Drinking water should be available indoors and outdoors all day. Milk is a fluid food. Milk should be served at meals or snacks where it is planned as part of the recommended intake for the child. Having ready access to drinking water is especially important on hot days except for infants. Infants who receive human milk or formula should receive extra human milk or formula, not water. Children should learn to drink water from a cup or, without mouthing the fixture, drink from a fountain as they can master these skills. Offer water as often as once an hour. No child should be allowed to have water by sucking continuously on a bottle or Sippy cup as it may interfere with proper nutrition. It is best to have children brush their teeth after at least one feeding. When children who have teeth eat and do not brush their teeth afterward, they should have a drink of water to rinse the food from their teeth.

More resources about water and other drinks for children: https://www.healthychildren.org/English/healthy-living/nutrition/Pages/Choose-Water-for-Healthy-Hydration.aspx 

Reviewed and reaffirmed 6/2021

  • Influenza Vaccine for 2015-2016
  • Screen Time, Child Development and Nutrition
  • Organic Food – Is It Healthier?
  • Background Music and Noise Interferes with Language Learning?
  • Oral Health Screening Added to Routine Well-Child Visit Schedule
  • National Center on Health—Materials All Early Educators Can Use
  • Increasing Physical Activity in Afterschool Programs
  • Three Newly Revised and a List of All ECELS Self-Learning Modules
  • Eating Together - Mealtime Matters

See Managing Infectious Diseases in Child Care and Schools, 4th Edition available at https://shop.aap.org or search www.healthychildren.org for more information. In PA, please send your health and safety request with your name and phone number to This email address is being protected from spambots. You need JavaScript enabled to view it..

Early educators and families need to follow oral health recommendations related to use of fluoride for children. Experts no longer recommend that children take fluoride tablets and liquid supplements. Instead, children should brush their teeth twice a day with fluoride-containing toothpaste. The amount of toothpaste should be appropriate for the child's age. Infants use a smear or rice grain amount of toothpaste. Children 2-5 years of age use a pea-sized amount. From then on, a small ribbon is appropriate. By 12 months of age, or 6 months after the first tooth appears, children should visit a pediatric or child-friendly dentist. Thereafter, children should visit a dentist every 6 months. The dentist may apply fluoride varnish to their teeth at periodic visits. Medicaid and some private health insurance will pay for these preventive dental services. The child's pediatrician may be able to temporarily provide these services to healthy children up to age 5 if dental services are not available in the community. Reviewed and reaffirmed 7/2021

This workshop uses the interactive curriculum from the Food Allergy Network. It includes a video and mock epinephrine (EpiPen) demonstration. Participants practice reading food labels to find hidden ingredients that are the same as common food allergens and learn the basics of food allergy and allergen types in foods. The group discusses how to modify the child care setting for a child with a food allergy, and a plan for handling a food allergy response. 

Food-borne illness is very common. The risk of this type of illness increases in warm weather. Sending food from home and eating out-of-doors may allow perishable food to reach temperatures that foster bacterial growth. A 2011 study reported in the journal, Pediatrics measured temperatures of lunches that families packed and sent with their preschool children. The researchers found only 1.6% of lunches with perishable items were at safe temperature. The study was done in nine Texas child care centers and measured temperatures in the packed lunches of more than 700 preschoolers. Even when sent with ice packs, most of the lunches were at unsafe temperatures over an hour before the food was ready to be served. The message is clear: Early educators and families must adopt practices that ensure food is at a safe temperature before feeding it to children. 

 ECELS/Healthy Child Care PA outlined the key gaps and necessary steps that ECELS recommends to improve the quality of early education and child care in Pennsylvania. This fact sheet provides data and talking points to guide policy-makers and other stakeholders seeking quality child care. 2007 published, reaffirmed 2012.

This online professional development opportunity is for directors and administrative staff in centers that serve 25 or more children and who are new users (subscribers) using the WellCareTrackerTM Internet application software.  The professional development experience involves working with the user-friendly internet application on any computer connected to the Internet to review children's health records, identify and track gaps in the children's required preventive health services. WellCareTrackerTM software uses the dates of preventive health care services entered for each child at any time thereafter to report whether the child is currently up to date, overdue or will be due in the next three months for specific services. WellCareTrackerTM lets staff make sure children have received all the services that they need to be healthy and ready to learn. In addition to being protected against vaccine preventable infectious disease, they need to be free of treatable conditions such as hearing and vision problems, anemia or lead poisoning. PA child care practitioners may submit completed work for review for credit by scanning the pages and attaching them to an e-mail, sending them by fax or by surface mail to ECELS. Be sure to follow the instructions in the “Important Reminders” box next to the list of self-learning modules on this webpage. (ECERS-ITERS: Personal Care Routines, Program Structure.4/2021

Children die in hot vehicles every year. Heatstroke begins when the core body temperature reaches about 104 degrees and the ability to maintain or control body temperature is overwhelmed. Vehicles heat up quickly – even with a window rolled down two inches.   If the outside temperature is in the low 80°s Fahrenheit, the temperature inside a vehicle can reach deadly levels   in only 10 minutes! Children’s bodies overheat easily, and infants and children under four years of age are among those at greatest risk for heat-related illness. When left in a hot vehicle, a young child’s body temperature may increase three to five times as fast an adult. High body temperatures can cause permanent injury or even death.

Warning signs of heatstroke include:

  • Red, hot, and moist or dry skin
  • No sweating, even though the child is warm
  • Strong rapid pulse or slow weak pulse
  • Throbbing headache
  • Dizziness
  • Nausea
  • Confusion, or acting strangely

If a child exhibits any of these signs after being in a hot vehicle, call 911 or your local emergency number immediatelyCool the child rapidly. Spray the child with cool water - do NOT place child in an ice bath.

ALWAYS LOOK BEFORE YOU LOCK!

  • Always check the back seat before you lock the vehicle and walk away.
  • Get in the habit of always opening the back door to check the back seat before leaving a vehicle. Put something you will need like your cell phone, handbag, or briefcase, etc., in the back seat to create a reminder to open the back door to retrieve that item every time you park.
  • Keep a large stuffed animal in the child’s car seat. When the child is placed in the car seat, put the stuffed animal in the front passenger seat as a visual reminder that the child is in the back seat.
  • Distractions and/or a change in routine increase the risk of forgetting a child in a back seat. If someone else is driving your child, or your daily routine is altered, always check to make sure your child has arrived safely.
  • Have a strict policy in place with the childcare provider about morning drop-off.
    • If your child will not be attending childcare as scheduled, the parent’s responsibility is to call and inform the childcare provider.
    • If the child does not show up as scheduled, and the child care provider did not receive a call, the childcare provider pledges to contact the parent immediately to ensure the safety of your child.
  • Never leave a child alone in a car.
  • Never let children play in an unattended vehicle. Teach children that a vehicle is not a play area.
  • Never leave a child in a parked vehicle, even if the windows are partially open.
  • Observe and Report: If you see a child alone in a car, call 911, especially on warm days!

Resource: National Highway Traffic Safety Administration

It’s unsafe and bad practice to leave a child unattended in a car for any reason, even for a quick stop – e.g. in a parking lot or elsewhere to pick up food from a restaurant. In PA, it is a summary offense as specified in PA Statute Title 75 3701.1 Leaving an unattended child in a motor vehicle.

For heatstroke prevention information cited above, click here. For other traffic injury prevention information, contact the PA Traffic Injury Prevention Project of the PA Chapter of the American Academy of Pediatrics (PA-TIPP) at      1-800-CARBELT, 484-446-3008 or see their website and resource page. Updated 6/2021

Steps for child care facilities to prevent illness. This approach is for all facilities, but will be especially helpful to those who want to meet the Pennsylvania standards for STARS. 

See Managing Infectious Diseases in Child Care and Schools, 4th Edition available at https://shop.aap.org/ or search www.healthychildren.org for more information. In PA, please send your health and safety request with your name and phone number to This email address is being protected from spambots. You need JavaScript enabled to view it..

This updated module explains current nationally recommended immunizations, requirements for early care and education (ECE) programs in Pennsylvania, tools to manage immunization records for children in care and steps to take during an outbreak. View online videos and learn about vaccines on the website of the Vaccine Education Center of The Children's Hospital of Philadelphia. ECE staff may earn 2 hours of professional development credit for completing this module. Follow the instructions in the "Important Reminders" box beside the list of self-learning modules for ECELS to review your work to award professional development credit. 1/20

As you prepare for fall enrollment, now is a good time for early care and education programs to make sure all staff are up-to-date with recommended immunizations.  Getting vaccinated is an important part of staying healthy.  Routine immunization of adults is the best way to protect yourself against vaccine-preventable diseases.  Several of the vaccines routinely recommended for adults will prevent diseases that can be spread to children in the child care setting, including pertussis (whooping cough), varicella (chicken pox), measles, mumps, rubella and influenza.

Start your influenza vaccine efforts now too!  All children 6 months of age and older and staff should get influenza vaccine.   

This workshop enables the user to learn how to assess health and safety practices in programs for infants and toddlers in conjunction with use of the ITERS assessment tool. Discuss feeding, diapering, sleeping, fostering early brain development, managing illness and more. Use the assessment to make improvements in the program. 

Follow the American Academy of Pediatrics policy about preventing sleep related deaths in group care settings. Standards 2.2.0.2, 3.1.4.1, and 3.1.4.2 of the updated, HTML version of Caring for Our Children, say what should be done. Many early childhood programs must change some common practices.

Outbreaks of influenza can be stopped by requiring that most child care workers and children who are over 6 months of age get flu vaccine. The CDC reported low influenza vaccination rates among child care workers in a national sample. The most common reasons for not getting the vaccine were mistaken ideas. The respondents didn't understand that they needed to get the vaccine, that the vaccine does prevent or reduce the severity of the flu, and that the vaccine is safe. Those who got the vaccine had the facts and felt some external pressure to receive the vaccine. Strong promotion of flu vaccine is associated with significantly decreased rates of emergency department visits for flu-like symptoms.