Health Capsules

ECELS offers brief articles to insert into parent and staff newsletters, post on bulletin boards or otherwise share information on health and safety topics. Whenever ECELS publishes a new Health Capsule, ECELS sends an E-Mail Alert from ECELS to everyone who signed up on the ECELS home page for these alerts. You may reproduce these brief articles as long as the wording of sentences is not changed, and ECELS is indicated as the source.

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 Updated 5/31/2022

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.

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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, including the skin of infants and toddlers. The ultraviolet radiation that damages skin is UVA and UVB. 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. Sun screen 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. Combine wearing sun protective clothing with wearing sun screen, except that children less than 6 months of age should not have sunscreen products on their skin.

When selecting sunscreen, make sure the label reads “Broad spectrum”, “SPF 15” or higher up to “SPF 50”, and “Water Resistant.” All sun screen products need to be applied at least 15 minutes before exposure to the sun. This gives the product time to attach to the skin for protection. Sunscreen products should be reapplied if sun exposure occurs more than 2 hours after the product was last applied.

“Broad Spectrum” means that the product protects against both UVB and UVA rays. These rays can cause sunburn and skin cancer.

The SPF rating indicates how long the sunscreen is effective. No sunscreen blocks 100% of the rays of the sun. Products rated lower than 15 SPF do not provide enough protection. Products with ratings higher than 50 SPF do not offer significant additional protection.

“Water Resistant” means that the product resists removal by sweat or water. Water resistance decreases with time. The product should be water resistant for up to 40 minutes or 80 minutes. This means the sunscreen provides protection while swimming or sweating up to the time listed on the label.

The American Academy of Pediatrics (AAP) and the American Academy of Dermatology (AAD) recommend products with titanium dioxide or zinc oxide for babies older than 6 months. Apply this type of product to all areas of the body, being careful around the eyes. If babies rub sunscreen into their eyes, wipe the eyes and hands clean with a damp cloth. If the sunscreen irritates the skin, try a different brand.

Choose a sunscreen product without oxybenzone if possible. Oxybenzone is a hormone modifier when tested on animal skin. Select sunscreen without insect repellent. Sunscreen should be reapplied more frequently than the insect repellent. Follow manufacturer’s directions. See the AAD’s article for more information on sunscreen.

The rays of the sun are strongest between 10 am and 4 pm. Since those are good hours for outdoor play, be sure to use skin protection and provide shade where children play during those hours.
The National Council on Skin Cancer Prevention recommends: 

  • Do not burn or tan
  • Seek shade
  • Wear protective clothing
  • Generously apply sunscreen
  • Use extra caution near water, snow, and sand
  • Get vitamin D safely

Carefully examine all of your skin once a month. A new or changing spot should be evaluated. Early detection of melanoma can save your life.

See Caring for Our Children, CFOC Online Database: 3.4.5 Sun Safety and Insect Repellent for more information.

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.


The holiday season is a fun-filled time of year. Don’t let an injury dampen your holiday spirit. Choose safe toys to help keep kids safe.

How to Buy Safe Toys at the American Academy of Pediatrics’ (AAP) website for parents and caregivers provides 10 toy buying tips and guidelines:

Right toys for right age based on the:

  • Safety of the toy (for example, if there any possible choking hazards)
  • Ability of a child to play with the toy
  • Ability of a child to understand how to use a toy
  • Needs and interests at various levels of a child's development

Areas of concern addressed include - choking hazards, eye injuries, hearing injury, lacerations from broken toys, toxic materials, crib toys, and the need to buy “UL approved” electric toys. Some reasons toys are recalled include unsafe lead levelschoking or fire hazard.

No matter what the season…check for recalls: 

Report an unsafe product or an incident where someone was injured by a product to CPSC at

Register your new products on the firms’ website so that companies know how to contact you if there is a recall.
Avoid purchasing counterfeit toys.Trouble in Toyland (web version) or (PDF) addresses how counterfeit toys evade safety rules and endanger children. The report highlights categories of dangerous toys and how to keep children safer. Hazards discussed include: 
  • mislabeled choking hazards,
  • recalled toys available for purchase online, 
  • noisy toys, 
  • items not advisable for children (such as strong magnets). 
 The article cautions to beware of products which permit in-app purchases, collect data on a child or may be counterfeit. See Tips to Spot Counterfeit Toys Before You Buy Them.

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. 

Pertussis, commonly known as whooping cough, is on the rise.  Whooping cough can kill infants who are too young to have received all of their pertussis vaccine doses. Infants and young children routinely receive a vaccine called DTaP. The letters stand for diphtheria, tetanus and acellular pertussis.