can be missed even with thorough checks and the CDC can’t say for sure there is no transmission of Lyme until at least 36 hours of attachment, prompt removal of any tick is recommended.”
OCDEL Certification recommends that if a childcare provider finds an embedded tick, they should immediately contact the child’s parent or guardian so that next steps can be determined quickly. This is consistent with regulation 132(a). While it is not recommended for a provider to remove an embedded tick, there is no regulation that states that they cannot do so. With that being said, it is advised that a provider not remove a tick unless there is written authorization by the parent and the provider has received the appropriate health and safety training to do so. Following proper technique for tick removal can be challenging; even with proper technique, heads can stay attached and need to be dug out, which can be difficult.

Tick Removal and Prevention
The Centers for Disease Control and Prevention ( provides information on prevention, removal and symptoms of tickborne diseases. Helpful resources include:
o Tick Bite: What to do (includes removal of tick)
o Preventing tick bites
o Preventing ticks in the yard
Caring for our Children (CFOC) standard includes information
on protection from ticks and how to remove a tick.
Pediatric First Aid for Caregivers and Teachers (2nd ed.) First Aid Care for tick bites section states: “Don’t grab a
tick by the rear of its body. The body might rupture. Then the infectious contents can enter the wound. If the ticks
head breaks off in the skin, use tweezers as you would remove a splinter. Wash area with soap and rinse with
water. Inform the parent or guardian that you have removed a tick from the child. Alert them to watch the bite
area for appearance of a rash. If a rash appears, or the child becomes ill, the child needs medical care.”
Managing Infectious Diseases in Child Care and Schools (5th ed.) includes a section on the roles of the
teacher/caregiver and family, and states that a child does not need to be excluded from a group setting for a tick
bite unless the child is ill with a tickborne illness and is unable to participate. Staff members determine whether
they are able to care for the child without compromising their ability to care for the health and safety of the other
children in the group.

For More information see Health Advisory - 571 - Lyme Disease and Other Tickborne Diseases in Pennsylvania
For questions, please call 1-877-PA-HEALTH (1-877-724-3258) or your local health department for more information.

Shared by ECELS, Healthy Child Care PA/PA Chapter, American Academy of Pediatrics 484/446-3003
Reviewed by Amy Requa: Senior Health Manager, The Pennsylvania Key 6/2021

Brushing children’s teeth during the day is a great way to promote health. It may also reduce the risk of tooth decay for young children. Bacteria can grow on toothbrushes that have been in someone’s mouth. They grow especially well on wet toothbrushes that are kept in closed, dark places. Follow these steps to make sure toothbrushes stay clean. Wet toothbrush bristles should not be covered. They should air dry.

Do you or the families you serve transport children? Review performance standards for transporting children safely in early care and education programs. Share this information with parents who transport their children in vehicles other than a public bus. The model policy is consistent with Caring for Our Children: National Health and Safety Performance Standards.

Chicks, Turtles, Lizards and Frogs - Oh My!

Spring is here! More choices for outdoor play. Take time to explore nature with the children in your care. Well-intentioned directors may want to incorporate hatching eggs into their curriculum. Caring for Our Children (CFOC), Standard - Prohibited Animals reminds us chickens and ducks excrete E. coli O157:H7, Salmonella, and other bacteria. The Centers for Disease Control and Prevention (CDC) webpage cautions, “… Because young children are more likely to get sick from harmful germs that animals can carry, CDC recommends that infants and children under 5 years old avoid contact with the following animals, which are commonly associated with outbreaks of disease:
•Amphibians (frogs, toads, newts, and salamanders)
Early care and education staff and parents must remember the risks. Children are more likely to get infected with the bacteria if they put unwashed hands into their mouths after touching a reptile or hermit crab. Follow CFOC guidance for prohibited animals. Avoid the risks. Do not collect or touch chicks, ducklings, reptiles, hermit crabs, or any prohibited animal. Encourage careful hand hygiene for everyone who interacts with animals. Reviewed and reaffirmed 7/2021

Water play offers wonderful developmental learning opportunities.  However, early educators must control the risks of drowning and spread of infection from contaminated water. It takes less than 30 seconds for a young child to begin to drown. More than 250 children less than 5 years of age drown each year. The American Academy of Pediatrics (AAP) recommends that most children age 4 and older should learn to swim. Children between 1 and 4 years of age may benefit from formal swimming lessons. However, nobody should rely on a child’s swimming skills to become less vigilant about supervising a child in the water.  To learn more about how to reduce the risk of drowning, go to the websites of the Consumer Product Safety Commission at and the AAP at Search for “drowning” on both sites. Preventing bad germs from spreading through contact with water requires vigilance too. Early care and education providers must pay attention to controlling both of these risks.