Accident and Illness (2 Clock Hours) 

Accidents and illness are two unavoidable incidents in a childcare setting. Even with every safeguard in place, they are both going to happen. With that said, there are things that you and your staff can do to minimize the risks, and as a result, reduce the occurrences. By learning about and focusing on what can cause an accident or injury in a childcare setting as well as what the most common childhood illnesses are, you have the ability to educate and arm yourself with prevention ideas and information that will surely make your center safer for everyone. Also important to remember is that you

must follow your licensing standards and rules. Having a thorough knowledge of your state’s licensing standards, as well as implementing them, should be your first priority. 

Accidents: 

With countless ways a child can be injured in the childcare setting, it is vital to the overall success of your business, that you understand what the most common risks for accident and injury are, and learn different ways to reduce the risk so that hopefully, you will never have to experience most of them first hand. 

Accidents happen. This statement is as true as it is simple. Even for a center with all the possible safeguards in place, from time to time, there will be an accident. Having knowledge of what could go wrong and also how to react or respond is very important. The endless accident you could see on any given day in your line of work, range from a scraped knee or bloody nose to a broken bone, listed below are the most common causes of these types of injuries: 

• Playground accidents – Examples would include falling off equipment such as slides, swings or tricycles. Of all of the causes for accident and injury, it is important to note that most occur from falls on the playground. For children under the age of 6, playground related injuries account for more visits to the E.R., than any other childcare related injury. Approximately 90,000 accidents of this type occur each year, and about 15 of those children die. Most injuries are a result of the child falling from the equipment onto the ground. Fractures are the most commonly reported injury, and most of these injuries are located on the child’s head/face (37%) and the arm/hand (37%). As an important safety precaution, the US Consumer Product Safety Commission recommends that you should apply at least 12 inches of wood chips, pea gravel, sand or mulch over the entire surface area that surrounds play equipment. Remember that each state’s licensing department has addressed playground surfacing issues and you must comply with their standards. 

If licensing requires more than the U.S. Consumer Product Safety Commission recommends, you should meet your licensing standards by applying play area surfacing to meet their specifications. The U.S. Consumer and Product Safety Commission has developed and written playground safety guidelines, which are widely used throughout the country, to design, operate and maintain safe public playgrounds. 

● Injuries from toys – Even when age appropriate and otherwise considered safe, a child could for example, fall with a toy in his hand and injure himself as a result. A child can also easily be injured by toys that have not been picked up and put away. Slipping on a book could be enough to cause a broken bone or a contusion on a child’s head from falling. Old toys also pose a threat as after a

period of time, they can begin to show signs of age that could make them unsafe. Be certain to clean and inspect toys on a daily basis. 

● Injury from other children – Some examples would include, one child hitting and injuring another child with a toy, or colliding while running outside. Second only to playground accidents and injuries is biting. The only safety measures you can take to avoid a child being bitten is to understand why children bite, and to be able to successfully identify a bite and be able to intervene before an incident occurs. If the child is 18 months or under, it is likely that he or she is teething. Simple redirection is sufficient, and you should offer the child different teething toys to provide a way to soothe the teeth and gums. If the child is over 18 months, the problem can be a little more serious, requiring disciplinary action, and should be discussed with parents to help identify the cause and find ways to help the child understand that biting is not okay. Once you have identified a “biter” you will have to help the child find positive ways to deal with frustration or conflict. Be sure to give lots of positive reinforcement when the child makes good choices in a stressful time. This can inspire him or her to repeat the positive action. Some common causes for biting include: 

● Teething- applying pressure helps to ease pain 

● Competition – For space or toys 

● Anxiety – Too much noise or activity going on around them 

● Attention – Even negative behavior will get them attention 

● Exploration – This is a child’s natural way of exploring 

● Independence – A child learns that their actions cause a reaction ● Frustration – When a toddler can’t express themselves verbally ● Imitation – Monkey see, monkey do! 

● Unsafe center / facility – A few examples would include a child slipping on a wet floor, having access to improperly stored chemicals, or suffocation or strangulation while in a baby bed. Regarding baby beds, it is very important that you use a firm mattress with no additional bedding that the baby could put up against his or her face, and no stuffed animals or loose toys. These have been noted as risk factors for SIDS. SIDS is the number one cause for death among children under the age of 1. You must be sure there are NO gaps between the mattress and the sides of the crib. If two adult fingers can fit between the bed and the mattress, the mattress is too small. As noted by the National Safety Council, there should be NO more than 2 3/8” between the slats. If the space between the slats is larger, remove the bed from your center. Bumper pads should never be used as a resolution for slats being too far apart. Once a child can stand up, move the mattress down to its lowest point. Be sure to keep the bed away from windows. Cords from blinds or curtains, pose a serious threat for strangulation. 

● Negligent Care – A few examples would include, a choking child after caregiver gives a slice of pizza to a 13 month old that only has 4 teeth, or a child that is pushed off a slide while his teacher is standing far away from where the children are playing and doesn’t see what is taking place. This can be a tough reality to face because one would hope to assume that everyone that works in this industry loves what they do and always puts a child’s health, safety and well being first. The sad reality is that this is simply not true. While the vast majority of providers are wonderful at what they do, making a lasting positive impact in the lives of the children they care for, there are some that simply consider this a job and nothing more. It is this perspective that can ultimately lead to an injury as a direct result of lack of supervision or negligent care.

Tips to Avoid Accidents and Injury: 

1. Have clearly defined policies for staff regarding supervision of children – This is an important first step. While most of us clearly understand that we must keep our eyes on the children we are caring for, this can easily become an issue. Listed below are just some of the possible distractions for caregivers 

• Visiting with co-teachers or teachers in another classroom – While it is important to have a good working relationship with our co-workers, it is more important to set guidelines on when it is appropriate to socialize in ways that are not related to the children you are caring for. Failing to do so can result in lack of supervision and possible injury to a child. 

● Visiting with parents - This is another area in which a procedural standard or rule should be set. This rule should be noted in both your policies for staff and the policies you have for parents. While clearly, you should get to know the parents of the children you care for and building a good working relationship is vital, you must not do this during times when you should be directing your attention to the children in the classroom. A quick hello and brief summary of the child’s day or quick discussion about an issue is fine provided you are in the classroom with the children and can see / hear what is going on but lengthy discussions of any kind simply cannot occur during the hours you are responsible for watching over children. Utilize emails and conference times or simply visit on your “down” time such as lunch or when you are off the clock. 

● Use of computers or cell phones in the classroom - With the ability to connect with the world socially literally at your fingertips, it is easy to see how this can pose a serious threat for distraction in the classroom. Clearly written policies covering when a staff member can and cannot use their cell phone or a computer for personal use is important. 

2. Educate yourself regarding licensing’s minimum standards for your center - The safety and well being of every child is paramount and this is clearly expressed in the specific standards that relate directly to safety. Where to start? Your director should have a copy of licensing’s minimum standards but online access is available as well. Once you access your local licensing’s website, it is a good idea to bookmark the website on your personal computer so that you have an easy reference. The standards or rules are broken up into main groups or categories so it should be fairly simple to look up information on a specific topic. Taking time to educate yourself or refresh your memory is a great way to put safety first, thus reducing risk for accident and injury in the workplace. 

3. Inspect your center daily – To further reduce the risk of unnecessary injury, safety checks should happen on a daily basis. Making certain toys are in good working order and your center is in compliance with all state safety standards is a common sense way to reduce risk of injury. An easy way to ensure a thorough inspection is a daily safety checklist. This would include anything that should be inspected / done on a daily basis to ensure safety standards are met. Remember ALL rooms should be included. Your center’s office, restrooms, and kitchen should not be overlooked. 

4. Have clearly written policies for parents that cover classroom behavior and redirection for children – With accidents and injury sometimes caused by other children, it is vital to set the standard early in the area of positive social interaction. This will require clear boundaries and structure in the classroom in the area of teaching / implementing rules for behavior and interaction, but also in the area of discipline and redirection. When we focus on helping each child to learn how to socialize in ways that are appropriate, the result is that there are fewer incidents caused by children injuring one another. When there is a continued problem with a particular child, having clearly written policy can help parents get on board and work towards a positive solution. 

Illness:  Illness, and the spread of communicable disease, can seem like a battle that can never be won. It is crucial to the well being of everyone in your center, that you and your staff are educated on the most common communicable diseases. You must know their symptoms, 

what medical treatment is required, if they are to be excluded from care and if so, for how long. Your state licensing standards and rules should have a section that gives you the basic details for different illnesses and communicable diseases, and what they require you to do. You may implement your own standards and policies for your childcare center, but they must include the state’s requirements. For example: If you allow a child with pink eye to return after 24 hours with no doctor’s note, but the standard as written by the state says that you must have a doctor's note which states the date the child is to return to class, then you are not following the state’s standards. Be

sure that as a minimum, you implement the states standards and rules. Listed below are several of the most common childhood illnesses we must be knowledgeable of. Please note this is not a complete list but rather a large selection of the most common childhood illnesses you may encounter with a child in your care. 

• Asthma- A chronic condition involving the respiratory system. Causes airways to restrict, become inflamed and produces a large amount of mucus. An asthma attack can be the result of one or more of many different triggers. Things like weather, candles, perfume, exercise, stress can all cause an asthma attack but for a child the most common trigger is a viral illness, such as the common cold. Symptoms include persistent cough, wheezing, tightness in chest, and shortness of breath. An asthma attack can be scary for anyone but for a child, the fear of not being able to breathe “right” or normal can cause panic and anxiety which makes this situation worse. Each asthmatic will be different so it is important to talk with parents, and you must have an asthma action plan. 

This is a written plan of action for the child in an asthma situation. The child’s doctor and parents develop this plan, sign off on it and then provide you with the details. 

● Allergies – This is an immune system disorder sometimes referred to as atopy. Substances in the environment known as allergens trigger allergies. Symptoms include: Itching, rash, sneezing, coughing, runny nose, asthma, food allergies and allergies to venom such as ant bites or bee stings. 

● Bronchitis – Inflammation of the bronchi and is characterized by cough and sputum (phlegm) and other symptoms related to the constriction of airways such as wheezing, and shortness of breath and sometimes fever, fatigue and chest pains. Can last days to weeks. 

● Conjunctivitis (pink eye) – Is an inflammation of the outermost layer of the eye and the inner surface of the eyelids, which is called the conjunctiva. Symptoms include itching, redness, tearing, gritty feeling in the eye and a discharge that usually forms a crust in the night. Both viral and bacterial conjunctivitis are extremely contagious. For children Bacterial conjunctivitis is more common than it is for adults. For a child with viral conjunctivitis, even if the eye appears clear, they may be contagious for up to a week or more. Bacterial conjunctivitis is considered safe for the child to be around others after a full 24 hours of antibiotic has been administered. 

● Influenza – It’s an infection causing chills, cough, fatigue, headache, fever, body aches, sinus problems, and sometimes earaches. The flu is caused by the influenza virus. There are certain people that are at a higher risk than others for complications of the flu. They include: asthmatics, people younger than five (especially younger than 2), people older than 65, and people with long term health issues or otherwise compromised immune systems. The CDC states that the best way to avoid the flu is to be vaccinated and recommends everyone 6 months and older to get the flu vaccine each year. The flu is very contagious and practicing good hygiene is another prevention tip. Things like hand washing, covering the mouth with the inside of the arm when sneezing are important to focus on with children. 

● Rhinovirus (common cold) - This is a viral infection of your upper respiratory tract. Preschool and young children are at a higher risk of contracting the virus because they have not built up a tolerance or resistance to the viruses that cause the cold. There are more than 100 viruses that can cause the cold but the Rhinovirus is the most common and it’s very contagious. Symptoms include itchy or sore throat, cough, stuffy or runny nose, mild fatigue, sneezing, watery eyes, low-grade fever, slight body ache / mild headache, and congestion. 

● Impetigo – This is a highly contagious skin infection affecting mainly infants and children. Children between the ages of 2 and 6 are most likely to get impetigo. Others at higher risk include people with atopic dermatitis or eczema. Impetigo appears most often on or around the nose and mouth areas on the face, and appears as red sores that can have a clear type liquid that causes a crusty scab. Children can usually return to school 24 full hours after antibiotics has begun. 

● Fifths Disease – Also called slapped cheek syndrome, caused by the Parvovirus B19. It is a contagious virus and can take 4 to 14 days to become ill after being exposed. Once a child’s symptoms appear, they are not contagious anymore. Symptoms usually do not make a person feel very sick and include: red cheeks, lacy rash on trunk of body and limbs, and may have a low grade fever or malaise. 

● Hand Foot and Mouth Disease – This is a viral illness common among infants and children. It causes fever and blisters like eruptions in the mouth and or a rash on the skin. It is contagious and passed from one person to the next through contact and is most common in children 10 and under. Not everyone that contracts HFMD will become ill but for those that do, the symptoms include: poor appetite, fever, malaise and often, a sore throat. Following 1 to 2 days of fever, the child will usually get red sores that then blister over in their mouth (most often on tongue, inside of cheeks and gums). After 1 to 2 days, the child will develop a non-itchy rash that appears with red spots with or without blisters and often found on palms of hands, bottoms of feet and sometimes on buttocks and genitalia.

● Streptococcus Pneumoniae (strep throat) – This is a bacterial throat infection that compared with a viral throat infection, generally has more severe symptoms. Only a small percentage of sore throats are the result of strep throat. Symptoms include, sore throat, swollen tonsils, sometimes with white patchy areas that can have puss, fever, rash, headache, stomachache, fatigue, and swollen lymph glands in the neck area. A child may not present all of these symptoms but may still have strep. Strep throat is contagious as long as symptoms are present and until a full 24 hours of antibiotic doses have been given. 

● Lice – Head lice are parasitic insects that live on a person’s head and feed off of blood. They are EXTREMELY contagious and multiply quickly. Symptoms include itching or tickling on the scalp, sores on the scalp from scratching and frequent itching. It is a good idea to have a periodic lice test at your center as a proactive measure. Some Other tips include not allowing children to wear or bring hats, combs, or brushes to school. Lice are most commonly transferred from head to head so this it is vital that children do not share sleep space including mats, pillows or blankets. 

● Ringworm – This is a fungal infection that forms on the top layer of the skin. It is caused by microorganisms that become parasites on your body. Also called tinea corporis, ringworm symptoms are: red, dry, circular, itchy spots on the skin that have healthy, normal skin in the middle. There may be one red circular patch or many. It is contagious and can transfer in the following ways: Human to human, soil to human, animal to human, and object to human. 

● Rotavirus – Is an infection that causes diarrhea and sometimes vomiting. It is one of the most common causes of diarrhea. Symptoms include nausea, fever, vomiting, stomach cramping and diarrhea. There is a risk of dehydration that comes with diarrhea so making certain children are getting enough fluids is vital. This is a contagious virus and is transferred or passed in the stool of an infected person. Small children may put their hands in their mouths after touching something that is contaminated. Hand washing is the MOST important tip to reduce the risk of spread of this virus in a childcare setting. 

● RSV- Or Respiratory Syncytial Virus, is a respiratory virus that affects the lungs and breathing passages. Most people that get RSV will recover well but this can be a serious illness for infants, young children and older adults. Onset is usually 4 to 6 days following exposure and symptoms include, loss of appetite, fever, runny nose, coughing and wheezing can occur as well. With younger infants, irritability, trouble breathing, and a decrease in activity. Most will fully recover in 1 to 2 weeks. This is a contagious virus.

● Meningitis (bacterial and viral) - Is a serious health condition. It presents with an inflammation of the membranes that cover the brain and spinal cord and is usually caused by a bacterial or viral infection. It is important to decipher which type of infection is the cause because treatment of the illness will be different. Viral meningitis is generally less severe while bacterial meningitis can be very serious and early treatment is vital. Meningitis is contagious and symptoms include: Stiff neck, high fever, headache, nausea, vomiting, sensitivity to bright lights and sleepiness. For infants, classic symptoms are more difficult to detect but they may have poor feedings, seem irritable, vomit or seem somewhat lethargic. 

● Chicken Pox – Is caused by the Varicella-Zoster Virus and is most common with children under 12. Symptoms include red itchy rash that can quickly spread to most anywhere on the body, even in a child’s mouth. The rash begins with red bumps that then develop blisters on the top of them. Some children report malaise, headache, abdominal pain, sore throat and fever up to 2 days before the rash first appears and these symptoms can last for several days. Chicken Pox are usually mild but for some infants of children with a compromised immune system, this can become more serious. Chicken Pox is VERY CONTAGIOUS and requires exclusion from care until all spots / blisters have dried and healed. Contagious period spans from 2 days before rash begins until all blisters have crusted over. Hand washing is key. NOTE: A pregnant woman that has never had the chicken pox can put her unborn child at risk for birth defects (especially before gestational week 20) if she contracts the virus while pregnant. 

● Gastroenteritis – This is an infection that results from a variety of different viruses causing diarrhea and vomiting. Often called the “stomach flu”, other symptoms may include: fever, stomach pain, and headache. The symptoms can last from 1 to 10 days. Gastroenteritis is contagious and prevention tips include frequent hand washing and sanitizing all surface areas frequently in your center. 

● Otitis Media (ear infection) - There are 3 types of ear infections. They are: 1. Acute Otitis Media – the most common of ear infections causing parts of the middle ear to become infected and swollen causing fluid to get trapped behind the eardrum. This causes ear pain and sometimes fever. 2. Chronic Otitis Media with Effusion – When fluid remains in the ear for long periods of time or returns repeatedly, this can make it tough for a child to fight a new infection and can cause hearing loss. 3. Otitis Media with Effusion – happens sometimes after a child has had an ear infection. Child may no longer have symptoms but Dr. can still see fluid in the ear.

● Pertussis - Also known as whooping cough, Pertussis is a bacterial infection with initial symptoms of a mild cold that include: runny nose, low grade fever and a mild cough but within 2 weeks, the cough becomes much worse with episodes of persistent cough that can then have a notable intake breath that sounds like a “whoop”. Coughing spells are worse at night and can last from 1 to 2 months. Pertussis is a contagious infection and can be treated with antibiotics. It is contagious until 5 days after treatment begins. 

To help reduce the risk of illness: 

● Wash your hands, and have the children wash their hands. Do this often! ● NO cup sharing with children 

● Sanitize classroom and toys daily 

● Lysol, to help kill surface germs 

● Hand sanitizer for in-between washes 

● Use disposable gloves 

● Be sure food is prepared at the correct temperature, and stored properly ● Clean bathrooms daily. More than once per day if possible. Use sanitizing wipes on toilet seats, doorknobs, and counters in-between thorough daily cleaning. 

This course is just an overview of some of the different common accidents and illnesses that you may experience in your childcare center. There are many other common communicable diseases. By familiarizing yourself with them all, you will know how to respond in an appropriate manner. It is suggested that you thoroughly read through your licensing standards for a much larger list of communicable childhood diseases. Sterling Enrichment Center also offers a course that takes a more in depth look at communicable childhood diseases.