Children are more at risk than adults to the effects of lead because their brains are still growing. Lead exposure can cause problems with the brain. This may lead to learning difficulties and behavior problems. There is no safe level of lead exposure for children. Sources of lead can include old paint, contaminated dust and soil, and water in lead pipes. The most important step is to prevent lead exposure before it occurs.
Children are especially at risk of lead exposure if they:
• live in the inner city or in poverty
• live in a home built before 1978
• have poor nutrition

Early care and education programs can help prevent and reduce lead exposure in the following ways:

Low income children enrolled more than 30 years ago in a high quality early care and education program grew up to be healthier and better-achieving as adults.

Many children who are enrolled in early education and child care programs have chronic health problems or special health needs.  In the United States, 14% of all children have such conditions. The American Academy of Pediatrics (AAP) published Managing Chronic Health Needs in Child Care and Schools to help teachers and caregivers understand these conditions and work with health care professionals to be sure children who have them stay well. The book explains how to develop specific Care Plans for educational settings. One section offers information about types of health professionals who might be involved in a child's care. Half the book is devoted to condition-specific Quick Reference Sheets and sample forms.  To order this book, go to the AAP bookstore at www.aap.org. Reviewed and reaffirmed 6/2018.

This workshop draws on the curriculum published  by the American Academy of Pediatrics in 2010 to teach how to manage the risks involved in giving medication in group care settings using the 5 Rights: the right child receives the right medication in the right dose, by the right method at the right time.  Participants practice skills and discuss scenarios to identify gaps in practice.  Key elements that should be in documentation of medication, policies and procedures are reviewed. Demonstrations and discussions include tips for giving a variety of different types of medication: liquids and pills, eye, ear, nose, topical medications such as diaper cream and sunscreen, inhalers and emergency medicines.

Many children's medicines come in liquid form. Household spoons may be handy for giving children liquid medicines, but using them is not a good way to give the correct dose. Parents and educators should use a syringe, special medicine cup, special dosing spoon or dropper. These devices are marked in milliliters (mL).

Different household teaspoons hold different amounts of liquids. Tablespoons vary in size too. A spoon that gives too little medicine may keep the medicine from working. If a spoon gives too much medicine, the overdose may cause a serious problem. For example, repeatedly giving a child too much acetaminophen (Tylenol)can lead to liver failure. More than 70,000 children go to emergency rooms each year for accidental medicine overdoses. Use of the wrong measuring device causes some of these. Many liquid medicines come with a special dose measuring device calibrated to accurately measure the particular medication. Be sure to use it. If there is no device with the medication, a pharmacist can provide one. If a syringe is used, squirt the medication slowly and gently between the child's tongue and the side of the mouth. This makes it easier for the child to swallow the medicine.

The American Academy of Pediatrics urges parents, physicians and pharmacists to use only metric measurements for oral liquid medications. Metric measurements for liquids in milliliters (ml) or cubic centimeters (cc) should be on prescriptions, medication labels, and dosing devices. This helps children get the correct dose of medication. Do not measure liquid medication in teaspoons or tablespoons.

Please share this information with teachers/caregivers and families. Download and display the new poster in English and in Spanish. Copy and distribute the updated article - also available in both English and Spanish. To access the article in in Spanish, click on "en Espanol" on the page. On the same page, you can listen to the article read to you in English or Spanish.

Families and early childhood educators need to understand how much medicine to give. They should know how often and how long to give it. If they are uncertain about the instructions, they should not give the medication until they have asked the child's health care provider about how to do it. Use the forms in the Medication Administration Packet, Appendix X in Model Child Care Health Policies, 5th edition. This publication is available at www.ecels-healthychildcarepa.org.

Health professionals recommend keeping medicine out of children's reach. Use child safety caps, understanding that these are not "child-proof". They make it harder for the child to open the medicine, giving adults more time to stop the child from getting the medicine. Check labels carefully before giving two medicines together because they may have the same ingredient. Do not mix medicine with food unless the instructions on the medicine say to do so. Also, urge families to bring a list of all medicines the child is taking each time the child sees a health professional.

For medicine mistakes, call the Poison Help number at 800-222-1222. If the child is unconscious, not breathing or having seizures, call 911 first. Be careful when getting rid of unused medicines. In some places, you can drop off medicines at a police department. Make sure to remove labels with personal details. Another way to safely dispose of medicines is to mix them with coffee grounds or kitty litter in a plastic bag you can seal. Throw this sealed bag away in a trash container where children and animals can't get to it. Don't dump the medicine in the toilet or drain, unless the medicine label says it is safe to do it. If you aren't sure how to dispose of a medicine, ask a pharmacist about what to do.

Contributed by Nancy Alleman, ECELS Lead Training and Technical Assistance Coordinator, in collaboration with Ian M. Paul, M.D., M.Sc., FAAP, a member of the American Academy of Pediatrics Committee on Drugs.

The PA Chapter of the American Academy of Pediatrics and the American Academy of Pediatrics published the 5th edition of Model Child Care Health Policies in October 2013. Significantly revised and updated, the new edition is a practical tool for adoption and implementation of best practices for health and safety in group care settings for young children. This edition replaces the previously published version and updates of individual policies that were posted on the ECELS website. ECELS encourages early education and child care professionals to adapt the model policies as site-specific documents that fit their programs. Two formats are available: one replicates the hard copy publication. The other format, posted 12-12-2014, has form fields that allow users to insert their site-specific details directly into the PDF document.

The National Center on Health offers visually attractive, simply stated resources for infant, toddler and preschool care. Anyone can down-load the electronic copies from the Internet. Head Start programs can order hard copy from the National Center at This email address is being protected from spambots. You need JavaScript enabled to view it.. These materials have excellent content for teachers/caregivers to use in their programs and to share with families:

Growing Healthy Flipcharts http://eclkc.ohs.acf.hhs.gov/hslc/tta-system/health/healthy-active-living/HAL_Resources/NCHEnglishFlipChartF011514_7-7final508.pdf

Take a look at the National Center’s Health Tips (Fact Sheets) for Families* (and teachers): Download an individual one page fact sheets when you need a handout on one of the topics or download the complete series in English [PDF, 1.2MB] and Spanish (español) [PDF, 309KB]* The following topic are available as handouts:

Active Play includes tips to help infants, toddlers and preschoolers develop positive active play behaviors.

Health Literacy provides information about how to understand and use health information that doctors and other health professionals give.

Healthy Breathing provides information about eliminating first-hand, second-hand and third-hand exposure to tobacco smoke.

Healthy Eating offers easy tips to help infants, toddlers and preschool-age children learn healthy eating.

Mental Health provides information about how to help infants, toddlers and preschoolers develop positive mental health behaviors.

Oral Health offers tips to promote oral health in infancy through preschool age.

Safety and Injury Prevention: Tips for Families (2 pages) provides easy tips families can use to ensure their children's health and safety at home, outside, in the water, and in a car or truck.

Dealing with Stress is a 4 page guide with simply stated, clear tips to help cope with stress in a healthy way.

*http://eclkc.ohs.acf.hhs.gov/hslc/tta-system/health/health-literacy-family-engagement/family-education/tipsheetfamily.htm

This workshop addresses national and state initiatives to reduce obesity among children in group care. It includes nutritional needs of infants, toddlers, preschool  and school age children. Participants learn how to adjust portion sizes, and evaluate food and nutrition labeling.  The discussion includes comparing the standards for physical activity and limitation of sedentary activities with current practices. The participants learn how to use research about how children acquire attitudes about food and physical activity. They identify nutrition education opportunities at mealtimes, snacks, holidays and birthdays.

 The National Resource Center for Health and Safety in Child Care has separately published the nutrition, physcial activity and screen time standards from Caring for Our Children. View these obesity prevention standards on the website of the National Resource Center for Health and Safety in Child Care.

Managing peanut allergy is challenging for child care providers and families who use child care. Peanut butter and products that contain peanuts are among the easiest and most tasty lunch and snack foods. Peanut allergy only occurs in 1-4% of the population. However, reactions to peanuts can be severe.

In 2013, a Princeton researcher, Miranda Waggoner studied the emergence of what some have called an “epidemic” of peanut allergy. She found that the publicity about peanut allergy has overstated the risk significantly.

Teach how to manage aggressive behavior with "Play Nicely." Pediatrician Dr. Seth Scholer developed this 40 minute free instructional multi-media program. It is available at www.playnicely.org. The Multimedia Program: Smartphone and Tablet Version runs on a computer. The program is Research done at the Children's Hospital at Vanderbilt University shows the instructional video lessens physical punishment. Many studies show physical punishment of young children is harmful. It fosters aggression, later mental health problems such as depression and an increased incidence of spouse and child abuse as physically punished children grow into adults.

State regulations require documentation that the child has received vaccines and screening tests according to the recommendations of the American Academy of Pediatrics and the Advisory Committee on Immunization Practices. Any document (including an electronic printout from the child's medical record) that provides this information is acceptable. The Office of Child Development and Early Learning (OCDEL) offers a form that allows health care providers to say whether the child is up to date, the CD 51. This Child Health Report form was last revised in 2008. It does not require the dates and results of the recommended screening tests. It has a check box to indicate "yes" or "no" that the child has received all the recommended screenings. The only screening information it requests is the results of any abnormal vision, hearing or lead screening. These are important, but not all the screenings that assess whether a child is healthy and ready to learn. 

This brief from Docs for Tots reviews the evidence of the cost-benefits of integrating health promotion with early learning in early care and education programs.
Reviewed and reaffirmed 4-2019 

RWJ is a national foundation focuses on health policy, prevention, leadership development and research. Recent work has focused on preventing obesity, ensuring health insurance coverage, and quality of health care. 12/2012

Children who eat more salty foods also drink more sweetened beverages. Children who drink more than one sugar-containing beverage per day are 26% more likely to be overweight or obese. These findings are from a study that enrolled over 4,200 Australian children. The study findings are in the January 2013 issue of Pediatrics, the journal of the American Academy of Pediatrics.